Sports clinic Paris
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Tendon injuries are significantly favored by physical activity. Over 20% of sports medicine consultations devoted to it.
Tendinopathy is caused by:
- Muscle strength and / or
- Conflict with a joint structure
The effect of vibrations and dehydration remains controversial.
In the absence of metabolic disease, diet appears without influence.
The "tendonitis" of the child does not exist. These are bone lesions.
Physical activity involved in the treatment of tendinopathy:
- Rehabilitation is a "retraining tendon"
- A "muscle rebalancing" is often necessary.
- Painless physical activities are allowed and encouraged.
Sport has demonstrated its aggressiveness for the tendons.
An epidemiological study involving 7,000 sports medicine consultation was carried out. It shows that the tendon is the most frequent pathologies, just behind sprains. Ligament injuries represent 25% of trauma and suffering tendon 22%. Tennis is the sport in which predominates tendinopathy. Most often, they are located at the elbow or shoulder. In this discipline, they represent 56% of consultations. Running also shows very purveyor of tendinopathy. This time, 38% of medical examinations devoted to it.
Among the sedentary, 2% of individuals 42 to 46 years complain of tendon shoulder pain. They are 22% between 56 and 60 years and 30% after 65 years. According to the authors, 3-80% of swimmers suffering from rotator cuff. Mac Master has followed North American competitive swimmers (3). He points out that 35% of them had, during their sports career, interrupted their training program because of shoulder pain. Can we then afford to compare the shoulder of a swimmer in 20 years to that of a pensioner?
Why sport he causes tendon injuries?
Muscle pulls seek the tendon. The braking work called "eccentric contraction" is particularly aggressive to the tendon tissue. Indeed, each receiving jump or stride, knee bends slightly to dampen the movement and accumulate elastic energy recovery. In these circumstances, the quadriceps mission is to slow and control the motion. It then contracts as the joint is flexed. It is as if the muscle pulled in one direction while the bone pieces were moving away. The tendon is particularly abused. Many fibrous lacerations can occur. It is the same for all joints and in particular at the elbow. When playing tennis during the setback, the forearm muscles are trying to stabilize the wrist. The epicondyle tendon is severely involved. The suffering of the latter is called epicondylitis or "tennis elbow".
The inherent tendon ischemia anaerobic exertion probably helps reduce the ability of the tendon to assume these mechanical stresses. Furthermore, research conducted by the sports footwear industry raise the influence of impacts on the ground (1). It would seem that insufficient or inadequate damping causes vibrations at high frequencies of about 20Hz. These could resonate with structures tendon, ligament or bone and cause responsible amplification of histological or vascular lesions.
In athletes, particularly at the shoulder, tendon pain are favored by a conflict with articular structures. According to Neer, the anterior inferior border of the acromion shows particularly aggressive to the rotator cuff (4). For Jobe, these tendon friction is increased in case of glenohumeral laxity (2). This hypermobility is sometimes facilitated by a degeneration of the rotator, a vicious circle is quick to install. These strain are repeated on the occasion of sporting gestures large amplitudes as the serve in tennis or swimming in the movement of arms.
In children, in the chain muscle / tendon / bone, the bone insertion area is the weak link. The latter is particularly sensitive in periods of growth. The excess mechanical stress causes osteochondrosis. The best known is on the tibial tuberosity, occurs between 12 and 15 years and carries the disease name Osgood Shlatter. Sever's disease is equivalent to Achilles tendinitis and touches the calcaneus children aged 9 to 11 years.
Can the doping favor tendinitis?
Of course, there are no openly study including doped athletes. However, common sense pathophysiological and anecdotes of "land" suggest an answer. Unlike tendons, muscles have an intense metabolic activity. Anabolic significantly stimulate the production of contractile proteins and less synthesis tendon fibers. Thus, doping would cause an imbalance between muscle and tendon structure. The mechanical stresses imposed are disproportionate to the tendon and sources of injury. In addition, the tendon brittleness is surely accentuated in case of use of cocktail "anabolic / steroids."
What are the effects of hydration and sports nutrition?
Sufficient water intake generating always clear urine probably contributes to the prevention of tendinitis. Proper hydration tendons improve the mechanical qualities of these fibrous structures and poorly vascularized. Gout and high cholesterol can cause tendon pain. It is highly recommended to look for these pathologies in case of tendinopathy in athletes mature. However, in the absence of metabolic disease, diet has not demonstrated its influence on the injuries of the tendons. The acidity provided by a serving of meat is 20 times lower than that caused by a very intense workout.
Physical activity involved in the treatment of tendinopathy
Strength training humeral depressors, pectoralis and latissimus involved in the treatment of scapular pain. Strengthening these muscles helps reduce conflict tendons with acromial vault. This "rebalancing muscular" shoulder joins correction often imperfect technical movement in case of damage to the rotator cuff.
Stanish has shown that eccentric contractions and stretching prove particularly useful in the rehabilitation of chronic tendinopathy (5). He concluded by even a provocative slogan: "no pain, no gain" (No pain, no benefit). In fact, stretching and work muscular braking mechanized tendon structure. Gradually, it adapts to the constraints inherent in the specifically sporting mission. This is a real retraining tendon. However, in practice, the therapist must avoid pain as the coach was careful not to cause aches at the end of each session.
More than hinder scarring, the pursuit of physical activity in the pain threshold contributes to the tendon mechanization. If there is discomfort in the beginning of effort, it must gradually subside during the warm up. If she returns to cold, after training, it is necessary that the next meeting be shorter or less intense. In case of persistent pain in running, cycling devoid of eccentric contraction is often possible and beneficial!
1 - The 200 Follachier Mr. keyword sports chausure. Lyon. Ed CTC. 1991.
2 - Jobe et al: pain in the Schoulder overhand or throwing athlete: relationship of anterior stability and rotator cuff impingement. Orthop. Rev. 18 963 1989.
3 - Mac Master et al: Shoulder torque exchange in the swimming athlete. Am J Sports Med. 20, 3: 323-7, 1992.
4 - Neer CS: Impingement lesions. Orthop Clin. 173: 70, 1983.
5 - Stanish and neck: Eccentric exercise in chronics tendinitis. Clin. Orthop 208: 265-8, 1986.
What sport are we talking about?. In effect resumption of sport is a generic term that encompasses businesses that lives and cardiovascular, an activity of a well pivots sports activities in competition. We talk of return to sport or to pre-injury or to pre-surgery or even be the maximum possible level of the knee recovery. For example, the recovery of a knee that has been unstable for several years with meniscal and cartilage damage could not be the same without a knee cartilage injuries of the meniscus operated in a quick time after the breakup.
We sent a questionnaire to licensees judokas of the French Judo Federation to identify carriers sports a total hip replacement. We sent 212 questionnaires to older judokas over 60 years and at least 6th Dan black belt. Of 83 responses, 36 men, mean age 72 years (60-86 years) are holders of at least a prosthesis.