51
|
Barker-Davies RM, Roberts A, Watson J, Baker P, Bennett AN, Fong DTP, Wheeler P, Lewis MP. Kinematic and kinetic differences between military patients with patellar tendinopathy and asymptomatic controls during single leg squats. Clin Biomech (Bristol, Avon) 2019; 62:127-135. [PMID: 30759406 DOI: 10.1016/j.clinbiomech.2019.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/26/2018] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee valgus alignment has been associated with lower-limb musculoskeletal injury. This case-control study aims to: assess biomechanical differences between patients with patellar tendinopathy and healthy controls. METHODS 43 military participants (21 cases, 22 controls) were recorded using 3D-motion capture performing progressively demanding, small knee bend, single leg and single leg decline squats. Planned a priori analysis of peak: hip adduction, knee flexion, pelvic tilt, pelvic obliquity and trunk flexion was conducted using MANOVA. Kinematic and kinetic data were graphed with bootstrapped t-tests and 95% CI's normalised to the squat cycle. ANOVA and correlations in SPSS were used for exploratory analysis. FINDINGS On their symptomatic side cases squatted to less depth (-6.62°, p < 0.05) than controls with exploratory curve analysis revealing a pattern of increased knee valgus collapse throughout the squatting movement (p < 0.05). Greater patella tendon force was generated by: the eccentric than concentric phase of squatting (+30-43%, ES 0.52-1.32, p < 0.01), declined (plantarflexed) compared to horizontal surface (+36-51%, ES 1.19-1.68, p < 0.01) and deeper knee flexion angles (F ≥ 658.3, p < 0.01) with no difference between groups (F ≤ 1.380, p > 0.05). Cases experienced more pain on testing on decline board (ES = 0.69, p < 0.01). For symptomatic limbs pain (rs = 0.458-0.641, p ≤ 0.05), but not VISA-P (Victoria Institute of Sport Assessment) (rs = 0.053-0.090, p > 0.05), correlated with extensor knee moment. INTERPRETATION Knee valgus alignment is a plausible risk factor for patellar tendinopathy. Conclusions relating to causation are limited by the cross-sectional study design. Increasing squat depth, use of a declined surface and isolating the eccentric phase enable progression of loading prescription guided by pain.
Collapse
Affiliation(s)
- Robert M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, London, UK; National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, UK.
| | - Andrew Roberts
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, London, UK; Army Personnel Research Capability, Army Headquarters, Andover, UK
| | - James Watson
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, London, UK
| | - Polly Baker
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, London, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, London, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
| | - Daniel T P Fong
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, UK
| | - Patrick Wheeler
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, UK
| | - Mark P Lewis
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, UK
| |
Collapse
|
52
|
Habets B, van den Broek AG, Huisstede BMA, Backx FJG, van Cingel REH. Return to Sport in Athletes with Midportion Achilles Tendinopathy: A Qualitative Systematic Review Regarding Definitions and Criteria. Sports Med 2018; 48:705-723. [PMID: 29249084 PMCID: PMC5808052 DOI: 10.1007/s40279-017-0833-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Midportion Achilles tendinopathy (AT) can cause long-term absence from sports participation, and shows high recurrence rates. It is important that the decision to return to sport (RTS) is made carefully, based on sharply delimited criteria. Lack of a well-defined definition and criteria hampers the decision to RTS among athletes with AT, and impedes comparison of RTS rates between different studies. Objective The aim of this study was to systematically review the literature for definitions of, and criteria for, RTS in AT research. Study Design Qualitative systematic review. Methods The PubMed, EMBASE, Cochrane, CINAHL, PEDro, and Scopus electronic databases were searched for articles that reported on the effect of a physiotherapeutic intervention for midportion AT. Article selection was independently performed by two researchers. Qualitative content analysis was used to analyze the included studies and extract definitions of, and criteria for, RTS. Results Thirty-five studies were included in the content analysis, showing large variety in both the definitions and criteria. Thirty-two studies reported a definition of RTS, but only 19 studies described the criteria for RTS. The content analysis revealed that ‘reaching pre-injury activity/sports level, with the ability to perform training and matches without limitations’, ‘absence of pain’, and ‘recovery’ were the main content categories used to define RTS. Regarding the criteria for RTS, eight different content categories were defined: (1) ‘level of pain’; (2) ‘level of functional recovery’; (3) ‘recovery of muscle strength’; (4) ‘recovery of range of motion’; (5) ‘level of endurance of the involved limb’; (6) ‘medical advice’; (7) ‘psychosocial factors’; and (8) ‘anatomical/physiological properties of the musculotendinous complex’. Many criteria were not clearly operationalized and lacked specific information. Conclusions This systematic review shows that RTS may be defined according to the pre-injury level of sports (including both training and matches), but also with terms related to the absence of pain and recovery. Multiple criteria for RTS were found, which were all related to level of pain, level of functional recovery, muscular strength, range of motion, endurance, medical advice, psychosocial factors, or anatomical/physiological properties of the Achilles tendon. For most of the criteria we identified, no clear operationalization was given, which limits their validity and practical usability. Further research on how RTS after midportion AT should be defined, and which criteria should be used, is warranted. PROSPERO Registration Number CRD42017062518. Electronic supplementary material The online version of this article (10.1007/s40279-017-0833-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bas Habets
- Papendal Sports Medical Centre, Papendallaan 7, 6816 VD, Arnhem, The Netherlands. .,Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Anke G van den Broek
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bionka M A Huisstede
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J G Backx
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert E H van Cingel
- Papendal Sports Medical Centre, Papendallaan 7, 6816 VD, Arnhem, The Netherlands.,Radboud University Medical Centre, Research Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| |
Collapse
|
53
|
Brauner T, Pourcelot P, Crevier-Denoix N, Horstmann T, Wearing SC. Achilles Tendon Load is Progressively Increased with Reductions in Walking Speed. Med Sci Sports Exerc 2018; 49:2001-2008. [PMID: 28509763 DOI: 10.1249/mss.0000000000001322] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Achilles tendon rehabilitation protocols commonly recommend a gradual increase in walking speed to progressively intensify tendon loading. This study used transmission-mode ultrasound to evaluate the influence of walking speed on loading of the human Achilles tendon in vivo. METHODS Axial transmission speed of ultrasound was measured in the right Achilles tendon of 33 adults (mean ± SD: age, 29 ± 3 yr; height, 1.725 ± 0.069 m; weight, 71.4 ± 19.9 kg) during unshod, steady-state treadmill walking at three speeds (slow, 0.85 ± 0.12 ms; preferred, 1.10 ± 0.13 m·s; fast, 1.35 ± 0.20 m·s). Ankle kinematics, spatiotemporal gait parameters and vertical ground reaction force were simultaneously recorded. Statistical comparisons were made using repeated-measures ANOVA models. RESULTS Increasing walking speed was associated with higher cadence, longer step length, shorter stance duration, greater ankle plantarflexion, higher vertical ground reaction force peaks, and a greater loading rate (P < 0.05). Maximum (F1,38 = 7.38, P < 0.05) and minimum (F1,46 = 8.95, P < 0.05) ultrasound transmission velocities in the Achilles tendon were significantly lower (16-23 m·s) during the stance but not swing phase of gait, with each increase in walking speed. CONCLUSIONS Despite higher vertical ground reaction forces and greater ankle plantarflexion, increasing walking speed resulted in a reduction in the axial transmission velocity of ultrasound in the Achilles tendon; indicating a speed-dependent reduction in tensile load within the triceps surae muscle-tendon unit during walking. These findings question the rationale for current progressive loading protocols involving the Achilles tendon, in which reduced walking speeds are advocated early in the course of treatment to lower Achilles tendon loads.
Collapse
Affiliation(s)
- Torsten Brauner
- 1Faculty of Sports and Health Sciences, Technische Universität München, Munich, GERMANY; 2Unite 957, BPLC, INRA, Ecole Nationale Vétérinaire d'Alfort (National Veterinary School of Alfort), University Paris Est, Maisons-Alfort, FRANCE; and 3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, AUSTRALIA
| | | | | | | | | |
Collapse
|
54
|
Cross-cultural Adaptation of the Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire for Spanish Athletes With Achilles Tendinopathy. J Orthop Sports Phys Ther 2018; 48:111-120. [PMID: 29237355 DOI: 10.2519/jospt.2018.7402] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Clinical measurement study. Background Achilles tendinopathy is a prevalent sport-related injury. The Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a widely used patient-reported outcome to assess the severity of symptoms for this injury. Objective To adapt the VISA-A questionnaire into Spanish and to assess its psychometric properties. Methods Cross-cultural adaptation was conducted according to recommended guidelines. The Spanish VISA-A (VISA-A-Sp) questionnaire was administered to 210 subjects: 70 healthy students, 70 active at-risk subjects (participating in running and jumping), and 70 patients diagnosed with Achilles tendinopathy. Participants were assessed at baseline and after 3 to 5 days. The injured subjects were also evaluated with a quality-of-life questionnaire (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) and at discharge. The final VISA-A-Sp was evaluated for reliability, validity, and responsiveness. Results Cronbach alpha for the VISA-A-Sp was greater than .8. The intraclass correlation coefficient (model 2,1) was 0.993 (95% confidence interval: 0.991, 0.995; P<.05). In the confirmatory factor analysis, a 1-factor solution obtained a relatively good fit. Subjects with Achilles tendinopathy scored significantly lower than the other 2 groups (P<.001). The VISA-A-Sp score within the Achilles tendinopathy group showed significant correlations with SF-36 physical components (Spearman rho>0.5, P<.001). The standard error of the measurement was 2.53, and the minimal detectable change at the 95% confidence level was 7 points. The responsiveness indicators included an effect size of 2.16 and a standardized response mean of 1.92. Conclusion The VISA-A-Sp showed satisfactory psychometric properties that were comparable to the original English-language version. Therefore, it can be recommended for use in clinical practice and research for assessing the severity of symptoms in Spanish-speaking athletes who suffer from Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(2):111-120. Epub 13 Dec 2017. doi:10.2519/jospt.2018.7402.
Collapse
|
55
|
Opdam KTM, Baltes TPA, Zwiers R, Wiegerinck JJI, van Dijk CN. Endoscopic Treatment of Mid-Portion Achilles Tendinopathy: A Retrospective Case Series of Patient Satisfaction and Functional Outcome at a 2- to 8-Year Follow-up. Arthroscopy 2018; 34:264-269. [PMID: 28822636 DOI: 10.1016/j.arthro.2017.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the results of endoscopic treatment in patients affected by mid-portion Achilles tendinopathy, by release of the paratenon combined with a resection of the plantaris tendon, regarding patient satisfaction, functional outcome, and pain scores. METHODS This retrospective study evaluated patients endoscopically treated for mid-portion Achilles tendinopathy between 2000 and 2013. Patient satisfaction, functional outcome, pain scores, and health-related quality of life were measured by the use of a numeric rating scale, the Foot and Ankle Outcome Score, the Victorian Institute of Sport assessment for the Achilles tendon, the numeric rating scale for pain during running and during sports, and the EuroQol 5D (EQ-5D-3L) standardized questionnaire. Additional questions were asked on the effectiveness of the treatment and sport participation. RESULTS The response rate was 76.3% (45 of 59). Thirty-five (78%) patients were treated unilaterally and 10 (22%) patients were treated bilaterally. For the unilaterally treated patients, the median time to follow-up was 67 months (interquartile range [IQR] 48-99 months), and for the bilaterally treated patients, it was 89.5 months (IQR 37.5-161.75 months). The median satisfaction score for treatment results was 9 out of 10 (IQR 7-10) and 9.5 (IQR 7-10), respectively. The median Foot and Ankle Outcome Score subscales were scored 75 to 99 and 75 to 97, the median Victorian Institute of Sport assessment for the Achilles tendon scored 81 (IQR 47-90) and 97 (IQR 87-100), and the median numeric rating scale pain scores during both running and sports were 1 (IQR 0-6.5) for the unilaterally treated patients and 0 (IQR 0-4.5) and 0 (IQR 0-1) for the bilaterally treated patients, respectively. The median EQ-5D were 0.81 (IQR 0.71-1) and 1 (IQR 0.64-1), respectively. One reoperation for recurrence of symptoms was necessary. CONCLUSIONS This study shows high patient satisfaction and good functional outcomes in patients affected by mid-portion Achilles tendinopathy who were endoscopically treated by means of release of the paratenon in combination with transection of the plantaris tendon. LEVEL OF EVIDENCE Level IV, retrospective case series (therapeutic).
Collapse
Affiliation(s)
- Kim T M Opdam
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
| | - Thomas P A Baltes
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - Ruben Zwiers
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Jan Joost I Wiegerinck
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
| | - C Niek van Dijk
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| |
Collapse
|
56
|
THE REHABILITATION OF A RUNNER WITH ILIOPSOAS TENDINOPATHY USING AN ECCENTRIC-BIASED EXERCISE-A CASE REPORT. Int J Sports Phys Ther 2017; 12:1150-1162. [PMID: 29234566 DOI: 10.26603/ijspt20171150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose While there is much discussion about tendinopathy in the literature, there is little reference to the less common condition of iliopsoas tendinopathy, and no documentation of the condition in runners. The iliopsoas is a major decelerator of the hip and eccentric loading of the iliopsoas is an important component of energy transfer during running. Eccentric training is a thoroughly researched method of treating tendinopathy but has shown mixed results. The purpose of this case report is to describe the rehabilitation of a runner with iliopsoas tendinopathy, and demonstrate in a creative eccentric-biased technique to assist with treatment. A secondary objective is to illustrate how evidence on intervention for other tendinopathies was used to guide rehabilitation of this seldom described condition. Case Description The subject was a 39-year-old female middle distance runner diagnosed with iliopsoas tendinopathy via ultrasound, after sudden onset of left anterior groin pain. Symptoms began after a significant increase in running load, and persisted, despite rest, for three months. The intervention consisted of an eccentric-biased hip flexor exercise, with supportive kinetic chain exercises and progressive loading in a return to running program. Outcomes The Copenhagen Hip and Groin Outcome Score, the Visual Analogue Scale, the Global Rating of Change Scale and manual muscle testing scores all improved after 12 weeks of intervention with further improvement at the five-year follow up. After 12 weeks of intervention, the subject was running without restriction and had returned to her pre-injury running mileage at the five-year follow up. Discussion The eccentric-biased exercise in conjunction with exercises addressing the kinetic chain and a progressive tendon loading program, were successful in the rehabilitation of this subject with iliopsoas tendinopathy. This case report is the first to provide a description on the rehabilitation of iliopsoas tendinopathy, and offers clinicians suggestions and guidance for treatment and exercise choice in the clinical environment. Level of Evidence 5.
Collapse
|
57
|
Innovations and pitfalls in the use of wearable devices in the prevention and rehabilitation of running related injuries. Phys Ther Sport 2017; 29:26-33. [PMID: 29172095 DOI: 10.1016/j.ptsp.2017.10.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Running-related injuries are common and are associated with a high rate of reoccurrence. Biomechanics and errors in applied training loads are often cited as causes of running-related injuries. Clinicians and runners are beginning to utilize wearable technologies to quantify biomechanics and training loads with the hope of reducing the incidence of running-related injuries. Wearable devices can objectively assess biomechanics and training loads in runners, yet guidelines for their use by clinicians and runners are not currently available. This article outlines several applications for the use of wearable devices in the prevention and rehabilitation of running-related injuries. Applications for monitoring of training loads, running biomechanics, running epidemiology, return to running programs and gait retraining are discussed. Best-practices for choosing and use of wearables are described to provide guidelines for clinicians and runners. Finally, future applications are outlined for this rapidly developing field.
Collapse
|
58
|
Bogaerts S, De Brito Carvalho C, Scheys L, Desloovere K, D’hooge J, Maes F, Suetens P, Peers K. Evaluation of tissue displacement and regional strain in the Achilles tendon using quantitative high-frequency ultrasound. PLoS One 2017; 12:e0181364. [PMID: 28727745 PMCID: PMC5519157 DOI: 10.1371/journal.pone.0181364] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/29/2017] [Indexed: 01/08/2023] Open
Abstract
The Achilles tendon has a unique structure-function relationship thanks to its innate hierarchical architecture in combination with the rotational anatomy of the sub-tendons from the triceps surae muscles. Previous research has provided valuable insight in global Achilles tendon mechanics, but limitations with the technique used remain. Furthermore, given the global approach evaluating muscle-tendon junction to insertion, regional differences in tendon mechanical properties might be overlooked. However, recent advancements in the field of ultrasound imaging in combination with speckle tracking have made an intratendinous evaluation possible. This study uses high-frequency ultrasound to allow for quantification of regional tendon deformation. Also, an interactive application was developed to improve clinical applicability. A dynamic ultrasound of both Achilles tendons of ten asymptomatic subjects was taken. The displacement and regional strain in the superficial, middle and deep layer were evaluated during passive elongation and isometric contraction. Building on previous research, results showed that the Achilles tendon displaces non-uniformly with a higher displacement found in the deep layer of the tendon. Adding to this, a non-uniform regional strain behavior was found in the Achilles tendon during passive elongation, with the highest strain in the superficial layer. Further exploration of tendon mechanics will improve the knowledge on etiology of tendinopathy and provide options to optimize existing therapeutic loading programs.
Collapse
Affiliation(s)
- Stijn Bogaerts
- Department of Development & Regeneration, KULeuven / Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
| | | | - Lennart Scheys
- Department of Development & Regeneration, Institute for Orthopedic Research and Training (IORT), KULeuven / Division of Orthopedics, University Hospitals Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Clinical Motion Analysis Laboratory, Department of Rehabilitation Sciences, KULeuven and University Hospitals Leuven, Leuven, Belgium
| | - Jan D’hooge
- Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Frederik Maes
- ESAT/PSI & UZ Leuven, MIRC, KULeuven and University Hospitals Leuven, Leuven, Belgium
| | - Paul Suetens
- ESAT/PSI & UZ Leuven, MIRC, KULeuven and University Hospitals Leuven, Leuven, Belgium
| | - Koen Peers
- Department of Development & Regeneration, KULeuven / Department of Physical Medicine & Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
59
|
Stanley LE, Lucero A, Mauntel TC, Kennedy M, Walker N, Marshall SW, Padua DA, Berkoff DJ. Achilles tendon adaptation in cross-country runners across a competitive season. Scand J Med Sci Sports 2017; 28:303-310. [DOI: 10.1111/sms.12903] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 02/03/2023]
Affiliation(s)
- L. E. Stanley
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Human Movement Science Curriculum; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - A. Lucero
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - T. C. Mauntel
- Department of Orthopaedics; Walter Reed National Military Medical Center; Bethesda MD USA
| | - M. Kennedy
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - N. Walker
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - S. W. Marshall
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Epidemiology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - D. A. Padua
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Human Movement Science Curriculum; University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Orthopaedics; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - D. J. Berkoff
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Orthopaedics; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| |
Collapse
|
60
|
McClinton S, Luedke L, Clewley D. Nonsurgical Management of Midsubstance Achilles Tendinopathy. Clin Podiatr Med Surg 2017; 34:137-160. [PMID: 28257671 DOI: 10.1016/j.cpm.2016.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Midsubstance Achilles tendinopathy is one of the most common lower leg conditions. Most patients can recover with nonsurgical treatment that focuses on tendon loading exercises and, when necessary, symptom modulating treatments such as topical, oral, or injected medication, ice, shoe inserts, manual therapy, stretching, taping, or low-level laser. If unresponsive to initial management, a small percentage of patients may consider shockwave or sclerosing treatment and possibly surgery.
Collapse
Affiliation(s)
- Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA.
| | - Lace Luedke
- Kinesiology Department, University of Wisconsin-Oshkosh, 108B Albee Hall, 800 Algoma Boulevard, Oshkosh, WI 54901, USA
| | - Derek Clewley
- Division of Doctor of Physical Therapy, Duke University, 2200 West Main Street, B-230, Durham, NC 27705, USA
| |
Collapse
|
61
|
Abstract
In response to the growth of JOSPT, Editor-in-Chief J. Haxby Abbott introduces 3 new Associate Editors to the JOSPT Editorial Board, and announces the promotion of 1 outstanding Editorial Board member to an Editor role. J Orthop Sports Phys Ther 2016;46(8):610-612. doi:10.2519/jospt.2016.0111.
Collapse
|
62
|
Alfredson H. Low recurrence rate after mini surgery outside the tendon combined with short rehabilitation in patients with midportion Achilles tendinopathy. Open Access J Sports Med 2016; 7:51-4. [PMID: 27274323 PMCID: PMC4876099 DOI: 10.2147/oajsm.s102692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a general opinion that a structured and specific rehabilitation is needed after treatment of midportion Achilles tendinopathy to minimize recurrence of the condition. There is sparse knowledge about the recurrence rates in large patient materials after specific treatments for midportion Achilles tendinopathy. AIM This study aimed to investigate the recurrence rates in a large number of patients with chronic painful midportion Achilles tendinopathy that had been surgically treated with the ultrasound (US) and Doppler (DP)-guided mini-surgical scraping technique. Postoperatively, a relatively simple rehabilitation protocol, including a range of movement exercises and gradually increased walking and biking before allowing free activity, was used. MATERIALS AND METHODS From a database, information about the recurrence rates after US + DP-guided mini-surgical scraping, performed by a single surgeon on 519 tendons with US + DP-verified chronic painful midportion Achilles tendinopathy, was obtained. RESULTS Recurrence of painful midportion Achilles tendinopathy was found in 26 of 519 (5%) operated tendons, 13 from women and 13 from men. In 13 tendons, a close by located plantaris tendon was extirpated during the reoperation. CONCLUSION In this large material on patients treated with US + DP-guided mini-surgical scraping for midportion Achilles tendinopathy, there were few recurrences, although only a simple and nonspecific rehabilitation protocol was used.
Collapse
Affiliation(s)
- Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden; Institute of Sport, Exercise and Health, University College London Hospitals, London, UK
| |
Collapse
|
63
|
Hägglund M, Waldén M, Ekstrand J. Injury recurrence is lower at the highest professional football level than at national and amateur levels: does sports medicine and sports physiotherapy deliver? Br J Sports Med 2016; 50:751-8. [DOI: 10.1136/bjsports-2015-095951] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/03/2022]
|
64
|
Abstract
Tendinopathy has significant consequences for both the athletic population and, more importantly, those who exercise for health or engage in physical activity as part of their occupation. That we are now able to perform high-quality evidence syntheses based on robust primary evidence for a wide range of conditions and therapeutic approaches is a credit to the pioneers who have driven the evidence explosion, and an inspiration for those striving to emulate and build on their achievements. How do we take that evidence and apply it in the clinical setting to individual patients? How do we adjust our decision-making schema in response to the presented information and challenges? J Orthop Sports Phys Ther 2015;45(11):819-822. doi:10.2519/jospt.2015.0111.
Collapse
|
65
|
Abstract
The majority of muscles have distinct tendinous attachments to bones; however, only a few tendons develop painful conditions. That simple observation prompts us to ask a few questions. Are there commonalities in morphology and pathology among the painful tendons? What contributes to the propensity for pathology in some, but not all, tendons? And, consequently, should all tendinopathies be managed equally? Two common tendinopathies are those affecting the Achilles and supraspinatus, which are presented in this special issue and serve as excellent models to discuss similarities and contrasts. J Orthop Sports Phys Ther 2015;45(11):829-832. doi:10.2519/jospt.2015.0114.
Collapse
|
66
|
Abstract
Patients presenting with pain at the tendon, which is associated with physical tasks and activities that specifically load that tendon, are at the center of this special issue. The current terminology for a symptomatic tendon presentation is tendinopathy, as this does not denote an underlying pathology, but rather signals that all is not well in the tendon. Tendinopathy is a prevalent and substantial problem, as it interferes with a person's capacity to lead a physically active and healthy life, which has a considerable flow-on effect on society in general. This issue deals with the contemporary physical therapy management of tendinopathy by providing a mix of evidence review and clinical expert opinion on commonly presenting tendinopathies of the lower and upper limbs. J Orthop Sports Phys Ther 2015;45(11):816-818. doi:10.2519/jospt.2015.0110.
Collapse
|