A review on the
„Biopsychosocial approach to
tendinopathy“
BMJ Open Sport & Exercise Medicine
published 01.08.2022
Edgar N, Clifford C, O'Neill S, et al.
Biopsychosocial approach to tendinopathy. BMJ
Open Sport & Exercise Medicine
2022;8:e001326. doi:10.1136/ bmjsem-2022-001326
This review discusses the current psychological and psychosocial developments in
muscolosceletal medicine and how these translate to treating tendinopathy through a
biopsychosocial model.
Muscolosceletal
u
psychosocial factors
u
u
self-efficacy +
u
u
individual’s perception of their ability to succeed in particular situations
influencing the relationship between pain and disability
fear-avoidance u
u
fear, anxiety and depression affect pain and disability levels, harming
rehabilitation
describes the interpretation of pain via maladaptive pathways with
catastrophizing and hypervigilance
kinesiophobia u
causing deconditioning and predisposing to further injury
FACS (Fear Avoidance Components Scale)
Tendinopathy
u
Changes in damaged tendons, leading to pain and reduced function
u
Exercise and loading programmes are the first-line management
u
Persistent tendon pain can have a negative psychological impact
u
An increasing awareness of the psychological impact on rehabilitation
outcomes
Psychosocial factors in Tendinopathy
u
structural changes in imaging often do not explain the response to exercise led
interventions
u
factors
u
u
psychological fears
u
patient rating of pain
u
tendinopathy’s impact on quality of life
u
self-efficacy
u
fear-avoidance
Misconceptions lead to psychological distress, depression and sensitivity to pain
Patient education in Tendinopathy
u
Health literacy for informed choices
u
Empowerment for self-management
u
u
self-efficacy
u
pain catastrophising
Patient–clinician interaction with involvement and emotional support
u
communication style
u
being open to patient questions
u
-> better adherence and improved outcomes
Empowerment
Common-Sense Model of Self-Regulation
Reframing biopsychosocial factors
through patient education
u
Misconceptions regarding
u
pain
u
treatment
u
prognosis
Pain education
u
Physiological or pathological
u
Chronic pathological pain
u
u
u
increased sensitisation of the central nervous system via altered
processing in the brain, malfunctioning of antinociceptive mechanisms and
increased activity of pain pathways
u
neuronal regulation on tendon homeostasis and neuropathic pain
Self-efficacy
u
no further degeneration and progress to rupture
u
pain not a measure of tissue damage
u
pain is not harmful during treatment -> fear-avoidance
RECONCEPTUALISING
Treatment education
u
50% of patients abandon exercise programs
u
Patient empowerment
u
Self-efficacy
u
Self-prescribed rests tend to give suboptimal outcomes
u
Inform about the various treatments and mention the effectiveness of active
loading programs
Conclusion
u
Loading programmes remain the gold standard
u
Psychological misconceptions influence patients adherence
u
Psychosocial factors such as fear-avoidance are not innate and are a result of
social and environmental factors -> patient education
u
Psychosocial factors are being recognised as key components in tendinopathy
u
Opportunity for positive outcomes