A major change in our approach has been the introduction of ‘Echography’ or ‘Musculo-Skeletal Ultrasound Scan’. A very common tool used in ante-natal consultations or internal medicine, but relatively new in physiotherapy.
Echography has the ability to ‘see’ inside your body, and check the affected soft tissues. By doing so, it is much easier to confirm or deny the initial diagnosis. However it is not yet a widespread approach, simply because it is not easy to do and the equipment is expensive.
Nevertheless, in my practice it has changed tremendously the concept of tendon pathology. Just to give you an example: we found that ‘tendinitis’ (inflammation of the tendon) simply does not exist!

Nowadays we name it ‘tendinopathy’ (disease of the tendon). This sounds like a semantic discussion, but it does impact on the treatment.
The tissue is not inflamed; therefore the majority of treatments used in the past are not the most appropriate and may even be harmful!
Another big advantage is the cost of investigation. Echography is a lot cheaper than CT or MRI scans. It can be done during the initial consultation, therefore avoiding wasting time! Diagnostics with echography will determine your problem specifically, and treatment is based on the actual picture we see!
Echography is only suitable for soft tissue, such as tendons, muscles, joint capsules, ligaments etc. The surface of bone can be made visible, but not the inside.


Because of these improved diagnostic tools (Echography), we created a problem for ourselves. The old-fashioned way of treating has no effect on the majority of tendon problems!

New ways are being tested and through evidenced based studies we are entering a new era.
Chronic tendon problems or affected collagen tissues have a specific way of reacting. One of them is thickening of tissue, calcifications and ingrowing of free nerve endings. This results in chronic pain, particularly in the shoulder (rotator cuff), elbow, hip, knee, Achilles and foot (fasciitis plantaris/heel spur).
Basically we have two conservative non-surgical ways of treatment for chronic tendon pain: Eccentric loading, (a specific treatment programme) and Shockwave. The two are complimentary.
By shockwave, a mechanical burst of sound is being conducted into the affected tissue. This results in a stimulation of self-healing processes, but also ‘shuts down’ nerve endings, therefore creating less pain in the tendon. But it does not make a tendon stronger, so that is why eccentric loading is an important follow-up for a long-term solution.

Centre for Diagnostics and Therapy

Berry works with the above mentioned tools, but is also the one to see when you are suffering with recurrent spinal problems. The main objective is to provide you with knowledge to understand your problem. Treatment is short and intense, and in most cases you will go home with a ‘programme’ or additional advice, such as changes in work conditions, posture and self-help. All created to give you the independency and reassurement you need in your physical state. Thankfully a lot of physical problems can be solved!

Does it work for every complaint?

Unfortunately there are problems that need an alternative approach. For example, a rotator cuff problem can be caused by severe swelling around the tendon causing pressure and entrapment. Here surgery may be the only solution. But let’s be clear on one thing: cortisone injections have now been shown not to give any positive long-term results

If you would like more information, please contact Bernard Vrijaldenhoven (mob. 91 847 6000) or the International Health Centres in Albufeira (Tel. 289 588 923)