Friction Treatment for Supraspinatus Tendonitis

[Longstaff]

Does anybody know of any articles in regrads to the effectiveness of Deep friction on chronic supraspinatus tendonitis? I need some ifo quick!!!!

[perfphysio]

look for articles by Cyriax. Good luck

[rodw]

Whilst tendonitis (suggesting inflammation [-itis] of a tendon) indeed has been the prevailing thinking regarding pathology of the superior cuff for quite a long time; more recent work suggests a reappraisal is in order. Firstly, inflammation of a tendon is probably rare, much more likely is tendon necrosis (See for eg Khan, Cook, etc for their reviews on tendinosis; the 'new' term in vogue being tendinosis, suggesting death of the tendon). Secondly, the supraspinatus tendon seems 'at risk' in two ways: Classic impingement, where the superior or bursal side is mechanically irritated by direct abutment into the acromion and/or coraco-acromial ligament. This seems to be LESS common than the articular side (or undersurface) tears, which more easily fit to the model of tensile or overload failure due to poor glenohumeral mechanics. Your key then, is to find out what the pathology is being caused by (assuming that it is primary supraspinatus) - perhaps altered glenohumeral mechanics; and then find the factors contributing to this (including, but not limited to incorrect cuff and scapular activation, tight posterior capsule, incorrect activation of deltoid and pectorals, cervical spine involvement) and then address these factors with a view to altering the original pathology. I think it's time we tried to look at addressing pathology rather than trying recipe treatments.
Rod