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Ragone F, Pérez-Guillén S, Carrasco-Uribarren A, Cabanillas-Barea S, Ceballos-Laita L, Rodríguez-Rubio PR, Cabanas-Valdés R. The Effects of Soft-Tissue Techniques and Exercise in the Treatment of Patellar Tendinopathy-Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:427. [PMID: 38391804 PMCID: PMC10887760 DOI: 10.3390/healthcare12040427] [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: 11/06/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Patellar tendinopathy is a degenerative clinical disorder that causes load-related pain in the lower pole of the patella or patellar tendon. It predominantly affects young male athletes engaged in sports involving repetitive tendon loading, particularly explosive jumping. The combination of manual techniques with therapeutic exercise is hypothesized to provide greater benefits than exercise alone. OBJECTIVE The aim of this study is to analyze the scientific evidence regarding the effects of soft-tissue techniques combined with therapeutic exercise versus therapeutic exercise alone on pain intensity and function in individuals with patellar tendinopathy. METHODS A systematic review with meta-analysis was conducted following the PRISMA guidelines. PubMed, Lilacs, IBECS, CENTRAL, WOS, SciELO, Academic Search, CINAHL, SportDiscus, PEDro, and Google Scholar databases were consulted. Randomized controlled trials and quasi-randomized trials focusing on the effects of soft-tissue techniques combined with therapeutic exercise (experimental group) versus therapeutic exercise alone (control group) on pain and function in individuals aged 16 years and older with patellar tendinopathy were selected. The Cochrane tool for risk-of-bias assessment and the PEDro scale for methodological quality were used. RESULTS AND DISCUSSION A total of six studies (n = 309; age range = 16-40 years), considered to have a low risk of bias and moderate-to-high methodological quality, were included. The results showed improvements in function in the experimental group (mean of 60% on the Visa-P scale) and pain in the experimental group (mean decrease of 2 points in the VAS scale). There were improvements in 50% of the studies when comparing variables between the experimental and control groups. CONCLUSIONS The combination of manual techniques, such as dry needling, percutaneous electrolysis, transverse friction massage, and stretching, along with a squat on a 25° inclined plane, appears to be effective in the treatment of patellar tendinopathy. Static stretching of the quadriceps before and after the squat five times per week, along with dry needling or percutaneous electrolysis sessions twice a week for 8 weeks, is recommended. However, future studies analyzing groups with passive techniques versus therapeutic exercise are needed to standardize the treatment and establish the optimal dose.
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Affiliation(s)
- Federico Ragone
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Silvia Pérez-Guillén
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Andoni Carrasco-Uribarren
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Sara Cabanillas-Barea
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Luis Ceballos-Laita
- Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, University of Valladolid, 42004 Soria, Spain
| | - Pere Ramón Rodríguez-Rubio
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
| | - Rosa Cabanas-Valdés
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain
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Mokkink LB, Eekhout I, Boers M, van der Vleuten CPM, de Vet HCW. Studies on Reliability and Measurement Error of Measurements in Medicine - From Design to Statistics Explained for Medical Researchers. Patient Relat Outcome Meas 2023; 14:193-212. [PMID: 37448975 PMCID: PMC10336232 DOI: 10.2147/prom.s398886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/27/2023] [Indexed: 07/18/2023] Open
Abstract
Reliability and measurement error are measurement properties that quantify the influence of specific sources of variation, such as raters, type of machine, or time, on the score of the individual measurement. Several designs can be chosen to assess reliability and measurement error of a measurement. Differences in design are due to specific choices about which sources of variation are varied over the repeated measurements in stable patients, which potential sources of variation are kept stable (ie, restricted), and about whether or not the entire measurement instrument (or measurement protocol) was repeated or only part of it. We explain how these choices determine how intraclass correlation coefficients and standard errors of measurement formulas are built for different designs by using Venn diagrams. Strategies for improving the measurement are explained, and recommendations for reporting the essentials of these studies are described. We hope that this paper will facilitate the understanding and improve the design, analysis, and reporting of future studies on reliability and measurement error of measurements.
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Affiliation(s)
- Lidwine B Mokkink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Iris Eekhout
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Child Health, Netherlands Organisation for Applied Scientific Research, Leiden, the Netherlands
| | - Maarten Boers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Development and Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Henrica C W de Vet
- Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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3
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Frouin A, Guenanten H, Le Sant G, Lacourpaille L, Liebard M, Sarcher A, McNair PJ, Ellis R, Nordez A. Validity and Reliability of 3-D Ultrasound Imaging to Measure Hamstring Muscle and Tendon Volumes. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1457-1464. [PMID: 36948893 DOI: 10.1016/j.ultrasmedbio.2023.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The validity and reliability of 3-D ultrasound (US) in estimation of muscle and tendon volume was assessed in a very limited number of muscles that can be easily immersed. The objective of the present study was to assess the validity and reliability of muscle volume measurements for all hamstring muscle heads and gracilis (GR), as well as tendon volume for the semitendinosus (ST) and GR using freehand 3-D US. METHODS Three-dimensional US acquisitions were performed for 13 participants in two distinct sessions on separate days, in addition to one session dedicated to magnetic resonance imaging (MRI). Volumes of ST, semimembranosus (SM), biceps femoris short (BFsh) and long (BFlh) heads, and GR muscles and from the tendon from semitendinosus (STtd) and gracilis (GRtd) were collected. RESULTS The bias and the 95% confidence intervals of 3-D US compared with MRI ranged from -1.9 mL (-0.8%) to 1.2 mL (1.0%) for muscle volume and from 0.01 mL (0.2%) to -0.03 mL (-2.6%) for tendon volume. For muscle volume assessed using 3-D US, intraclass correlation coefficients (ICCs) ranged from 0.98 (GR) to 1.00, and coefficients of variation (CV) from 1.1% (SM) to 3.4% (BFsh). For tendon volume, ICCs were 0.99, and CVs between 3.2% (STtd) and 3.4% (GRtd). CONCLUSION Three-dimensional US can provide a valid and reliable inter-day measurement of hamstrings and GR for both muscle and tendon volumes. In the future, this technique could be used as an outcome for strengthening interventions and potentially in clinical environments.
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Affiliation(s)
- Antoine Frouin
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; Institut Sport Atlantique (ISA), Nantes, France
| | - Hugo Guenanten
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France
| | - Guillaume Le Sant
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; School of Physiotherapy, IFM3R, Nantes, France
| | - Lilian Lacourpaille
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France
| | - Martin Liebard
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; School of Physiotherapy, IFM3R, Nantes, France
| | - Aurélie Sarcher
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France
| | - Peter J McNair
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Ellis
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Active Living and Rehabilitation: Aotearoa, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Antoine Nordez
- Nantes Université, Movement - Interactions - Performance, MIP, UR 4334, F-44000 Nantes, France; Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; Institut Universitaire de France (IUF), Paris, France.
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Marshall SJ, Hicks KM, Howatson G, Cox L, Thomas K. B-Mode Ultrasonography Is a Reliable and Valid Alternative to Magnetic Resonance Imaging for Measuring Patellar Tendon Cross-Sectional Area. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:578-587. [PMID: 36376155 DOI: 10.1016/j.ultrasmedbio.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/27/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
This study investigated the validity and reliability of measuring patellar tendon (PT) cross-sectional area (CSA) using magnetic resonance imaging (MRI) and ultrasound (US) imaging. Nineteen healthy participants (10 women, 9 men) participated in three imaging sessions of the PT, once via MRI and twice via US, with image acquisition conducted by two raters, one experienced (rater 2) and one inexperienced (rater 1). All PT segmentations were analyzed by both raters. The validity of US-derived estimates of PT CSA against MRI estimates was analyzed using linear regression. Within-day reliability of US and MRI measurements and between-day reliability of US measurements were quantified using typical error (TE) and intra-class correlation coefficients (ICC3,1). There was good agreement between US- and MRI-derived estimations of PT CSA (standard errors of the estimate of 3.3 mm2 for rater 1 and 2.6 mm2 for rater 2; Pearson's r = 0.97 and 0.98 for raters 1 and 2, respectively). Within-session reliability for estimations of total PT CSA from US and MRI were excellent (ICC3,1 >0.95, coefficient of variation [CV] <4.1%, TE = 1.3-3.6 mm2. Between-day reliability for US was excellent (ICC3,1 >0.97, CV <2.7%, TE = 1.6-2.3 mm2), with little difference between raters. These findings suggest that MRI and US both provide reliable estimates of PT CSA and that US can provide a valid measure of PT CSA.
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Affiliation(s)
- Steven J Marshall
- Department of Service Sector Management, Sheffield Hallam University, Howard Street, Sheffield, South Yorkshire, UK; Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK
| | - Kirsty M Hicks
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK; Water Research Group, North West University, Potchefstroom, South Africa
| | - Lisa Cox
- Newcastle Clinic, Independent House, Team Valley, Gateshead, UK
| | - Kevin Thomas
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle City Campus, Newcastle upon Tyne, UK
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Rieder F, Wiesinger HP, Herfert J, Lampl K, Hecht S, Niebauer J, Maffulli N, Kösters A, Müller E, Seynnes OR. Whole body vibration for chronic patellar tendinopathy: A randomized equivalence trial. Front Physiol 2022; 13:1017931. [PMID: 36338477 PMCID: PMC9633993 DOI: 10.3389/fphys.2022.1017931] [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: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 02/02/2023] Open
Abstract
Purpose: Whole body vibration (WBV) triggers anabolic responses in various tissues, including tendons, without requiring high force production. In this waitlist-controlled equivalence trial, we tested its clinical effectiveness as an alternative treatment for patellar tendinopathy against conventional heavy slow resistance training (HSR). Methods: Thirty-nine patients were randomized to either 3 months of WBV training (n = 13), HSR training (n = 11), or a waitlist control (WLC) group (n = 15). In a partly cross-over design, 14 patients of the WLC group were redistributed to one of the two intervention groups (5 in WBV, 9 in HSR). Pre- and post-intervention testing included pain assessments (VAS), functional limitations (VISA-P), knee extension strength and tendon morphological, mechanical and material properties. Follow-up measurements (VAS, VISA-P) were performed in the WBV and HSR groups 6 months after the intervention. Results: Comparisons with the WLC group revealed significant improvements in VISA-P and VAS scores after HSR (41%, p = 003; 54%, p = 0.005) and WBV (22%, p = 0.022; 56%, p = 0.031) training. These improvements continued until follow-up (HSR: 43%, 56%; WBV: 24%, 37%). Pre-post improvements in VAS scores were equivalent between WBV and HSR groups but inconclusive for the VISA-P score and all pre-test to follow up comparisons. The mid-tendon cross-sectional area was significantly reduced after WBV (-5.7%, p = 0.004) and HSR (-3.0%, p = 0.004) training compared to WLC although the equivalence test between interventions was inconclusive. Conclusion: Whole body vibration improved symptoms typically associated with patellar tendinopathy. This type of intervention is as effective as HSR against maximum pain, although equivalence could not be confirmed for other variables. The beneficial responses to WBV and HSR treatments persisted for 6 months after the end of the intervention. Clinical Trial Registration: https://www.drks.de/drks_web/setLocale_EN.do, identifier DRKS00011338.
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Affiliation(s)
- Florian Rieder
- Institute of Physical Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria,Department of Sport and Exercise Science, Paris-Lodron University Salzburg, Salzburg, Austria,*Correspondence: Florian Rieder,
| | - Hans-Peter Wiesinger
- Department of Sport and Exercise Science, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Jürgen Herfert
- Institute of Physical Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria,Red Bull Athlete Performance Center, Thalgau, Austria
| | - Katrin Lampl
- Institute of Physical Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Hecht
- Institute of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Josef Niebauer
- Institute of Physical Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria,Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy,Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, United Kingdom,School of Pharmacy and Bioengineering, Keele University School of Medicine, Staffordshire, United Kingdom
| | - Alexander Kösters
- Department of Sport and Exercise Science, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Erich Müller
- Department of Sport and Exercise Science, Paris-Lodron University Salzburg, Salzburg, Austria
| | - Olivier R. Seynnes
- Department of Physical Performance, Norwegian School of Sport Science, Oslo, Norway
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6
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Paantjens MA, Helmhout PH, Gerardus Backx FJ, Willibrord Martens MTA, van Dongen JPA, Petrus Bakker EW. Intra- and Inter-Rater Reliability of Processing Ultrasound Tissue Characterization Scans in Midportion Achilles Tendinopathy. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:9348298. [PMID: 38655162 PMCID: PMC11022779 DOI: 10.1155/2022/9348298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/31/2022] [Indexed: 04/26/2024]
Abstract
Purpose Ultrasound tissue characterization (UTC) is used to visualize and quantify the Achilles tendon structure. We investigated the intra-rater and inter-rater reliability of UTC for quantifying the midportion tendon structure and the area of maximum degeneration (AoMD) in military personnel with midportion Achilles tendinopathy. Method UTC scans of 50 patients (16-60 years) were processed twice by rater 1 and once by rater 2. First, the midportion tendon structure was quantified and subsequently the AoMD. The intraclass correlation coefficient (ICC) was calculated for echo-types I, II, III, IV, aligned fibrillar structure (echo-types I + II), and disorganized tendon structure (echo-types III + IV). Results For midportion tendon structure, all ICC values were excellent for intra-rater reliability (range: 0.97 to 0.99) and inter-rater reliability (range: 0.98 to 0.99). Regarding the AoMD, intra-rater reliability showed excellent ICC values for all echo-types (range: 0.94 to 0.98) except for echo-type II (0.85). Inter-rater reliability showed excellent ICC values for all echo-types (range: 0.92 to 0.98). Conclusion Processing of UTC scans is highly reliable in quantifying the midportion Achilles tendon structure and the AoMD.
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Affiliation(s)
- Marc Adriaan Paantjens
- Sports Medicine Centre, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter Herman Helmhout
- Centre of Excellence, Training Medicine and Training Physiology, Royal Netherlands Army, Utrecht, Netherlands
| | | | | | | | - Eric Wilhelmus Petrus Bakker
- Department Epidemiology and Data Science, Division EPM, University Medical Center Amsterdam, Amsterdam, Netherlands
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7
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Rodriguez Sanz D, LOSA IGLESIAS MARTA, BECERRO DE BENGOA VALLEJO RICARDO, SORIANO MEDRANO ALFREDO, MORALES PONCE ANGEL, CALVO LOBO CESAR, San Antolin M, Ramirez Navarro PC, Garcia Garcia D. Actualización científica en ecografía y tendinopatía aquilea. Implicaciones anatómicas relacionadas, abordaje terapéutico y nuevas perspectivas basadas en la evidencia. REVISTA ESPAÑOLA DE PODOLOGÍA 2022. [DOI: 10.20986/revesppod.2022.1632/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Grant D, Tomlinson D, Tsintzas K, Kolić P, Onambélé-Pearson G. Minimizing sedentary behavior (without increasing medium-to-vigorous exercise) associated functional improvement in older women is somewhat dependent on a measurable increase in muscle size. Aging (Albany NY) 2020; 12:24081-24100. [PMID: 33276345 PMCID: PMC7762509 DOI: 10.18632/aging.202265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022]
Abstract
The optimal pattern of sedentarism displacement and mechanisms underlying its health effects are poorly understood. Therefore, the aim of this study was to quantify muscle-tendon adaptation in response to two different sedentarism displacement interventions and relate any adaptations to functional outcomes. Thirty-four older women (73±5yrs) underwent skeletal muscle-tendon size and functional assessments. Participants were randomly allocated to: Sedentary behavior fragmentation (SBF), Light intensity physical activity (LIPA), or Control groups. Measures were taken at weeks 0 and 8. Gait speed significantly increased (p=0.003), in both experimental groups (SBF: 0.06 ± 0.08m/s, 6±10%, LIPA: 0.06 ± 0.07m/s, 6±6%), but not control (-0.02 ± 0.12m/s, -2±9%). Accordingly, the relative change in Vastus Lateralis muscle volume, accounted for 30% (p=0.027), and 45% (p=0.0006) of the explained variance in the relative change in gait speed, for SBF and LIPA respectively. Gastrocnemius Medialis fascicle length changes were positively associated with gait speed changes, following LIPA exclusively (R2= 0.50, p=0.009). This is the first study to show SBF and LIPA are adequate loading in older women, with related muscle adaptation and clinically relevant gait speed improvements. Such adaptations appear similar irrespective of whether sedentarism displacement is prescribed in a single bout (LIPA) or in frequent micro-bouts (SBF).
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Affiliation(s)
- Dale Grant
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - David Tomlinson
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Kostas Tsintzas
- MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK
| | - Petra Kolić
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Gladys Onambélé-Pearson
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Sports and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
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Ge X, Zhang L, Xiang G, Hu Y, Lun D. Cross-Sectional Area Measurement Techniques of Soft Tissue: A Literature Review. Orthop Surg 2020; 12:1547-1566. [PMID: 32930465 PMCID: PMC7767688 DOI: 10.1111/os.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/19/2020] [Accepted: 06/21/2020] [Indexed: 01/08/2023] Open
Abstract
Evaluation of the biomechanical properties of soft tissues by measuring the stress-strain relationships has been the focus of numerous investigations. The accuracy of stress depends, in part, upon the determination of the cross-sectional area (CSA). However, the complex geometry and pliability of soft tissues, especially ligaments and tendons, make it difficult to obtain accurate CSA, and the development of CSA measurement methods of soft tissues continues. Early attempts to determine the CSA of soft tissues include gravimetric method, geometric approximation technique, area micrometer method, and microtomy technique. Since 1990, a series of new methods have emerged, including medical imaging techniques (e.g. magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging (USI)), laser techniques (e.g. the laser micrometer method, the linear laser scanner (LLS) technique, and the laser reflection system (LRS) method), molding techniques, and three-dimensional (3D) scanning techniques.
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Affiliation(s)
- Xiao‐jing Ge
- Beijing Wonderful Biomaterials Co., Ltd.BeijingChina
| | - Lei Zhang
- Beijing Wonderful Biomaterials Co., Ltd.BeijingChina
| | - Gang Xiang
- Beijing Wonderful Biomaterials Co., Ltd.BeijingChina
| | | | - Deng‐xing Lun
- Beijing Ceramic BiotechnologyBeijingChina
- Weifang People's HospitalWeifangChina
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10
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Wiesinger HP, Seynnes OR, Kösters A, Müller E, Rieder F. Mechanical and Material Tendon Properties in Patients With Proximal Patellar Tendinopathy. Front Physiol 2020; 11:704. [PMID: 32733263 PMCID: PMC7358637 DOI: 10.3389/fphys.2020.00704] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/28/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction The effect of chronic patellar tendinopathy on tissue function and integrity is currently unclear and underinvestigated. The aim of this cohort comparison was to examine morphological, material, and mechanical properties of the patellar tendon and to extend earlier findings by measuring the ability to store and return elastic energy in symptomatic tendons. Methods Seventeen patients with chronic (>3 months, VISA-P < 80), inferior pole patellar tendinopathy (24 ± 4 years; male = 12, female = 5) were carefully matched to controls (25 ± 3 years) for training status, pattern, and history of loading of the patellar tendon. Individual knee extension force, patellar tendon stiffness, stress, strain, Young’s modulus, hysteresis, and energy storage capacity, were obtained with combined dynamometry, ultrasonography, magnetic resonance imaging, and electromyography. Results Anthropometric parameters did not differ between groups. VISA-P scores ranged from 28 to 78 points, and symptoms had lasted from 10 to 120 months before testing. Tendon proximal cross-sectional area was 61% larger in the patellar tendinopathy group than in the control group. There were no differences between groups in maximal voluntary isometric knee extension torque (p = 0.216; d < −0.31) nor in tensile tendon force produced during isometric ramp contractions (p = 0.185; d < −0.34). Similarly, tendon strain (p = 0.634; d < 0.12), hysteresis (p = 0.461; d < 0.18), and strain energy storage (p = 0.656; d < 0.36) did not differ between groups. However, patellar tendon stiffness (−19%; p = 0.007; d < −0.74), stress (−27%; p< 0.002; d < −0.90) and Young’s modulus (−32%; p = 0.001; d < −0.94) were significantly lower in tendinopathic patients compared to healthy controls. Discussion In this study, we observed lower stiffness in affected tendons. However, despite the substantial structural and histological changes occurring with tendinopathy, the tendon capacity to store and dissipate energy did not differ significantly.
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Affiliation(s)
- Hans-Peter Wiesinger
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Olivier R Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Alexander Kösters
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Erich Müller
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Florian Rieder
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria.,Institute of Physical Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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11
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López-Royo MP, Gómez-Trullén EM, Ortiz-Lucas M, Galán-Díaz RM, Bataller-Cervero AV, Al-Boloushi Z, Hamam-Alcober Y, Herrero P. Comparative study of treatment interventions for patellar tendinopathy: a protocol for a randomised controlled trial. BMJ Open 2020; 10:e034304. [PMID: 32066608 PMCID: PMC7045155 DOI: 10.1136/bmjopen-2019-034304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Patellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of this study is to determine the additional effect of two interventions combined with eccentric exercise and compare which one is the most effective at short-term and long-term follow-up for patients with patellar tendinopathy. METHODS AND ANALYSIS This study is a randomised controlled trial with blinded participants. Measurements will be carried out by a specially trained blinded assessor. A sample of 57 patients with a medical diagnosis of patellar tendinopathy will participate in this study and will be divided into three treatment groups. Eligible participants will be randomly allocated to receive either: (a) treatment group with percutaneous needle electrolysis, (b) treatment group with dry needling or (c) treatment group with placebo needling. In addition, all groups will perform eccentric exercise. Functionality and muscle strength parameters, pain, ultrasound appearances and patient perceived quality of life shall be evaluated using the Victorian Institute of Sports Assessment for patellar (VISA-P), jump tests, Visual Analogue Scale, ultrasound images and Short Form-36 (SF-36), respectively. Participants will be assessed at baseline, at 10 weeks and at 22 weeks after baseline. The expected findings will allow us to advance in the treatment of this injury, as they will help determine whether a needling intervention has additional effects on an eccentric exercise programme and whether any of the needling modalities is more effective than the other. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee of Aragon (N° PI15/0017). The trial will be conducted in accordance with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT02498795.
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Affiliation(s)
- Maria Pilar López-Royo
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Aragón, Spain
| | - Eva Maria Gómez-Trullén
- Facultad de Ciencias de la Salud y del Deporte, Universidad de Zaragoza, Campus de Huesca, Aragón, Spain
| | - Maria Ortiz-Lucas
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Rita Maria Galán-Díaz
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Ana Vanessa Bataller-Cervero
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Zaid Al-Boloushi
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Aragón, Spain
- Kuwait Ministry of Health, Safat, Al Asimah, Kuwait
| | - Yasmina Hamam-Alcober
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Pablo Herrero
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
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Kositsky A, Gonçalves BAM, Stenroth L, Barrett RS, Diamond LE, Saxby DJ. Reliability and Validity of Ultrasonography for Measurement of Hamstring Muscle and Tendon Cross-Sectional Area. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:55-63. [PMID: 31668942 DOI: 10.1016/j.ultrasmedbio.2019.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/15/2019] [Accepted: 09/18/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to determine the reliability and validity of ultrasonography for measurement of hamstring muscle and semitendinosus (ST) tendon cross-sectional area (CSA). On two consecutive days, muscle anatomical CSA (ACSA) and ST tendon CSA were measured at standardized positions (30%-80% of thigh length; half the distance from the distal muscle-tendon junction to the popliteal crease) on 12 legs using ultrasonography and compared with corresponding magnetic resonance imaging measures. Inter-day intraclass correlation coefficients were good-to-excellent (0.882-0.996) for all assessed muscle and tendon sites. The limits of agreement widths were narrowest (range: 17%-52%) when muscle ACSA was large but were wide at sites with relatively small ACSA (≤184%) and for ST tendon CSA (range: 72%). Results suggest ultrasound-based measures of individual hamstring muscle maximal ACSA are reliable and valid and ST tendon CSA measures are reliable but require comparison with cadaveric or intra-operative measurements to verify validity.
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Affiliation(s)
- Adam Kositsky
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Basílio A M Gonçalves
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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