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Editorial
Ten treatments to avoid in patients with lower limb tendon pain
  1. Jill L Cook
  1. Correspondence to Dr. Jill L Cook, La Trobe Sport and Exercise Medicine Centre, La Trobe University, Melbourne, VIC 3086, Australia; J.Cook{at}latrobe.edu.au

https://doi.org/10.1136/bjsports-2018-099045

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    Tendon pain and dysfunction are the presenting clinical features of tendinopathy. Research has investigated many treatment options, but consistent, positive, clinical outcomes remain elusive. We know that treatment should be active (eg, exercise-based), and that a consistent and ongoing investment in rehabilitation is required. It is important to maximise this investment by understanding (and conveying to patients) treatments that do not help. The following 10 points highlight treatment approaches to avoid as they do not improve lower limb tendinopathy.

    1. Don’t rest completely.

    Rest decreases the load tolerance of tendon, and complete rest decreases tendon stiffness within 2 weeks.1 It also decreases strength and power in the muscle attached to the tendon and the function of the kinetic chain,2 and likely changes the motor cortex, leaving the person less able to tolerate load at multiple levels. Treatment should initially reduce painful, high tendon load (point 2) and introduce beneficial loads (eg, isometrics3). Once pain is low and stable (consistent …

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    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.