Tendon Clinic

at NYDNRehab

Tendons are thick fibrous soft tissues that are continuous with muscle fibers, attaching muscles to bones at your joints. When muscles contract, tendons pull on the bone to which they are attached, causing movement. Because tendons are exposed to high force loads, especially during sports or exercise, they are vulnerable to injuries ranging from mild to severe.

Categories of tendon injuries include:

Tendinitis: Inflammation of the tendon, often caused by overuse. Although painful, tendinitis often resolves itself after a few days, once the activity that caused it is discontinued.

Tendinosis: Pain caused by micro tears of the tendon tissue. Tendinosis is often caused by physical activities that challenge the muscles, such as during sports or exercise. If not allowed to heal, tendinosis may progress to more serious tendon ruptures.

Tendon Rupture: Damage to a tendon that may either occur suddenly or progress gradually. A rupture is often very painful at its onset, and can lead to disability if left untreated.

Tendinopathy: A catch-all term for tendon pain or injury.

While tendon pain and injury are often related to sports and exercise, they can also occur as a consequence of trauma, such as a fall. Older adults are vulnerable to tendon injuries as muscles become weakened with age.

Tendon injuries commonly occur near joints that are highly mobile, such as the shoulder, elbow, hip, knee and ankle. Because it can be difficult to distinguish tendon inflammation from a tendon rupture, it is advised that you seek diagnosis and treatment in the early stages of pain.

Tendinopathy Diagnosis

At NYDNRehab, we are dedicated to rehabilitating your injury, not just treating your symptoms. To accurately diagnose and treat your tendinopathy, your therapist will conduct a comprehensive exam consisting of:

• thorough health history
• review of physical activity at onset of pain
• manual physical exam
• strength and range of motion assessment
• high resolution ultrasonography and elatography to pinpoint the root of inflammation, injury and pain

For sport-specific injuries, we use the latest technological innovations to analyze movement mechanics and identify motor deficiencies. By eliminating training errors, athletes are able to improve their performance while reducing their risk of injury.

Running Diagnostics

Our state-of-the-art running gait analysis lab is devoted to identifying biomechanical and neuromuscular deficiencies, enabling our technicians to distinguish between compensation strategies and injuries that are invisible to the naked eye.

Gait analysis enables us to:

• Measure and quantify functional limitations, impaired movement and disability
• Identify movement deviations that are invisible during clinical examinations.
• Discern compensation from the root cause, so that treatment interventions target the injury and not the symptoms

Data from gait analysis equips the therapist to design effective treatment strategies that address the source of tendinopathy, retraining the athlete to run more efficiently, prolonging their running career and preventing future injury.

Jumping Diagnostics

Sports that require jumping like basketball, tennis, volleyball and dance place huge demands on the athlete’s body. From preparation to landing, jumps impose enormous forces on an athlete’s muscles, joints and connective tissue. Poor mechanics not only reduce the level of performance, but mechanical deficiencies can lead to debilitating and career-ending injuries.

At NYDNR we use the most advanced real-time force plate technology and 3D video analysis to evaluate the athlete in motion. Excessive and damaging forces often stem from poor muscle coordination, improper motor control and muscle imbalances.

Jumping diagnostics evaluates:

• ground reaction forces
• joint angles
• compensation patterns
• coordination of movement

Real-time force plate analysis enables the athlete to see where their mechanical deficiencies lie, so they can focus on correcting them. The therapist will apply the data to implement a rehab training protocol to strengthen weak muscles, improve motor coordination and refine the athlete’s jumping technique.

Other Treatment Therapies

The clinicians at NYDNRehab employ an array of treatment therapies for tendinopathy, depending on the needs of the individual patient. Once the source of your tendinopathy has been identified, therapy will focus on progressive rehabilitation of your tendon, corrective interventions for mechanical deficiencies, and restoration of functional pre-injury performance levels.

Your tendinopathy therapy may include:

Load management: Traditionally, treatment for tendinopathy has focused on rest and stretching exercises, but current research indicates that tendons heal and restore function more quickly when they are treated with progressive weight loading therapy.

Eccentric strengthening: Muscles and their associated tendons generate force in two phases. In the concentric phase, the muscle fibers shorten, creating torque that exceeds the force of gravity. In the eccentric phase, muscle fibers lengthen, still generating force, but somewhat less than the force of gravity. Current research suggests that strengthening therapy that emphasizes eccentric tendon loading is most effective for treatment of pain and restoration of tendon function.

C.A.R.E.N (Computer Assisted Rehabilitation Environment): Using C.A.R.E.N, patients are immersed in a virtual reality environment while their motion is captured by 12 infrared cameras that provide 360º real-time feedback. Used for both diagnosis and treatment, C.A.R.E.N provides precise therapeutic strategies based on muscles being activated, removing human error from the equation.

ESWT (Extracorporeal Shockwave Therapy): A shockwave is a pulse of energy that can pass at near-supersonic speeds through any material. Shockwave therapy works by inducing micro-trauma to the tendon tissue, initiating a healing response that promotes blood vessel formation and increased blood flow for oxygen and nutrient delivery. ESWT has been shown to accelerate tendon healing and reduce pain.

Biofeedback Motor Control Training: This groundbreaking approach for patients with lower extremity tendinopathy uses force plate technology to measure the direction and magnitude of ground reaction forces during movement. Muscle activity in the area of injury is carefully evaluated, and adjustments are then made to improve function and eliminate errors in movement.

Platelet Reach Plasma. Different tendons have a different anatomy, structure and loading mechanics. Since each tendon is designed for a different function it must be treated independently. Science suggests that stem cell or Platelet Reach Plasma (PRP) injections may be potentially helpful in the future, but concrete evidence at the moment is still lacking. Science has not identified how much and which growth factors would be most helpful. The different anatomy and genetic makeup of each tendon makes it more complicated to figure out. The cookie cutter approach to each tendinitis is PRP or stem cell injection and is nothing but a fashion. However, scientific research in the last couple of years has led into very successful clinical therapeutic non-invasive interventions, which lead to many optimal clinical outcomes. At NYDN Rehab we have put this program together to help New York’s athletic population successfully treat and prevent tendon issues.

The expertise of the sports medicine professionals at NYDNRehab combined with the most advanced technological tools make the Tendon Clinic at NYDNRehab your top choice in NYC for tendinopathy diagnosis and treatment. If you are suffering from tendon pain, call NYDNRehab today, and begin treating your injury, not just your symptoms.