🇺🇸 Approved for CEUs for PTs & PTAs in 42 states

Tendon investment framework: a new communication model for navigating load, symptoms and behaviour in tendinopathy

Review written by Dr Seth O’Neill info

Key Points

  1. The Tendon Investment Framework identifies three common behavioural patterns in people with tendinopathy: Overloaders - who push through pain; Underloaders - who avoid loading due to fear of aggravating symptoms; and Oscillators - who alternate between overloading and underloading.
All key points available for members only
Start free trial Icon
Or log in here

BACKGROUND & OBJECTIVE

This editorial article centres on managing people with tendon pain and three common character types – the Overloader, the Underloader and the Oscillator. Whilst the terms are new, the character traits are common and routinely seen across all musculoskeletal complaints. The authors use “investment psychology” to inform the proposed framework.

The Overloader (AKA Endurance Coper) (1); is the type of person who continually forces through their activity or exercises and constantly irritates their tendon. These people are often of the mindset “more pain more gain”.

The Underloader (AKA Avoidance Coper) (1); This person is likely to have some fear avoidance beliefs or perceptual issues related to pain perception – rather than more severe pathology. This cohort of patients has been identified in previous work using the Tampa Scale of Kinesiophobia (2). Higher, more serious levels of this behavior may present in people with hypervigilance or even catastrophizing thoughts.

The Oscillator (Boom-Buster) varies between overloading and underloading, failing to find the middle ground needed for progression of loading.

As clinicians we can probably all relate to seeing and working with people in each of these categories. Likely we may even see patients that seem to fluctuate between the categories showing elements of all three during their rehabilitation.

This editorial article centres on managing people with tendon pain and three common character types – the Overloader, the Underloader and the Oscillator.
bulb
Overloaders need defined boundaries and symptom thresholds, underloaders need reassurance and carefully managed predictable/defined steps and Oscillators need consistency and pre-agreed adjustment levels.

METHODS

This paper was an editorial. Editorials are essentially short opinion pieces. They are normally, as in this case, written by leading experts in the subject area.

Start free trial Icon
to unlock full access to this review and 1337 more
Or log in here
Trustpilot