Originally Posted by
Will Morris
I'll take conjecture right now, because at least you are thinking about this. In the span of several thread posts, you have started to learn more about tendinopathy rather than just be given some prescription for treatment. You have already started to show a deeper understanding of the topic. The anatomy assignment got you to thinking more about the area, because, as a future PT, you always have to consider the other structures in the area, as well as the areas that refer pain to the area in question.
For chronic trapezius-related pain, especially in a training population, don't forget the 1st rib. A 1st rib dysfunction can masquerade as myofascial pain in the trap, and the myofascial pain tends to be recalcitrant to soft tissue treatment. It will also cause a pronounced myofascial trigger point production in the upper trap.
For tendinopathy, the usual suspects are tendons with long attachments relative to the muscle. Long tendon bodies will allow for there to be a rotational component to loading which is further compounded by multimuscular attachments. The patellar tendon, Achilles tendon, rotator cuff tendons, and biceps tendons are all long tendon bodies. There just doesn't seem to be much in the way of diagnosable tendinopathy in broad based tendinous insertions, as we see in the trap. Certainly, statistics doesn't take away a tendinopathy as a differential, but there may be more to consider here.
As far as treatment, eccentric loading has been shown to produce decreased pain, however eccentric loading protocols tend to have exceptionally poor compliance. The Beyer et al RCT from 2015 randomized eccentric loading against heavy, slow resistance training and showed a slight advantage to HSR. As such, my general prescription for tendinopathies is heavy, slow resistance training and very few individuals get strictly eccentric loading anymore. HSR gives improved function, equally good pain reduction, and higher overall patient satisfaction at 3 months than eccentric only.