British Journal of Sports Medicine has been transformed in recent times. In place of papers largely concerned with exercise physiology and injury profiles in less-well-known sports we now find stacks of really useful and informative research and reviews on everyday musculoskeletal problems encountered by primary care clinicians.
The themed April issue
provides more insight on the nature and management of painful tendons, notably the rotator cuff, the lateral elbow and the Achilles. Eccentric exercise programmes (loading the tendon while it lengthens) are currently the cornerstone of the treatment of these problems, although it is not exactly clear how or why they work. 1
A new model of lateral elbow pain (tennis elbow) is proposed. Long disappeared is the notion that this is an inflammatory problem requiring anti-inflammatory treatments. It is suggested that the problem comprises a variable combination of three interlinked processes – degenerative tendon pathology and failed repair, changes in pain processing with hyperalgesia, and muscle dysfunction. Treatment, it is suggested, must address all three components to be effective.
There is also an interesting observation that patients with tendon pain have a higher body mass index and higher, though not abnormal, blood glucose levels. And there is more – but sadly Synovium does not have sufficient space so you will have to look this up yourselves.