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Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework

PainSci » bibliography » Pringels et al 2022
Tags: tendinosis, neat, etiology, running, pain problems, overuse injury, injury, pro, exercise, self-treatment, treatment
Photo of the back of a heel on blue-green surgical sheets. There is a large posterior incision fully exposing the shiny, white Achilles tendon.

Surgically exposed Achilles tendon.

PainSci commentary on Pringels 2022: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Maybe your painful tendons are … swollen? We do not normally think of tendons as something that can swell, but we should, because they can. Like most everything else in anatomy, they are specialized “containers.” From a paper by Pringels et al. (and including Jill Cook, well known for her tendon research):

“Although somewhat ignored in tendons, every structure in our body (eg, nerves, muscles, joints, brain) has a total tissue pressure…”

I can’t recommend actually reading this paper to most people — it’s a slog, quite technical — but here is the cool gist of it…

The pressure inside tendons has never really been studied, and it might be an important key to how tendinitis works and how to treat it. We certainly aren’t doing very well treating tendinopathy based on our current understanding! So clearly we need to understand it better, and this is a serious attempt to figure out how tendinopathy really works. Just basic science, with no real clinical implications yet.

But maybe someday. I would love to see more like this.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Despite the high prevalence of tendon pathology in athletes, the underlying pathogenesis is still poorly understood. Various aetiological theories have been presented and rejected in the past, but the tendon cell response model still holds true. This model describes how the tendon cell is the key regulator of the extracellular matrix and how pathology is induced by a failed adaptation to a disturbance of tissue homeostasis. Such failure has been attributed to various kinds of stressors (eg, mechanical, thermal and ischaemic), but crucial elements seem to be missing to fully understand the pathogenesis. Importantly, a disturbance of tissue pressure homeostasis has not yet been considered a possible factor, despite it being associated with numerous pathologies. Therefore, we conducted an extensive narrative literature review on the possible role of intratendinous pressure in the pathogenesis of tendon pathology. This review explores the current understanding of pressure dynamics and the role of tissue pressure in the pathogenesis of other disorders with structural similarities to tendons. By bridging these insights with known structural changes that occur in tendon pathology, a conceptual model was constituted. This model provides an overview of the possible mechanism of how an increase in intratendinous pressure might be involved in the development and progression of tendon pathology and contribute to tendon pain. In addition, some therapies that could reduce intratendinous pressure and accelerate tendon healing are proposed. Further experimental research is encouraged to investigate our hypotheses and to initiate debate on the relevance of intratendinous pressure in tendon pathology.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: