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Klein M, Patterson C, Karim A, Cuddeford T. Running biomechanical and isokinetic strength differences in masters runners with and without Achilles tendinopathy. Sports Biomech 2024:1-14. [PMID: 38949234 DOI: 10.1080/14763141.2024.2373376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024]
Abstract
Masters runners are an increasing proportion of the running community. The most significant musculoskeletal changes in runners occur after the age of 50 in addition to changes in injury rates and types, the most common being Achilles tendinopathy (AT). Previous evidence has suggested similarities between risk factors for AT and age-related changes that are focused at the hip and the ankle during the propulsive stage of running. The purpose of this study was to investigate biomechanical and peak torque association to AT in masters runners. Thirty-two masters runners over age 50 with AT (60.31 ± 8.37, n = 16) and without (59.94 ± 4.95 n = 16) were included. 3D motion capture and force plates were used to assess running biomechanics. A motor-driven dynamometer was used to assess isokinetic peak torque production. No significant differences in running biomechanics were found between masters runners with and without AT. Hip peak isokinetic torque production was found to be significantly less in masters runners with AT, but no significant differences in ankle plantarflexion peak isokinetic torque production were found. Masters runners with AT may be able to adapt their running biomechanics and muscular torque production during submaximal running efforts.
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Affiliation(s)
- Matthew Klein
- Department of Physical Therapy, Azusa Pacific University, Azusa, CA, USA
- Department of Rehabilitation and Movement Science, Azusa Pacific University, Azusa, CA, USA
- Department of Physical Therapy, West Coast University Center for Graduate Studies, Los Angeles, CA, USA
| | - Chris Patterson
- Department of Rehabilitation and Movement Science, Azusa Pacific University, Azusa, CA, USA
- Department of Physical Therapy, West Coast University Center for Graduate Studies, Los Angeles, CA, USA
| | - Annette Karim
- Department of Rehabilitation and Movement Science, Azusa Pacific University, Azusa, CA, USA
- Department of Physical Therapy, West Coast University Center for Graduate Studies, Los Angeles, CA, USA
| | - Tyler Cuddeford
- Department of Physical Therapy, George Fox University, Newberg, OR, USA
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Joachim MR, Kliethermes SA, Heiderscheit BC. Preinjury Knee and Ankle Mechanics during Running Are Reduced among Collegiate Runners Who Develop Achilles Tendinopathy. Med Sci Sports Exerc 2024; 56:128-133. [PMID: 37703042 DOI: 10.1249/mss.0000000000003276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Achilles tendinopathies (AT) are common in runners, but prospective data assessing running mechanics associated with developing AT are limited. Asymmetry in running mechanics is also considered a risk factor for injury, although it is unknown if the problematic mechanics occur on the injured limb only or are present bilaterally. PURPOSE This study aimed to prospectively identify differences in preinjury running biomechanics in collegiate runners who did and did not develop AT and determine if between-limb asymmetries were associated with which limb developed AT. METHODS Running gait data were obtained preseason on healthy collegiate cross-country runners, and AT incidence was prospectively recorded each year. Spatiotemporal, ground reaction forces, and joint kinematics and kinetics were analyzed. Linear mixed-effects models assessed differences in biomechanics between those who did and did not develop AT during the subsequent year. Generalized linear mixed-effects models determined if the asymmetry direction was associated with which limb developed an AT, with odds ratios (OR) and 95% confidence intervals (95% CI) reported. RESULTS Data from 106 runners were analyzed and 15 developed AT. Preinjury biomechanics of runners who developed AT showed less peak knee flexion (noninjured: 45.9° (45.2°-46.6°), injured: 43.2° (41.5°-44.9°), P < 0.001), ankle dorsiflexion (noninjured: 28.7° (28.0°-30.2°), injured: 26.0° (23.8°-28.3°), P = 0.01), and knee extensor moment (noninjured: -2.18 (N·m)·kg -1 (-2.24 to -2.12 (N·m)·kg -1 ), injured: -2.00 (N·m)·kg -1 (-2.17 to -1.84 (N·m)·kg -1 ), P = 0.02). The limb demonstrating less peak knee flexion had greater odds of sustaining an AT (OR, 1.29 (1.00-1.65), P = 0.05). CONCLUSIONS Knee and ankle kinematics, in addition to knee kinetics, were associated with developing an AT. Monitoring these mechanics may be useful for prospectively identifying runners at risk of developing AT.
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Janowski AJ, Post AA, Heredia-Rizo AM, Mosby H, Dao M, Law LF, Bayman EO, Wilken JM, Sluka KA, Chimenti RL. Patterns of movement-evoked pain during tendon loading and stretching tasks in Achilles tendinopathy: A secondary analysis of a randomized controlled trial. Clin Biomech (Bristol, Avon) 2023; 109:106073. [PMID: 37657267 PMCID: PMC10543613 DOI: 10.1016/j.clinbiomech.2023.106073] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND This study aimed to characterize movement-evoked pain during tendon loading and stretching tasks in individuals with Achilles tendinopathy, and to examine the association between movement-evoked pain with the Achilles tendinopathy type (insertional and midportion), biomechanical, and psychological variables. METHODS In this laboratory-based, cross-sectional study, 37 individuals with chronic Achilles tendinopathy participated. Movement-evoked pain intensity (Numeric Rating Scale: 0 to 10) and sagittal-plane ankle biomechanics were collected simultaneously during standing, fast walking, single-leg heel raises, and weight-bearing calf stretch. Description of symptoms, including location of Achilles tendon pain and duration of tendon morning stiffness, as well as pain-related psychological measures, including the Tampa Scale of Kinesiophobia were collected. Linear mixed effects models were built around two paradigms of movement-evoked pain (tendon loading and stretching tasks) with each model anchored with pain at rest. FINDINGS Movement-evoked pain intensity increased as task demand increased in both models. Lower peak dorsiflexion with walking (β = -0.187, 95% CI: -0.305, -0.069), higher fear of movement (β = 0.082, 95% CI: 0.018, 0.145), and longer duration of tendon morning stiffness (β = 0.183, 95% CI: 0.07, 0.296) were associated with greater pain across tendon loading tasks (R2 = 0.47). Lower peak dorsiflexion with walking (β = -0.27, 95% CI: -0.41, -0.14), higher dorsiflexion with the calf stretch (β = 0.095, 95% CI: 0.02, 0.16), and insertional Achilles tendinopathy (β = -0.93, 95% CI: -1.65, -0.21) were associated with higher pain across tendon stretching tasks (R2 = 0.53). INTERPRETATION In addition to exercise, the ideal management of Achilles tendinopathy may require adjunct treatments to address the multifactorial aspects of movement-evoked pain.
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Affiliation(s)
- Adam J Janowski
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
| | - Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Alberto M Heredia-Rizo
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Spain; Uncertainty, Mindfulness, Self, and Spirituality (UMSS) Research Group, Spain
| | - Hadley Mosby
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Megan Dao
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Laura Frey Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Emine O Bayman
- Department of Biostatistics and Department of Anesthesia, University of Iowa, Iowa City, IA, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
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The Effects of Increasing Trunk Flexion During Stair Ascent on the Rate and Magnitude of Achilles Tendon Force in Asymptomatic Females. J Appl Biomech 2023; 39:10-14. [PMID: 36513076 DOI: 10.1123/jab.2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 12/15/2022]
Abstract
Research indicates that increasing trunk flexion may optimize patellofemoral joint loading. However, this postural change could cause an excessive Achilles tendon force (ATF) and injury risk during movement. This study aimed to examine the effects of increasing trunk flexion during stair ascent on ATF, ankle biomechanics, and vertical ground reaction force in females. Twenty asymptomatic females (age: 23.4 [2.5] y; height: 1.6 [0.8] m; mass: 63.0 [12.2] kg) ascended stairs using their self-selected and flexed trunk postures. Compared with the self-selected trunk condition, decreases were observed for peak ATF (mean differences [MD] = 0.14 N/kg; 95% confidence interval [CI], 0.06 to 0.23; Cohen d = -1.2; P = .003), average rate of ATF development (MD = 0.25 N/kg/s; 95% CI, 0.07 to 0.43; Cohen d = -0.9; P = .010), ankle plantar flexion moment (MD = 0.08 N·m/kg; 95% CI, 0.03 to 0.13; Cohen d = -1.1; P = .005), and vertical ground reaction force (MD = 38.6 N/kg; 95% CI, 20.3 to 56.90; Cohen d = -1.8; P < .001). Increasing trunk flexion did not increase ATF. Instead, this postural change was associated with a decreased ATF rate and magnitude and may benefit individuals with painful Achilles tendinopathy.
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Quarmby A, Mönnig J, Mugele H, Henschke J, Kim M, Cassel M, Engel T. Biomechanics and lower limb function are altered in athletes and runners with achilles tendinopathy compared with healthy controls: A systematic review. Front Sports Act Living 2023; 4:1012471. [PMID: 36685067 PMCID: PMC9845578 DOI: 10.3389/fspor.2022.1012471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Achilles tendinopathy (AT) is a debilitating injury in athletes, especially for those engaged in repetitive stretch-shortening cycle activities. Clinical risk factors are numerous, but it has been suggested that altered biomechanics might be associated with AT. No systematic review has been conducted investigating these biomechanical alterations in specifically athletic populations. Therefore, the aim of this systematic review was to compare the lower-limb biomechanics of athletes with AT to athletically matched asymptomatic controls. Databases were searched for relevant studies investigating biomechanics during gait activities and other motor tasks such as hopping, isolated strength tasks, and reflex responses. Inclusion criteria for studies were an AT diagnosis in at least one group, cross-sectional or prospective data, at least one outcome comparing biomechanical data between an AT and healthy group, and athletic populations. Studies were excluded if patients had Achilles tendon rupture/surgery, participants reported injuries other than AT, and when only within-subject data was available.. Effect sizes (Cohen's d) with 95% confidence intervals were calculated for relevant outcomes. The initial search yielded 4,442 studies. After screening, twenty studies (775 total participants) were synthesised, reporting on a wide range of biomechanical outcomes. Females were under-represented and patients in the AT group were three years older on average. Biomechanical alterations were identified in some studies during running, hopping, jumping, strength tasks and reflex activity. Equally, several biomechanical variables studied were not associated with AT in included studies, indicating a conflicting picture. Kinematics in AT patients appeared to be altered in the lower limb, potentially indicating a pattern of "medial collapse". Muscular activity of the calf and hips was different between groups, whereby AT patients exhibited greater calf electromyographic amplitudes despite lower plantar flexor strength. Overall, dynamic maximal strength of the plantar flexors, and isometric strength of the hips might be reduced in the AT group. This systematic review reports on several biomechanical alterations in athletes with AT. With further research, these factors could potentially form treatment targets for clinicians, although clinical approaches should take other contributing health factors into account. The studies included were of low quality, and currently no solid conclusions can be drawn.
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Affiliation(s)
- Andrew Quarmby
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany,Correspondence: Andrew Quarmby
| | - Jamal Mönnig
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Hendrik Mugele
- Department of Sport Science, Laboratory for Environmental and Exercise Science, University of Innsbruck, Innsbruck, Austria
| | - Jakob Henschke
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - MyoungHwee Kim
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
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Malliaras P. Physiotherapy management of Achilles tendinopathy. J Physiother 2022; 68:221-237. [PMID: 36274038 DOI: 10.1016/j.jphys.2022.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 02/15/2023] Open
Affiliation(s)
- Peter Malliaras
- Department of Physiotherapy Monash University, Melbourne, Australia.
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Lalumiere M, Bourbonnais D, Goyette M, Perrino S, Desmeules F, Gagnon DH. Unilateral symptomatic Achilles tendinopathy has limited effects on bilateral lower limb ground reaction force asymmetries and muscular synergy attributes when walking at natural and fast speeds. J Foot Ankle Res 2022; 15:66. [PMID: 36071465 PMCID: PMC9450385 DOI: 10.1186/s13047-022-00570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) may affect ground reaction force (GRF) and muscle synergy (MS) during walking due to pain, biological integrity changes in the tendon and neuroplastic adaptations. The objective of this study was to compare GRF asymmetries and MS attributes between symptomatic and asymptomatic lower limbs (LL) during walking at natural and fast speeds in adults with unilateral AT. METHODS A convenience sample consisting of twenty-eight participants walked on an instrumented treadmill at natural (1.3 m/s) and fast (1.6 m/s) speeds. Peak GRF were measured in mediolateral, anteroposterior and vertical directions. Individualized electromyography (EMG) activation profiles were time- and amplitude-normalized for three consecutive gait cycles and MS were extracted using non-negative matrix factorization algorithms. MS were characterized by the number, composition (i.e., weighting of each muscle) and temporal profiles (i.e., duration and amplitude) of the MS extracted during walking. Paired Student's t-tests assessed peak GRF and MS muscle weighting differences between sides whereas Pearson correlation coefficients characterized the similarities of the individualized EMG and MS activation temporal profiles within sides. RESULTS AT had limited effects on peak GRF asymmetries and the number, composition and temporal profiles of MS between symptomatic and asymptomatic LL while walking on a level treadmill at natural and fast speeds. In most participants, four MS with a specific set of predominantly activated muscles were extracted across natural (71 and 61%) and fast (54 and 50%) walking speeds for the symptomatic and asymptomatic side respectively. Individualized EMG activation profiles were relatively similar between sides (r = 0.970 to 0.999). As for MS attributes, relatively similar temporal activation profiles (r = 0.988 to 0.998) and muscle weightings (p < 0.05) were found between sides for all four MS and the most solicited muscles. Although the faster walking speed increased the number of merged MS for both sides, it did not significantly alter MS symmetry. CONCLUSION Faster walking speed increased peak GRF values but had limited effects on GRF symmetries and MS attribute differences between the LL. Corticospinal neuroplastic adaptations associated with chronic unilateral AT may explain the preserved quasi-symmetric LL motor control strategy observed during natural and fast walking among adults with chronic unilateral AT.
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Affiliation(s)
- Mathieu Lalumiere
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Daniel Bourbonnais
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Michel Goyette
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Sarah Perrino
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada
| | - François Desmeules
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada.,Centre de recherche de l'Hôpital Maisonneuve-Rosemont (CRHMR), Montreal, QC, Canada
| | - Dany H Gagnon
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, QC, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada.
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Zainuddin FL, Abd Rahman NA, Razman R, Shaharudin S. Lower limb biomechanical factors associated with Achilles tendinopathy in runners: a systematic review. SPORT SCIENCES FOR HEALTH 2021. [DOI: 10.1007/s11332-021-00862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Fehlhaltung der Körperachse triggert funktionelle Schmerzsyndrome – Behandlung durch neurozentriertes Training. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-021-00826-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Squier K, Scott A, Hunt MA, Brunham LR, Wilson DR, Screen H, Waugh CM. The effects of cholesterol accumulation on Achilles tendon biomechanics: A cross-sectional study. PLoS One 2021; 16:e0257269. [PMID: 34529718 PMCID: PMC8445482 DOI: 10.1371/journal.pone.0257269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Familial hypercholesterolemia, a common genetic metabolic disorder characterized by high cholesterol levels, is involved in the development of atherosclerosis and other preventable diseases. Familial hypercholesterolemia can also cause tendinous abnormalities, such as thickening and xanthoma (tendon lipid accumulation) in the Achilles, which may impede tendon biomechanics. The objective of this study was to investigate the effect of cholesterol accumulation on the biomechanical performance of Achilles tendons, in vivo. 16 participants (10 men, 6 women; 37±6 years) with familial hypercholesterolemia, diagnosed with tendon xanthoma, and 16 controls (10 men, 6 women; 36±7 years) underwent Achilles biomechanical assessment. Achilles biomechanical data was obtained during preferred pace, shod, walking by analysis of lower limb kinematics and kinetics utilizing 3D motion capture and an instrumented treadmill. Gastrocnemius medialis muscle-tendon junction displacement was imaged using ultrasonography. Achilles stiffness, hysteresis, strain and force were calculated from displacement-force data acquired during loading cycles, and tested for statistical differences using one-way ANOVA. Statistical parametric mapping was used to examine group differences in temporal data. Participants with familial hypercholesterolemia displayed lower Achilles stiffness compared to the control group (familial hypercholesterolemia group: 87±20 N/mm; controls: 111±18 N/mm; p = 0.001), which appeared to be linked to Achilles loading rate rather than an increased strain (FH: 5.27±1.2%; controls: 4.95±0.9%; p = 0.413). We found different Achilles loading patterns in the familial hypercholesterolemia group, which were traced to differences in the centre of pressure progression that affected ankle moment. This finding may indicate that individuals with familial hypercholesterolemia use different Achilles loading strategies. Participants with familial hypercholesterolemia also demonstrated significantly greater Achilles hysteresis than the control group (familial hypercholesterolemia: 57.5±7.3%; controls: 43.8±10%; p<0.001), suggesting that walking may require a greater metabolic cost. Our results indicate that cholesterol accumulation could contribute to reduced Achilles function, while potentially increasing the chance of injury.
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Affiliation(s)
- Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alexander Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael A. Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Liam R. Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hazel Screen
- School of Engineering & Materials Science, Queen Mary University of London, London, United Kingdom
| | - Charlie M. Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Griffin C, Daniels K, Hill C, Franklyn-Miller A, Morin JB. A criteria-based rehabilitation program for chronic mid-portion Achilles tendinopathy: study protocol for a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:695. [PMID: 34391384 PMCID: PMC8364697 DOI: 10.1186/s12891-021-04553-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Achilles tendinopathy (AT) is a common overuse injury in running-related sports where patients experience pain and impaired function which can persist. A graded rehabilitation program has been successful in reducing pain and improving function to enable a return to sport. The aim of this study is to compare the effectiveness of a criteria-based rehabilitation program including strength and reactive strength targets, with a previously successful rehabilitation program on changes in pain and function using the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire. Secondary aims will be to assess changes in calf strength, reactive strength, and lower limb running and forward hop biomechanics over the course of a 12-week rehabilitation program, and long-term follow-up investigations. METHODS Sixty eligible participants with chronic mid-portion AT who train in running-based sports will be included in this study. They will be randomly assigned to a group that will follow an evidence-based rehabilitation program of daily exercises with progression guided by symptoms or a group performing 3 high-intensity rehabilitation sessions per week with individualised load targets progressing to reactive strength exercises. Testing will take place at baseline, week 6 and 12. Plantar flexor peak torque will be measured using isokinetic dynamometry, reactive strength will be measured using a drop jump and lower limb biomechanical variables will be measured during a single leg forward hurdle hop test and treadmill running using 3D motion analysis. Follow-up interviews will take place at 6, 12 and 24 months after beginning the program which will assess patient participation in sport and possible re-injury. DISCUSSION This is the first study to propose an individualised criteria-based graded rehabilitation program in patients in with chronic mid-portion Achilles tendinopathy where progression is guided by strength and reactive strength outcome measures. This study will provide a comprehensive assessment of plantar flexor strength, reactive strength and lower limb biomechanical variables in running and forward hopping with the VISA-A questionnaire as the primary outcome measure and long term post-intervention follow-up assessments performed. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT04384874 ). Registered retrospectively on April 23rd 2020.
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Affiliation(s)
- Colin Griffin
- Université Côte d'Azur, LAMHESS, Nice, France.
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland.
| | - Katherine Daniels
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland
- University of Bristol, Queen's School of Engineering, University Walk, Bristol, BS81TR, UK
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Caroline Hill
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland
| | - Andrew Franklyn-Miller
- Sports Surgery Clinic, Santry Demesne, Dublin 9, Ireland
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jean-Benoît Morin
- Université Côte d'Azur, LAMHESS, Nice, France
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
- Univ Lyon, UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Biology, EA 7424, F-42023, Saint-Etienne, France
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Andere NFB, Godoy-Santos AL, Mochizuki L, Rodrigues MB, Fernandes TD, Soares-Júnior JM, Alonso AC, Luna NMS, Brech GC, Greve JMD. Biomechanical evaluation in runners with Achilles tendinopathy. Clinics (Sao Paulo) 2021; 76:e2803. [PMID: 34133661 PMCID: PMC8158676 DOI: 10.6061/clinics/2021/e2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in non-runners. METHODS Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this cross-sectional study and divided into three groups: AT group (ATG, n=24), healthy runners' group (HRG, n=24), and non-runners' group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120°/s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage.
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Affiliation(s)
- Nathalie Ferrari Bechara Andere
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Alexandre Leme Godoy-Santos
- Departamento de Cirurgia Ortopedica, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luis Mochizuki
- Laboratorio de Biomecanica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Bordalo Rodrigues
- Departamento de Cirurgia Ortopedica, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Túlio Diniz Fernandes
- Departamento de Cirurgia Ortopedica, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, BR
| | - Angélica Castilho Alonso
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Programa de Ciencias do Envelhecimento, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Natália Mariana Silva Luna
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Guilherme Carlos Brech
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Programa de Ciencias do Envelhecimento, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Júlia Maria D’Andréa Greve
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Campanini I, Disselhorst-Klug C, Rymer WZ, Merletti R. Surface EMG in Clinical Assessment and Neurorehabilitation: Barriers Limiting Its Use. Front Neurol 2020; 11:934. [PMID: 32982942 PMCID: PMC7492208 DOI: 10.3389/fneur.2020.00934] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/20/2020] [Indexed: 12/23/2022] Open
Abstract
This article addresses the potential clinical value of techniques based on surface electromyography (sEMG) in rehabilitation medicine with specific focus on neurorehabilitation. Applications in exercise and sport pathophysiology, in movement analysis, in ergonomics and occupational medicine, and in a number of related fields are also considered. The contrast between the extensive scientific literature in these fields and the limited clinical applications is discussed. The "barriers" between research findings and their application are very broad, and are longstanding, cultural, educational, and technical. Cultural barriers relate to the general acceptance and use of the concept of objective measurement in a clinical setting and its role in promoting Evidence Based Medicine. Wide differences between countries exist in appropriate training in the use of such quantitative measurements in general, and in electrical measurements in particular. These differences are manifest in training programs, in degrees granted, and in academic/research career opportunities. Educational barriers are related to the background in mathematics and physics for rehabilitation clinicians, leading to insufficient basic concepts of signal interpretation, as well as to the lack of a common language with rehabilitation engineers. Technical barriers are being overcome progressively, but progress is still impacted by the lack of user-friendly equipment, insufficient market demand, gadget-like devices, relatively high equipment price and a pervasive lack of interest by manufacturers. Despite the recommendations provided by the 20-year old EU project on "Surface EMG for Non-Invasive Assessment of Muscles (SENIAM)," real international standards are still missing and there is minimal international pressure for developing and applying such standards. The need for change in training and teaching is increasingly felt in the academic world, but is much less perceived in the health delivery system and clinical environments. The rapid technological progress in the fields of sensor and measurement technology (including sEMG), assistive devices, and robotic rehabilitation, has not been driven by clinical demands. Our assertion is that the most important and urgent interventions concern enhanced education, more effective technology transfer, and increased academic opportunities for physiotherapists, occupational therapists, and kinesiologists.
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Affiliation(s)
- Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, San Sebastiano Hospital, Correggio, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Catherine Disselhorst-Klug
- Department of Rehabilitation & Prevention Engineering, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - William Z. Rymer
- Shirley Ryan Ability Lab, Single Motor Unit Laboratory, Chicago, IL, United States
| | - Roberto Merletti
- Laboratory for Engineering of the Neuromuscular System (LISiN), Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
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Ferreira VMLM, Oliveira RR, Nazareno TS, Freitas LV, Mendonça LD. Interaction of foot and hip factors identifies Achilles tendinopathy occurrence in recreational runners. Phys Ther Sport 2020; 45:111-119. [PMID: 32763839 DOI: 10.1016/j.ptsp.2020.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To investigate the interaction of ankle-foot complex and hip joint factors with Achilles Tendinopathy (AT) occurrence in recreational runners. DESIGN Cross-sectional. SETTING Research Laboratory. PARTICIPANTS 51 runners, 26 healthy and 25 with AT. MAIN OUTCOMES MEASURES Shank-forefoot alignment (SFA), weight bearing lunge test (WBLT), passive hip internal rotation (IR) range of motion (ROM), hip external rotators (ER) and ankle plantar flexors (PF) isometric strength. CART analyses were performed to assess interactions that could distinguish those with AT. RESULTS Passive hip IR ROM, ankle PF torque, SFA, and hip ER isometric torque were associated AT occurrence. The model correctly classified 92% of individuals without AT and 72% of those with AT. The area under the receiver operating characteristic curve was 0.88. Interaction factors revealed in nodes 3 and 10 were statistically significant. In node 3, runners with more than 29.33° of passive hip IR ROM had a 130% increased likelihood (PR = 2.30) of AT. Node 10 showed that individuals with higher PF torque, SFA varus, ER torque, but reduced passive hip IR ROM had an 87% increased likelihood (PR = 1.87) of AT. CONCLUSION Interactions between hip and foot factors could accurately classify recreational runners with and without AT.
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Affiliation(s)
- Victor M L M Ferreira
- Postgraduate Program in Rehabilitation and Functional Performance -Universidade Federal dos Vales do Jetiquinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000 Alto da Jacuba, 39100-000, Diamantina, Minas Gerais, Brazil.
| | - Rodrigo R Oliveira
- Physical Therapy Department - Universidade Federal do Ceará, Rua Major Weyne, 1440, Rodolfo Teófilo, 60430-160, Fortaleza, Ceará, Brazil.
| | - Thamiris S Nazareno
- Physical Therapy Department - Universidade Federal do Ceará, Rua Major Weyne, 1440, Rodolfo Teófilo, 60430-160, Fortaleza, Ceará, Brazil.
| | - Lucas V Freitas
- Physical Therapy Department - Universidade Federal do Ceará, Rua Major Weyne, 1440, Rodolfo Teófilo, 60430-160, Fortaleza, Ceará, Brazil.
| | - Luciana D Mendonça
- Postgraduate Program in Rehabilitation and Functional Performance -Universidade Federal dos Vales do Jetiquinhonha e Mucuri, Rodovia MGT 367, Km 583, 5000 Alto da Jacuba, 39100-000, Diamantina, Minas Gerais, Brazil; Physical Therapy Department, School of Biological and Health Sciences, Universidade Federal dos Vales do Jetiquinhonha e Mucuri, Rodovia MGT 367, Km 584, 5000 Alto da Jacuba, 39100-000, Diamantina, Minhas Gerais, Brazil.
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Vannatta CN, Heinert BL, Kernozek TW. Biomechanical risk factors for running-related injury differ by sample population: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2020; 75:104991. [PMID: 32203864 DOI: 10.1016/j.clinbiomech.2020.104991] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of biomechanical variables of running gait in the development of running related injury has not been clearly elucidated. Several systematic reviews have examined running biomechanics and its association with particular running related injuries. However, due to retrospective designs, inferences into the cause of these injuries are limited. Although prospective studies have been completed, no quantitative analysis pooling these results has been completed. METHODS A systematic review of MEDLINE, CINAHL, and PubMed was completed. Articles included used prospective study designs, human subjects currently completing a regular running program, and a minimum 12-week follow-up period. Excluded articles had no biomechanical data reported, participants who were beginning runners or military recruits, or had an intervention provided. FINDINGS Thirteen studies met these criteria. Pooled analyses were completed if two or more studies were available with samples that investigated the same sex and competition level. A qualitative synthesis was completed when pooled analysis was not possible. Five unique running samples were identified and allowed for pooled analyses of variables in mixed-sex collegiate runners and female recreational runners. Moderate evidence exists for increased hip adduction and reduced peak rearfoot eversion as risk factors for running related injury in female recreational runners. Variables differed in other samples of runners. INTERPRETATION A runner's sex and competition level may affect the relationship between biomechanical factors and the development of running related injury. Hip adduction and rearfoot eversion may be important factors related to running related injury in female recreational runners. Further investigation of biomechanical factors in running injury is warranted.
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Affiliation(s)
- C Nathan Vannatta
- Sports Physical Therapy Department, Gundersen Health System, 3111 Gundersen Drive, Onalaska, WI 54650, USA; La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA.
| | - Becky L Heinert
- Sports Physical Therapy Department, Gundersen Health System, 3111 Gundersen Drive, Onalaska, WI 54650, USA; La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, University of Wisconsin, La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA; Health Professions Department, University of Wisconsin - La Crosse, 1300 Badger Street, La Crosse, WI 54601, USA
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16
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Jauhiainen S, Pohl AJ, Äyrämö S, Kauppi J, Ferber R. A hierarchical cluster analysis to determine whether injured runners exhibit similar kinematic gait patterns. Scand J Med Sci Sports 2020; 30:732-740. [DOI: 10.1111/sms.13624] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/05/2019] [Accepted: 12/27/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Susanne Jauhiainen
- Faculty of Information Technology University of Jyväskylä Jyväskylä Finland
| | - Andrew J. Pohl
- Faculty of Kinesiology University of Calgary Calgary Alberta Canada
| | - Sami Äyrämö
- Faculty of Information Technology University of Jyväskylä Jyväskylä Finland
| | - Jukka‐Pekka Kauppi
- Faculty of Information Technology University of Jyväskylä Jyväskylä Finland
| | - Reed Ferber
- Faculty of Kinesiology University of Calgary Calgary Alberta Canada
- Faculty of Nursing University of Calgary Calgary Alberta Canada
- Running Injury Clinic Calgary Alberta Canada
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Sancho I, Malliaras P, Barton C, Willy RW, Morrissey D. Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis. Gait Posture 2019; 73:189-201. [PMID: 31351358 DOI: 10.1016/j.gaitpost.2019.07.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/19/2019] [Accepted: 07/01/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Biomechanical alterations during running and hopping in people with Achilles tendinopathy (AT) may provide treatment and prevention targets. This review identifies and synthesises research evaluating biomechanical alterations among people with AT during running, jumping and hopping. METHOD MEDLINE, EMBASE, CiNAHL and SPORTDiscus were searched in July 2018 for case control, cross-sectional and prospective studies investigating kinematics, kinetics, plantar pressures and neuromuscular activity in AT participants during running or hopping. Study quality was assessed with a modified version of the Downs and Black quality checklist, and evidence grading applied. RESULTS 16 studies reported 249 outcomes, of which 17% differed between groups. Reduced peroneus longus (standardized mean difference [95%CI]; -0.53 [-0.98, -0.09]) and medial gastrocnemius (-0.60 [-1.05, -0.15]) amplitude in AT runners versus control was found (limited evidence). Increased hip adduction impulse 1.62 [0.69, 2.54], hip peak external rotation moment (1.55 [0.63, 2.46] and hip external rotation impulse (1.45 [0.55, 2.35]) was found in AT runners versus control (limited evidence). Reduced anterior (-0.94 [-1.64, -0.24] and greater lateral (-0.92 [-1.61, -0.22]) displacement of plantar pressure preceded AT in runners (limited evidence). Delayed onsets of gluteus medius (1.95 [1.07, 2.83] and gluteus maximus (1.26 [0.48, 2.05] and shorter duration of gluteus maximus activation (-1.41 [-2.22, -0.61] was found during shod running in the AT group versus control (limited evidence). Earlier offset time of gluteus maximus (-1.03 [-1.79, -0.27] and shorter duration of activation of gluteus medius (-0.18 [-0.24, -0.12] during running in AT runners versus control was found (limited evidence). Reduced leg stiffness was found in the affected side during submaximal hopping (-0.39 [-0.79, -0.00]) (limited evidence). CONCLUSION This review identified potential biomechanical treatment targets in people with AT. The efficacy of treatments targeting these biomechanics should be assessed. SYSTEMATIC REVIEW REGISTRY PROSPERO registration number: CRD42016048636.
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Affiliation(s)
- Igor Sancho
- Sports and Exercise Medicine. Queen Mary University of London, United Kingdom.
| | | | - Christian Barton
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia.
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, Montana, United States.
| | - Dylan Morrissey
- Sports and Exercise Medicine. Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom.
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Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: A single cohort feasibility study. Phys Ther Sport 2019; 40:107-116. [PMID: 31518777 DOI: 10.1016/j.ptsp.2019.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine the feasibility of recommended education and exercise supplemented by a hopping intervention implemented based on self-reported pain over 12 weeks for recreational runners with Achilles tendinopathy. DESIGN Single cohort feasibility study. SETTING One private physiotherapy clinic in Melbourne, Australia. PARTICIPANTS Fifteen male recreational runners with midportion Achilles tendinopathy. MAIN OUTCOME MEASURES Recruitment and adherence measures, adverse events, intervention acceptability and treatment effect trends were measured at baseline, 4 and 12 weeks. RESULTS Recruitment (100%), retention (87%) and follow-up (93%) rates were high. Exercise adherence was 70% (SD = 12.7) but fidelity was 50% (SD = 13.9). Three participants suffered adverse events (undertaking activities contrary to advice). Participants reported the education package, perceived benefit, and feedback frequency as intervention enablers; while the onerous time commitment was regarded a barrier. At 12 weeks, five participants were satisfied and eight very satisfied, while VISA-A had improved 24 ± 20.65 points (μ2 = 0.740). CONCLUSIONS A randomised control trial including recommended education and exercise with a pain-guided hopping intervention as treatment for recreational runners with midportion Achilles tendinopathy may be warranted, once strategies to improve adherence and reduce adverse events are addressed.
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Inter-joint coordination patterns differ between younger and older runners. Hum Mov Sci 2019; 64:164-170. [PMID: 30738343 DOI: 10.1016/j.humov.2019.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/22/2022]
Abstract
Older runners are at greater risk of certain running-related injuries. Previous work demonstrated that aging influences running biomechanics, and suggest a compensatory relation between changes in the proximal and distal joints. Previous comparisons of interjoint coordination strategies between young and older runners could potentially have missed relevant differences by averaging coordination measures across time. OBJECTIVE To compare coordination strategies between male runners under the age of 30 to those over the age of 60. METHODS Twelve young (22 ± 3 yrs, 1.80 ± 0.07 m, 78.0 ± 12.1 kg) and 12 older (63 ± 3 yrs, 1.78 ± 0.06 m, 73.2 ± 15.8 kg) male runners ran at 3.35 m/s on an instrumented treadmill. Ankle frontal plane, tibial transverse plane, knee sagittal plane, and hip frontal plane motion were measured. Inter-joint coordination was calculated using a modified vector coding technique. Coordination patterns and variability time series were compared between groups throughout stance using ANOVA for circular data. RESULTS At the ankle, older runners use in-phase propulsion (inversion, tibia external rotation) pattern following midstance (46-47% stance) while young runners are still in an in-phase collapse pattern (eversion, tibia external rotation). In coordination of the knee and hip, older runners maintained an in-phase collapse pattern (knee flexion, hip adduction) approaching midstance (35-37% stance), while younger runners use an out of phase strategy (knee extension, hip adduction). In coordination of the ankle and hip in the frontal plane, older runners again maintained an in phase collapse pattern up to midstance (34-39% stance), while younger runners used an out of phase strategy (ankle inversion, hip adduction). Variability was similar between age groups. CONCLUSION Older runners appear to display altered coordination patterns during mid-stance, which may indicate protective biomechanical adaptations. These changes may also have implications for performance in older runners.
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van der Vlist AC, Breda SJ, Oei EHG, Verhaar JAN, de Vos RJ. Clinical risk factors for Achilles tendinopathy: a systematic review. Br J Sports Med 2019; 53:1352-1361. [PMID: 30718234 PMCID: PMC6837257 DOI: 10.1136/bjsports-2018-099991] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2019] [Indexed: 01/04/2023]
Abstract
Background Achilles tendinopathy is a common problem, but its exact aetiology remains unclear. Objective To evaluate the association between potential clinical risk factors and Achilles tendinopathy. Design Systematic review. Data sources The databases Embase, MEDLINE Ovid, Web of Science, Cochrane Library and Google Scholar were searched up to February 2018. Eligibility criteria To answer our research question, cohort studies investigating risk factors for Achilles tendinopathy in humans were included. We restricted our search to potential clinical risk factors (imaging studies were excluded). Results We included 10 cohort studies, all with a high risk of bias, from 5111 publications identified. There is limited evidence for nine risk factors: (1) prior lower limb tendinopathy or fracture, (2) use of ofloxacin (quinolone) antibiotics, (3) an increased time between heart transplantation and initiation of quinolone treatment for infectious disease, (4) moderate alcohol use, (5) training during cold weather, (6) decreased isokinetic plantar flexor strength, (7) abnormal gait pattern with decreased forward progression of propulsion, (8) more lateral foot roll-over at the forefoot flat phase and (9) creatinine clearance of <60 mL/min in heart transplant patients. Twenty-six other putative risk factors were not associated with Achilles tendinopathy, including being overweight, static foot posture and physical activity level. Conclusion From an ocean of studies with high levels of bias, we extracted nine clinical risk factors that may increase a person’s risk of Achilles tendinopathy. Clinicians may consider ofloxacin use, alcohol consumption and a reduced plantar flexor strength as modifiable risk factors when treating patients with Achilles tendinopathy. Trial registration number CRD42017053258.
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Affiliation(s)
- Arco C van der Vlist
- Department of Orthopedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stephan J Breda
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedic Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Wilson F, Walshe M, O'Dwyer T, Bennett K, Mockler D, Bleakley C. Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis. Br J Sports Med 2018; 52:1564-1574. [PMID: 30170996 DOI: 10.1136/bjsports-2017-098913] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To assess the efficacy of exercise, orthoses and splinting on function, pain and quality of life (QoL) for the management of mid-portion and insertional Achilles tendinopathy, and to compare different types, applications and modes of delivery within each intervention category. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, CINAHL, Embase, AMED, WHO ICTRP, Web of Science, PEDro and Cochrane Library from inception to October 2017. Citation tracking of published studies and conference proceedings and contacting experts in the field. STUDY ELIGIBILITY CRITERIA Controlled clinical trials evaluating either exercise, orthoses or splinting for the management of Achilles tendinopathy. METHODS Independent reviewers undertook searches, screening and risk of bias appraisal. Primary outcomes of interest were function, pain and QoL. RESULTS Twenty-two studies were included (1137 participants). Moderate level evidence favoured eccentric exercise over control for improving pain and function in mid-portion tendinopathy. Moderate level evidence favoured eccentric exercise over concentric exercise for reducing pain. There was moderate level evidence of no significant difference in pain or function between eccentric exercise and heavy slow resistance exercise. There was low level evidence that eccentric exercise was not superior to stretching for pain or QoL. There was moderate level evidence that a combined exercise protocol was not superior to a lower dosage protocol for improving functional performance. There was moderate to low level evidence of a significant difference in pain (mean difference (MD) 6.3 mm, 95% CI -4.45 to 17.04, moderate) or function (MD 1.83 Victoria Institute of Sport Assessment points, 95% CI -7.47 to 11.12, low) between high-dose and low-dose eccentric training. There was high to moderate level evidence of no difference in pain (moderate) or function (high) between orthoses and control. There was low level evidence of no significant benefit in adding a night splint to an eccentric exercise programme for function, and moderate level evidence for no reduction in pain (MD -3.50, 95% CI -10.49 to 3.48). Eccentric exercise was not superior to splinting for pain (moderate evidence) or function (low level evidence). SUMMARY We conditionally recommend exercise for improving pain and function in mid-portion Achilles tendinopathy. The balance of evidence did not support recommendation of one type of exercise programme over another. We conditionally recommend against the addition of a splint to an eccentric exercise protocol and we do not recommend the use of orthoses to improve pain and function in Achilles tendinopathy.
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Affiliation(s)
- Fiona Wilson
- School of Medicine, Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Tom O'Dwyer
- School of Medicine, Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- RCSI Population and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St. James Hospital, Dublin, Ireland
| | - Christopher Bleakley
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, North Carolina, USA
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