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.
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:
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.
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:
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.
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:
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.
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.
and a faulty diagnosis can make treatment a total waste of time.
Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.
Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris
with large hematoma (blood)
Separation of muscle ends due to tear elicited
on dynamic sonography examination
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