b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarship REHAB Update Executive Directors Update LEGAL Q&A CHIRO AssistINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE UpdateThe Importance MedicareQ&AMedicare Update of Eccentric Loading in OUR HEALTHBy Dr. Gregory H. Doerr Tendinopathy TreatmentWith the expanse in what chiropractors are educated to diagnose, as well as the increase in evidence influenced treatment, therapeutic exercise continues to be one of the most studied and utilized treatment in a number of different conditions. While it is impossible to cover all therapeutic exercise treatments in a short article, one of the most common injuries seen by chiropractors is tendinopathies. Commonly seen at the shoulder, elbow, knee, and Achilles, these are frequently treated by the chiropractor with ultrasound, stretching, and other modalities. Many sports chiropractors include soft tissue treatments, taping tech-niques, and exercise rehabilitation.It is important to understand what a tendinopathy is before we try and implement an effective treatment plan. Tendi-nosis/opathy once called tendinitis is not a true inflammation of the tendon. Nirschl has documented that there are no true signs of intratendinous inflammation, and that these injuries are actually degenerative in nature. The tendonsI collagen synthesis in injured tendons. These results have demonstrate a fibroblastic hyperplasia, vascular hyperplasia,been reproduced in several articles, including more clinical and abnormal collagen production. (1)In reality these injuriesoutcome related research as the studies done by Tim Tyler are quite the opposite of inflammatory, they are degen- on Lateral and Medial Epicondylopathy. (4,5,6)erative. Because of this, our treatments should be gearedAs information continues to be published in strong peer towards the breakdown of the abnormal chaotic injury, asreviewed journals, we continue to gain more insight into well as remodeling of proper collagen synthesis. how physiology can be manipulated by the methods we use. Depending on what soft tissue technique used, the speedFor this reason, evidence should INFLUENCE they way we and aggressiveness of treatment can be altered in thedesign our treatment protocols with patients.remodeling of the degenerative nidous depending onReferences:patient symptoms and sensitivity. The goal remains the same; enhance the proliferation of vascular elements and1. Kraushaar BS, Nirschl RP. Tendonosis of the Elbow. Journal of Bone & fibroblasts increasing collagen deposition and maturation. (2) Joint Surgery, 1999: 259-278But how do we assist our soft tissue treatments in this2. Nirschl RP, Ashman ES. Elbow tendonopathy: tennis elbow. Clin Sports process? Despite all the research done on therapeuticMed 22; 2003: 813-836exercise, it is one modality chiropractors tend not to educate3. Langberg H, et al. Eccentric rehabilitation exercise increases peritendi-themselves on. There has been countless research generatednous type I collagen synthesis in humans with Achilles tendinosis. SC and J on the effects of eccentric loading on just these topics. Med Sci Sports 17; 2007:61-66.4. Kenas A et al. 2015. Eccentric interventions for lateral epicondylalgia. Landberg et al demonstrated that eccentric rehabilitationStrength Condition J. 37(5):47-52exercises increases production of type 1 collagen synthesis5. Tyler T, et al. 2010. Addition of isolated wrist extensor eccentric exercise in injured Achilles tendons. (3)The training schedule includedto standard treatment for chronic lateral epicondylosis: A prospective 3 sets of 15 reps of eccentric heel raises on a bent kneerandomized trial. J Shoulder Elbow Surg.19(6):917-922.from maximum heel lift position to a maximum dorsiflexion6. Tyler T et al. 2014. Clinical outcomes of the addition of eccentrics for position using the healthy leg to achieve maximal heel liftrehabilitation of previously failed treatments of golfers elbow. Int J Sports position again. Weight using a backpack can be addedPhys Ther. 9(3):365-70.starting at about 20% of body weight then increasing if there is no pain immediately after training or the next morning.Gregory H. Doerr, DC, CCSP, is the owner of Bergen Chiropractic It is important to educate our patients that pain mayand Sports Rehabilitation Center. He is the developer of FST: increase for the first 3-4 weeks, but they should continueFunctional Soft Tissue, co-developer of FAKTR: Functional and with the rehab even if pain persists. In the same study,Kinetic Treatment with Rehabilitation, Provocation and Motion, and Landberg demonstrated approximately a 4x increase in typedeveloper of Functional Taping for Muscular Skeletal Injuries.www.njchiropractors.com I 15'