title: Rehabilitation of Tendon Problems in Patients with Diabetes Mellitus.
abstract: Exercise is crucial in the management of diabetes mellitus and its associated complications. However, individuals with diabetes have a heightened risk of musculoskeletal problems, including tendon pathologies. Diabetes has a significant impact on the function of tendons due to the accumulation of advanced glycation end-products in the load-bearing collagen. In addition, tendon vascularity and healing may be reduced due to diabetes-induced changes in the peripheral vascular system, and impaired synthesis of collagen and glycosaminoglycan. The current chapter presents an evidence-based discussion of considerations for the rehabilitation of tendon problems in people with diabetes. The following conditions are discussed in detail - calcific tendinopathy, tenosynovitis, tendon rupture, and non-calcifying tendinopathy. Common diabetes-related findings are presented, along with their potential impact on tendinopathy management and suggested modifications to standard tendinopathy treatment protocols. A holistic approach should be used to optimize musculotendinous function, including a comprehensive exercise prescription addressing strength, flexibility, and aerobic fitness.
authors.affiliation: Department of Rheumatology, Cambridge University Hospitals, Addenbrooke's Hospital, Cambridge, UK.|Academic Department of Sport and Exercise Medicine, Queen Mary College, London, UK.|Department of Sport and Exercise Medicine, Fortius Clinic, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rees
authors.affiliation: University of Canberra Research Institute for Sport and Exercise (UCRISE), Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia.
authors.forename: Jamie E
authors.initials: JE
authors.lastname: Gaida
authors.affiliation: Department of Physical Therapy, University of Delaware, Newark, DE, USA.
authors.forename: Karin Grävare
authors.initials: KG
authors.lastname: Silbernagel
authors.affiliation: Center for Sports Medicine, UMC Groningen, 30.001, 9700, RB Groningen, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Zwerver
authors.affiliation: Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Anthony
authors.affiliation: Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada. ascott@interchange.ubc.ca.
authors.forename: Alex
authors.initials: A
authors.lastname: Scott
mesh_terms: D000818:Animals; D048909:Diabetes Complications / Q000209:etiology / Q000534:rehabilitation*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005081:Exercise Therapy; D006801:Humans; D052256:Tendinopathy / Q000209:etiology / Q000534:rehabilitation*; D013710:Tendons / Q000503:physiopathology*
keywords: Calcification; Diabetes; Rehabilitation; Rupture; Tendinopathy; Tendon