Tendinopathies

Tendinopathies are tendon disorders that result in pain, swelling, and impaired function. Common tendinopathies affecting patients with lower spine problems include:

Greater Trochanteric Bursitis + Iliotibial (IT) Band Syndrome
There is a large bony bump on the side of the femur called the greater trochanter. Tendons attached to very strong muscles (like the gluteus medius) pass over this bony bump and attach to it. A fluid-filled sac, called a bursa, lies between the tendons and the bony prominence of the femur to protect the tendons from rubbing on the bone with movement. With abnormal, excessive, or repetitive stresses on the muscles and tendons overlying the bursa, the bursa may become inflamed, known as bursitis. If the iliotibial band becomes inflamed, this is known as IT band syndrome.

Posterior Superior Iliac Spine (PSIS) Tendonitis
A similar process occurs at the PSIS where all of the major ligaments of the hips attach.

Causes
Tendinopathies are the result of inflammation of tendons from micro-tears that occur from acute overload or degeneration of tendon’s collagen from
overuse. Overuse tendinopathies are most common and occur when abnormal or excessive repetitive stress on the tendons continues without a period of rest, resulting in repeated micro-injuries that lead to chronic tendon inflammation and/or degeneration. This causes the affected muscles to weaken and tendons to thicken which perpetuates the inflammatory and/or degenerative cycle.

Symptoms
There is usually pain with movement and weakness of the affected muscles.

Treatments
The primary goals of treatment are to break the cycle of injury, reduce inflammation, and strengthen surrounding muscles. We rely on a physical therapist to develop and optimize a customized exercise program for each patient that can be continued on a regular and consistent basis. In general, though, strengthening exercises should be done 1-2 times daily for at least 12 weeks. Occasionally a steroid injection is necessary to interrupt the inflammatory cycle. Surgery is not indicated to directly treat the tendinopathy but may be necessary to treat the underlying spine problem leading to abnormal stresses (i.e. abnormal gait) on the tendons causing pain.

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