WHY THESE INJURIES ARE DIFFICULT TO TREAT
While these conditions differ in anatomy and mechanism, they share several features that make treatment complex, prolonged, and often incomplete.
1. Multifactorial Pathophysiology Both ACL injuries and tendinopathies like tennis elbow involve more than just structural damage. ACL injuries involve not only ligament disruption but also arthrogenic muscle inhibition (AMI), proprioceptive loss, and kinetic chain disturbances, complicating recovery beyond the structural level. Similarly, tennis elbow involves chronic tendon degeneration, not just inflammation, often with persistent neurogenic and mechanical factors that resist quick resolution. 2. Delayed or Incomplete Neuromuscular Recovery Following ACL reconstruction, AMI leads to lasting quadriceps weakness, even in the absence of pain or instability, heightening the risk of suboptimal performance and reinjury. 1,2 In tennis elbow, deficits in motor control and the adoption of compensatory movement patterns can sustain symptoms long after structural tendon healing.
3. High Risk of Recurrence and Chronicity Both conditions are associated with high recurrence rates.
Return-to-sport after ACL reconstruction often occurs before full neuromuscular recovery, increasing the risk of re-injury. Tennis elbow, if biomechanical and occupational factors are unaddressed, frequently recurs or becomes chronic. 1,3
4. Biopsychosocial Influences Pain perception, movement fear, and patient expectations all influence recovery. In chronic tendinopathy, central sensitization can amplify pain, while in ACL patients, fear of reinjury can limit effort and engagement in rehabilitation, even when physical recovery appears adequate. 5. Rehabilitation Demands Time, Precision, and Patient Adherence Effective rehab requires targeted, progressive loading, neuromuscular retraining, and patient engagement over weeks or months. Suboptimal compliance or rushed timelines—often driven by return-to-play or return-to-work pressures, can undermine long-term outcomes.
In light of these complexities, adjunct therapies with strong mechanistic and clinical support can play a vital role in improving outcomes—particularly in patients who plateau or show suboptimal response to standard care. In this eBook, we’ll review how incorporating evidence-based modalities like NMES, ESWT, and HILT into rehabilitation protocols can target these diverse mechanisms, offering measurable benefits in muscle function, pain control, and tissue quality— and ultimately supporting more robust, long-term recovery for patients.
4
Made with FlippingBook - PDF hosting