Reduced Intratendinous Sliding in Achilles Tendinopathy During Active Plantarflexion Regardless of Horizontal Foot Position.

PURPOSE: The Achilles tendon consists of three subtendons with the ability to slide relative to each other. As optimal intratendinous sliding is thought to reduce the overall stress in the tendon, alterations in sliding behavior could potentially play a role in the development of Achilles tendinopathy. The aims of this study were to investigate the difference in intratendinous sliding within the Achilles tendon during isometric contractions between asymptomatic controls and patients with Achilles tendinopathy and the effect of changing the horizontal foot position on intratendinous sliding in both groups. METHODS: Twenty-nine participants (13 Achilles tendinopathy and 16 controls) performed isometric plantarflexion contractions at 60% of their maximal voluntary contraction (MVC), in toes-neutral, and at 30% MVC in toes-neutral, toes-in, and toes-out positions during which ultrasound images were recorded. Intratendinous sliding was estimated as the superficial-to-middle and middle-to-deep relative displacement. RESULTS: Patients with Achilles tendinopathy present lower intratendinous sliding than asymptomatic controls. Regarding the horizontal foot position in both groups, the toes-out foot position resulted in increased sliding compared with both toes-neutral and toes-out foot position. CONCLUSION: We provided evidence that patients with Achilles tendinopathy show lower intratendinous sliding than asymptomatic controls. Since intratendinous sliding is a physiological feature of the Achilles tendon, the external foot position holds promise to increase sliding in patients with Achilles tendinopathy and promote healthy tendon behavior. Future research should investigate if implementing this external foot position in rehabilitation programs stimulates sliding within the Achilles tendon and improves clinical outcome.

Therapeutic exercises in the clinical practice of Brazilian physical therapists in the management of rotator cuff tendinopathy: An online survey.

The objective of this study was to investigate how Brazilian physical therapists (PTs) use therapeutic exercises in the rehabilitation of individuals with rotator cuff (RC) tendinopathy. The study used an online survey with a mix of 62 open- and closed-ended questions divided into three sections: participant demographics, professional experience, and clinical practice in the rehabilitation of patients with RC tendinopathy. One hundred and fifty-nine Brazilian physical therapists completed the survey. Most of our sample recommended isometric exercises (69.9%) in the initial phase of rehabilitation and eccentric exercises (47.4%) in the advanced phase. However, there was a wide variability in determining the volume of exercises, particularly with isometric exercises. Most of our sample considered patient comfort and pain levels when adjusting exercise intensity, regardless of exercise type. The majority (48.40%) recommended weekly reassessment and modification of exercises. Additionally, despite pain being a key factor for discharge and the primary adverse effect of exercise, most of our sample would not discontinue exercises in case of pain during the early and late phases of rehabilitation. Despite the lack of consensus on some aspects, the clinical practice of our sample is in line with the current literature and practice in other countries. However, further research and implementation are crucial to enhance future rehabilitation outcomes, including exploring the exercise training volume, the safety and effectiveness of exercising with pain and identifying the optimal pain level for best results.

Asymmetric running is associated with pain during outdoor running in individuals with Achilles tendinopathy in the return-to-sport phase.

OBJECTIVES: To determine the relationships between (1) Achilles tendon pain and loading symmetry, and (2) number of running bouts and symptom severity, during two weeks of outdoor running in individuals with Achilles tendinopathy. DESIGN: Prospective, observational study. SETTING: Biomechanics laboratory and outdoors. PARTICIPANTS: Seventeen runners with Achilles tendinopathy in the return-to-sport phase of rehabilitation. MAIN OUTCOME MEASURES: Symptom severity was recorded with the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Running bouts and Achilles tendon pain during runs were recorded with daily training logs. Ground contact time was collected during runs with wearable sensors. Linear mixed modeling determined if the relationship between Achilles tendon pain and ground contact time symmetry during running was moderated by consecutive run days. Multiple regression determined the relationship between number of running bouts and change in VISA-A scores over two weeks, adjusted for run distance. RESULTS: Greater ground contact time on the contralateral leg corresponded to increased ipsilateral tendon pain for each consecutive run day (b = -0.028, p < 0.001). Number of running bouts was not associated with 2-week changes in VISA-A scores (p = 0.672). CONCLUSIONS: Pain during running is associated with injured leg off-loading patterns, and this relationship strengthened with greater number of consecutive run days. Number of running bouts was not related to short-term symptom severity.

Efficacy of ultrasound therapy combined with cryotherapy in pain management and rehabilitation in patients with Achilles tendinopathy: a retrospective observational study.

Background: Achilles tendinopathy (AT) is characterized by pain, reduced performance, and swelling in and around the tendon. The aim of our study was to evaluate and compare the effects of ultrasound therapy alone or associated with cryotherapy. Methods: We analyzed retrospectively amateur runner patients who run at least 3 times a week, with medical and ultrasound diagnosis of subacute AT of the midportion. All patients underwent 10 sessions of ultrasounds' therapy with qmd® ultrasound cryo and a therapeutic exercise with stretching and eccentric exercises. The Cryo-Ultrasound Group (CUG, 15, 8M and7/F), during the ultrasound treatment, underwent a session of cryo-ultrasound therapy. The Ultrasound Group (UD, 15, 7M and 8F) only performed ultrasound therapy. Results: All evaluations performed show significant improvement over time in both groups. The CUG shows at T1 a greater increase in pain and function compared to the UG. Friedmann's repeated measures analysis shows that both groups improved when assessed separately over time. From the subsequent post hoc analysis, a statistically significant difference is highlighted between the values evaluated at T0 and T3. Conclusions: The possible simultaneous delivery of the two treatment modalities, in patients suffering from tendinopathies, therefore represents a good possibility of synergistically exploiting their therapeutic actions. Future studies with a larger patient sample and longer follow-up are also needed to better evaluate the benefits of this treatment.

Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study.

OBJECTIVES: To estimate Achilles tendon forces and their relationship with self-reported pain in runners with Achilles tendinopathy (AT) during common rehabilitation exercises. DESIGN: Cross-sectional. SETTING: Laboratory. PARTICIPANTS: 24 recreational male runners (45.92 (8.24) years old; 78.20 (8.01) kg; 177.17 (6.69) cm) with symptomatic AT. MAIN OUTCOME MEASURES: Kinematic and kinetic data were collected to estimate Achilles tendon forces during 12 commonly prescribed exercises. Achilles tendon forces were estimated from biomechanical data and normalised to the participant's bodyweight. The secondary aim was to investigate the relationship between Achilles tendon forces and pain during these exercises. RESULTS: Two exercise clusters were identified based on Achilles tendon forces. Cluster1 included various exercises including double heel raises, single heel raises, and walking (range: 1.10-2.76 BWs). Cluster2 included running, jumping and hopping exercises (range: 5.13-6.35 BWs). Correlation between tendon forces and pain was at best low for each exercise (range: -0.43 - 0.20). Higher force exercises lead to more tendon load for a given amount of pain (R2 = 0.7505; y = 0.2367x + 0.6191). CONCLUSION: This study proposes a hierarchical exercise progression based on Achilles tendon forces to guide treatment of runners with AT. Achilles tendon forces and pain are not correlated in runners with AT.

Physical Therapy for People with Lateral Elbow Tendinopathy: Using the Evidence to Guide Musculoskeletal Rehabilitation Clinical Practice.

Lateral elbow tendinopathy (LET) is an overuse injury of the common extensor tendon that occurs in active people. Modifiable risk factors include repetitive movements of the elbow, forearm, and hand, and tasks like handling heavy tools, which may overload the tendon. The clinical course of LET varies considerably. Some people experience a single, brief episode of symptoms, whereas others have persistent or recurring episodes of LET. J Orthop Sports Phys Ther 2023;53(1):5-6. doi:10.2519/jospt.2023.0501.

Interventions for prevention and in-season management of patellar tendinopathy in athletes: A scoping review.

INTRODUCTION: Patellar tendinopathy (PT) has a high prevalence in jumping athletes and presents a significant burden on athletes and clinicians due to its long-lasting duration and persistent symptoms. This scoping review aimed to map existing evidence on prevention and in-season management interventions for PT in athletes, evaluating intervention parameters and outcomes. METHODS: This scoping review was reported in accordance with the PRISMA-ScR. Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, and the Cochrane library (Controlled trials, Systematic reviews). All primary study designs investigating prevention or in-season management interventions for PT, while maintaining athletes in sport were considered for inclusion. RESULTS: 5987 articles were identified with 29 included in the review. Five studies investigated exercise-based prevention interventions on athletes at risk for PT, including two randomized controlled trials (RCTs), two cohort studies and one case-control study. 24 studies investigated in-season management or rehabilitation in athletes with PT, including 18 RCTs, three case reports, one cohort study, one case series, and one retrospective review. Of these 24 studies, 22 used various resistance training interventions, one used ESWT and one used patellar strapping and taping. The types of resistance training included eccentric, heavy-slow, isometric, inertial flywheel, blood-flow restriction, and isotonic training. Eccentric training was used in 9 studies, with single leg decline squats the most common exercise used in 7 studies. Outcome measures and intervention parameters were heterogenous throughout studies. CONCLUSION: Despite a dearth of studies on preventative interventions for athletes with PT, resistance training may be a useful prophylactic method. Eccentric, heavy slow and isometric resistance training have been found to be feasible and clinically beneficial in-season. There are a lack of studies showing that ESWT offers any additional benefit over resistance training in competing athletes. Patellar strapping and taping may offer short-term pain relief during training and competition. Systematic reviews are required to make definitive recommendations for PT.

Psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy: a cross-sectional study.

OBJECTIVE: to examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function. DESIGN: cross-sectional study. SETTING: online survey platform. PARTICIPANTS: 119 patients (mean age: 44 years (SD 14)) diagnosed with Achilles or patellar tendinopathy. MAIN OUTCOME MEASURES: A range of patient-reported psychological and outcome measures were recorded. Multivariate regression analyses were performed to establish the association between each psychological factor and outcome measures, adjusted for relevant confounders. RESULTS: Psychological readiness and confidence to return to sports (I-PRRS) and pain catastrophizing (PCS) were significantly associated with tendinopathy severity (modified VISA), sport participation(OSTRC-O), and satisfaction. Kinesiophobia (TSK) and the importance to patients of returning to pre-injury activity level were significantly associated with sports participation and satisfaction. CONCLUSION: The current study provides evidence of impairments in psychological factors during rehabilitation of patients with Achilles and patellar tendinopathy. Most investigated psychological factors were associated with tendinopathy severity, function, participation, and satisfaction. Physical therapists should recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain.

Maximum dorsiflexion increases Achilles tendon force during exercise for midportion Achilles tendinopathy.

Rehabilitation is an important treatment for non-insertional Achilles tendinopathy. To date, eccentric loading exercises (ECC) have been the predominant choice; however, mechanical evidence underlying their use remains unclear. Other protocols, such as heavy slow resistance loading (HSR), have shown comparable outcomes, but with less training time. This study aims to identify the effect of external loading and other variables that influence Achilles tendon (AT) force in ECC and HSR. Ground reaction force and kinematic data during ECC and HSR were collected from 18 healthy participants for four loading conditions. The moment arms of the AT were estimated from MRIs of each participant. AT force then was calculated using the ankle torque obtained from inverse dynamics. In the eccentric phase, the AT force was not larger than in the concentric phase in both ECC and HSR. Under the same external load, the force through the AT was larger in ECC with the knee bent than in HSR with the knee straight due to increased dorsiflexion angle of the ankle. Multivariate regression analysis showed that external load and maximum dorsiflexion angle were significant predictors of peak AT force in both standing and seated positions. Therefore, to increase the effectiveness of loading the AT, exercises should apply adequate external load and reach maximum dorsiflexion during the movement. Peak dorsiflexion angle affected the AT force in a standing position at twice the rate of a seated position, suggesting standing could prove more effective for the same external loading and peak dorsiflexion angle.

Rehabilitation of patellar tendinopathy.

Patellar tendinopathy is a common musculoskeletal disorder characterized by progressive activity-related anterior knee pain and patellar tendon dysfunction. It is highly prevalent in sports which involve running and jumping. Various treatment methods are used in the management of PT including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery. Even though various treatment options are available for patellar tendinopathy, no single method has proven to result in a consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment. This study presents an overview of the current practice about the management of patellar tendinopathy with an emphasis on rehabilitation. This review can act as a guide to sports medicine and rehabilitation professionals' decision making in the management of this disorder.

Intramuscular stimulation vs sham needling for the treatment of chronic midportion Achilles tendinopathy: A randomized controlled clinical trial.

BACKGROUND: The insertion of filiform needles intramuscularly (a.k.a. intramuscular stimulation/dry needling) has been suggested as a possible treatment for various painful musculoskeletal conditions. Our aim was to answer the question, is intramuscular stimulation more effective than sham intramuscular stimulation/dry needling for the treatment of Achilles tendinopathy? METHODS: 52 participants with persistent midportion Achilles tendinopathy began and 46 completed one of three treatment protocols which were randomly assigned: (G3) a 12-week rehabilitation program of progressive tendon loading plus intramuscular stimulation (n = 25), (G2) the same rehabilitation program but with sham intramuscular stimulation (n = 19), or (G1) a reference group of rehabilitation program alone (as an additional control) (n = 8). The a priori primary outcome measure was change in VISA-A score at 12 weeks-VISA-A was also measured at 6 weeks, and at 6 and 12 months. Secondary outcome measures include the proportion of patients who rated themselves as much or very much improved (%), dorsiflexion range of motion (degrees), and tendon thickness (mm). RESULTS: The study retention was 94% at 12 weeks and 88% at 1 year. VISA-A score improved in all three groups over time (p<0.0001), with no significant difference among the three groups in VISA-A score at the start of the study (mean ± SD: G3 59 ± 13, G2 57 ± 17, G1 56 ± 22), at 12 weeks (G3 76 ± 14, G2 76 ± 15, G1 82 ± 11) or at any other timepoint. The percentage of patients who rated themselves as much or very much improved (i.e. treatment success) was not different after 12 weeks (G3 70%, G2 89%, G1 86% p = 0.94), or at 26 (p = 0.62) or 52 weeks (p = 0.71). No clinically significant effects of intervention group were observed in any of the secondary outcome measures. CONCLUSION: The addition of intramuscular stimulation to standard rehabilitation for Achilles tendinopathy did not result in any improvement over the expected clinical benefit achieved with exercise-based rehabilitation alone.

The Efficacy of Higher Versus Lower Dose Exercise in Rotator Cuff Tendinopathy: A Systematic Review of Randomized Controlled Trials.

OBJECTIVES: To compare the effectiveness and harms of higher exercise dose, including higher exercise load or higher volume, with lower exercise dose (lower load or lower volume) in individuals with rotator cuff tendinopathy. DESIGN: Systematic review. DATA SOURCES: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL from inception to March 2019. STUDY SELECTION: Randomized controlled trials comparing higher versus lower dose exercise that investigated function and pain (overall, activity, night) and adverse event outcomes were independently determined by 2 reviewers. DATA EXTRACTION: Two authors independently extracted data and assessed risk of bias using the Cochrane tool. The primary endpoint was at least 6 weeks to 3 months (other endpoints included up to 6 weeks and beyond 3 months) and the Grades of Recommendation, Assessment, Development and Evaluation was used to assess evidence certainty. DATA SYNTHESIS: Three trials (N=283), none at low risk of bias for all domains, were included. Low-certainty evidence (1 trial, N=102) indicated improved function (20 points [95% confidence interval, 12-28] on a 0-100 point scale) with higher load and volume exercise at 3 months, but little or no clinically important between-group difference in activity or night pain (overall pain not reported). Very low-certainty evidence (1 trial, N=120) indicated higher load exercise conferred no function benefits over lower load exercise at 6 weeks. Very low-certainty evidence (1 trial, N=61) indicated benefit of uncertain clinical importance in function with higher versus lower volume exercise at 3 months and clinically important benefit at more than 3 months (pain outcomes not reported). The risk of adverse events was uncertain. CONCLUSIONS: There are few studies that have investigated higher dose exercise for rotator cuff tendinopathy. There was low to very low certainty and conflicting evidence regarding the value of higher exercise dose in individuals with rotator cuff tendinopathy.

Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: A quasi-randomized clinical trial.

BACKGROUND: Isometric exercises may provide an immediate analgesic effect in patients with lower-limb tendinopathy and have been proposed as initial treatment and for immediate pain relief. Current evidence is conflicting, and previous studies were small. OBJECTIVE: To study whether isometric exercises result in an immediate analgesic effect in patients with chronic midportion Achilles tendinopathy. METHODS: Patients with clinically diagnosed chronic midportion Achilles tendinopathy were quasi-randomized to one of four arms: isometric calf-muscle exercises (tiptoes), isometric calf-muscle exercises (dorsiflexed ankle position), isotonic calf-muscle exercises, or rest. The primary outcome was pain measured on a visual analogue scale (VAS) score (0-100) during a functional task (10 unilateral hops) both before and after the intervention. Between-group differences were analyzed using a generalized estimation equations model. RESULTS: We included 91 patients. There was no significant reduction in pain on the 10 hop test after performing any of the four interventions: isometric (tiptoes) group 0.2, 95%CI -11.2 to 11.5; isometric (dorsiflexed) group -1.9, 95%CI -13.6 to 9.7; isotonic group 1.4, 95%CI -8.3 to 11.1; and rest group 7.2, 95%CI -2.4 to 16.7. There were also no between-group differences after the interventions. CONCLUSION: The isometric exercises investigated in this study did not result in immediate analgesic benefit in patients with chronic midportion Achilles tendinopathy. We do not recommend isometric exercises if the aim is providing immediate pain relief. Future research should focus on the use of isometric or isotonic exercise therapy as initial treatment as all exercise protocols used in this study were well-tolerated.

Shoulder pain: are there predictive factors of response to treatment and of ultrasound findings?

INTRODUCTION: Shoulder pain is a common cause of consultation in Primary Health Care, and may correspond to up to 30% of the reasons for consultation. Pathology of the rotator cuff is the most common cause of pain. Ultrasound is a valuable diagnostic tool in assessing shoulder disorders; it can be as effective as magnetic resonance imaging. OBJECTIVE: To determine the predictive factors of response to treatment and ultrasound findings in shoulder pain. METHODS: We performed an analysis of the patients' cases sent to the rheumatology consultation with shoulder pain, every patient had an echography shoulder evaluation, and the rheumatologist decided treatment based on the guidelines for the treatment of shoulder tendinopathies. The use of nonsteroidal anti-inflammatory drug (NSAIDs) and muscle relaxant medications as well as the following techniques: corticosteroids local injection, barbotage, capsular distension and physiotherapy programs were some of the variables assessed. Posteriorly, the patients were clinically assessed in a follow-up visit. RESULTS: A total of 119 patients were evaluated. There was a statistically significant relationship between the time from the beginning of the symptomatology and treatment response. Diabetes mellitus, arterial hypertension and dyslipidaemia were statistically significantly associated with some rotator cuff lesions and distention of the subscapular bursa. Age is the main predictor of rotator cuff ultrasound findings. CONCLUSION: In patients with shoulder pain, early intervention positively influences the response to treatment. Thus, it is important that these patients are evaluated more promptly. Some comorbidities seem to be associated with a higher risk of specific rotator cuff lesions. No relationship was found between response to treatment and age, sex, occupation, previous treatments or type of therapy selected. The associations found in this study seem to have clinical implications. Prevention of rotator cuff disease is a matter of major relevance as well as early institution of treatment.

Factors associated with positive outcomes of platelet-rich plasma therapy in Achilles tendinopathy.

BACKGROUND: The efficacy of platelet-rich plasma in the treatment for Achilles tendinopathy is debated. Therefore, it is important to know which factors, related to the subjects and/or the disease, are associated with positive or negative outcomes. Aim of this study was to evaluate in a large cohort of patients with Achilles mid-portion tendinopathy which variables were independently associated with a positive outcome after platelet-rich plasma treatment. MATERIAL AND METHODS: Eighty-four subjects with Achilles tendinopathy were evaluated by means of VISA-A score and ultrasound and treated with a single platelet-rich plasma injection once a week for 3 weeks. Afterward, a rehabilitation program, based on eccentric training, was implemented. At 3 and 6 months, the relationship between the mean VISA-A score and the following putative predictors was evaluated: sex, age, physical activity, sport, smoking, metabolic risk factors, BMI, symptoms duration, tendon damage, neovessels, adherence to eccentric training. Finally, the percentage of clinically evident positive outcomes (defined as an increase in VISA-A score ≥ 20 points) related to each variable was computed. RESULTS: At final follow-up, using the General Linear Model for Repeated Measures procedure, male sex (0.02), age ≤ 40 (0.05) and adequate eccentric training (0.02) were found to be independently associated with a significant increase in the mean VISA-A score. Moreover, the clinically evident positive outcomes, as previously defined, were significantly associated with male sex (0.01), age ≤ 40 (0.000), BMI ≤ 25 (0.001), symptoms duration ≤ 12 months (0.02) and good adherence to eccentric training (0.004). CONCLUSION: Younger age, male sex and good adherence to eccentric training can be considered predictors of better results after platelet-rich plasma therapy in Achilles tendinopathy.

'There is a very distinct need for education' among people with rotator cuff tendinopathy: An exploration of health professionals' attitudes.

BACKGROUND: Clinical practice guidelines recommend non-surgical care in the management of rotator cuff tendinopathy prior to considering imaging or surgery. However, this requires effective education to promote adherence to treatment. OBJECTIVES: To explore expert shoulder clinician's experiences with managing rotator cuff tendinopathy including practice beliefs towards providing education. DESIGN: An in-depth qualitative study. METHOD: We conducted interviews (n = 8) with an international sample of expert shoulder clinician-researchers. Data were analysed using an inductive thematic approach with constant comparison. RESULTS: Three key themes emerged: (1) The need for early, focused education: "Some beliefs can be detrimental to rehabilitation options", (2) Developing therapeutic alliance: "If a patients trust you then you are generally going to get much better results" and (3) What is required moving forward in current day RT management: "Maybe we can get better." CONCLUSIONS: Our findings highlight the importance of education to alleviate potential barriers to effective conservative care (including exercise) and self-management for rotator cuff tendinopathy. We also identified actionable ways to promote a collaborative therapeutic alliance however, this hinges on sufficient clinical time to educate patients adequately, which may be a barrier in busy clinical settings. Further, there is need for targeted education to facilitate development of clinical skills required to implement effective patient education strategies.

Upper limb active joint repositioning during a multijoint task in participants with and without rotator cuff tendinopathy and effect of a rehabilitation program.

STUDY DESIGN: Cross-sectional and longitudinal (exploratory) studies. INTRODUCTION: Rotator cuff (RC) tendinopathy is the most prevalent shoulder diagnosis, and proprioception deficits are often observed in individuals with RC tendinopathy. PURPOSE OF THE STUDY: This study aimed to evaluate upper limb proprioception during a multijoint task in participants with and without RC tendinopathy and to determine if symptoms, functional limitations, and proprioception are improved after a rehabilitation program. METHODS: Twenty participants with and 20 without RC tendinopathy were recruited for the cross-sectional study, and 23 participants with RC tendinopathy were recruited for the longitudinal study. Proprioception was evaluated by an active joint-repositioning task: The upper limb was passively moved to a predetermined position, and the participant was asked to actively replicate the movement. The difference between the predetermined position and the replicated position was measured. The mean errors in positions of lateral, medial, and neutral rotation of the shoulder and the global mean error were reported. In addition to the active-repositioning assessment in the longitudinal study, symptoms and functional limitations were evaluated by the Disability of the Arm Shoulder and Hand questionnaire. RESULTS: Significant deficits in active repositioning (p < .01), independent of the position, were observed in participants with RC tendinopathy compared with controls. The DASH score was improved after rehabilitation intervention (p < .001), and patients with active-repositioning deficits at baseline had reduced repositioning error (p < .05). CONCLUSIONS: Upper limb active joint repositioning was impaired in participants with RC tendinopathy. Symptoms and functional limitations and active joint repositioning in participants with RC tendinopathy and initial deficits were improved after a 6-week global rehabilitation program.