Waiting for a coffee early on a Sunday morning, I overhear a group of people discussing morbidity.
One person says, “When you say morbidities I think death”, the next “well I think of morbidities as maybe just a problem”, the third “I thought morbidities was like you had a physical problem and then... yeah I don’t know”.
Now being a Sunday I held back, didn't butt in and just sipped away on my long black coffee. However, the conversation got me thinking about inconsistency in health literacy, and how many health related topics would have so much mixed terminology. So today we are going to get a few things nice and clear, bridge the gap on a particular pathology, and get us all calling it for what it is: tendinopathy.
Hang on a minute, don't you mean tendinitis!? or Tendinosis!?
If you're thinking "nice one mate but my other health professional told me it was tendonitis or tendinosis", then I must apologise for throwing a spanner in your wheel. But first let me tell you how we got to tendinopathy, and then lets see if you're happy to get on board.
So a group of 30 really smart people (tendon experts) were called in together in late 2019 to come up with clear consensus on terminology. A nice mix of male and female sports Doctors, rheumatologists, physiotherapists, epidemiologists, clinicians, researchers, surgeons and radiologists who had published on tendinopathy, all came together to discuss the topic, complete surveys etc. After the obligatory backwards and forwards that occurs in such meetings, the multidisciplinary group agreed on tendinopathy (Scott, Squier et al. 2020).
So if I find myself in a discussion with a patient discussing tendinopathy, or you're talking to me about my tendinopathy, what are actually talking about?
What we hope everyone is talking about is: "persistent tendon pain related to mechanical loading"(Scott, Squier et al. 2020). In lay language, part of the muscle that can be sore or inhibited in function due to pain from movement.
So why is this language thing all so important to write a blog about?
It is important for a number of reasons
- The terminology needs to be consistent across health professionals and patients, so we all understand the pathology we are working with so we can apply best practice
- That if people are told "different" diagnoses from multiple sources (when really we are addressing the same thing), a person's perception of the injury can have a real impact on recovery
- There is potential for unnecessary intervention that can delay recovery (physiotherapy loading protocols are often best practice for tendinopathy)
- If patients are told to load or exercise on what people may believe is an inflamed tendon, or a partially torn tendon, treatment effect size can be limited, and outcomes may be less than satisfactory
Got any more lingo advice?
Sure, lets start calling a few things for what they are:
- Achilles tendinitis should be Achilles tendinopathy
- Golfers elbow, or lateral epicondylitis? Call it lateral elbow tendinopathy
- Fibularis tendinitis? Peroneal tendinopathy
- Patellar tendinitis? You guessed it - Patellar tendinopathy
So it is just language you want to change?
At this point I think that would be a good start, but like any other field, there is a long way to go. But for people who are going to come to Melbourne CBD Physiotherapy and Sports Medicinetherapy and Sports Medicine and see us, ready to use an imaging report as an "I told you so":
- Imaging is not always necessary for diagnosis
- It can be used to rule out differential diagnoses, but it not our first point of call
- On a lot of imaging you will find things, but imaging needs to correlate to clinical presentation
- And if you're about to say "but the report clearly says I have a partial tendon tear...", pause, because what you are referring to is the macroscopic discontinuity of a load-bearing tendon(Docking and Cook 2016). Meaning, you have a tiny little gap in your tendon (that has most likely been there for ages because you have used it over your lifespan, like many other people). Think of it as the wrinkles on your skin- just because it is there doesn't mean it's a problem.
Ok, that's enough for now. I hope that makes tendinopathy terminology a little more clear. The next steps are broadly accepting this at a grassroots level; bridging the gap between consensus and clinical practice; and adopting this approach in future tendonopathy research.
Docking, S. I. and J. Cook (2016). "Pathological tendons maintain sufficient aligned fibrillar structure on ultrasound tissue characterization (UTC)." Scand J Med Sci Sports 26(6): 675-683.
Scott, A., K. Squier, H. Alfredson, R. Bahr, J. L. Cook, B. Coombes, R. J. de Vos, S. N. Fu, A. Grimaldi, J. S. Lewis, N. Maffulli, S. P. Magnusson, P. Malliaras, S. Mc Auliffe, E. H. G. Oei, C. R. Purdam, J. D. Rees, E. K. Rio, K. Gravare Silbernagel, C. Speed, A. Weir, J. M. Wolf, I. V. D. Akker-Scheek, B. T. Vicenzino and J. Zwerver (2020). "ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology." Br J Sports Med 54(5): 260-262.