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Syu FY, Lin YL, Chien A, Chen CY, Hsieh BYT, Shih YF. Translation, Cross-Cultural Adaptation, and Validation of the Traditional Chinese Version of the VISA-P Questionnaire. Orthop J Sports Med 2024; 12:23259671241248165. [PMID: 38726236 PMCID: PMC11080721 DOI: 10.1177/23259671241248165] [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: 08/10/2023] [Accepted: 11/09/2023] [Indexed: 05/12/2024] Open
Abstract
Background The Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire is a widely accepted instrument for measuring the severity of symptoms and pain in patients having sustained patellar tendinopathy. Purpose To adapt the VISA-P questionnaire cross-culturally to a traditional Chinese version (VISA-P-Ch) and validate its psychometric properties. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods The VISA-P questionnaire was adapted to a traditional Chinese version following international recommended guidelines, including translation, synthesis, back translation, revision by expert committee, pretesting, and validation. The psychometric properties were tested in 15 healthy controls and 15 participants with patellar tendinopathy. Face validity was judged by the authors and participants. Known-groups validity was tested by comparing the VISA-P-Ch scores between symptomatic and asymptomatic participants using an independent t test. Concurrent validity was determined by comparing the Blazina classification of the participants against VISA-P-Ch scores using the Spearman correlation coefficient. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC) following a 24- to 48-hour interval. Internal consistency was determined by the Cronbach alpha. Results The expert committee and participants reported good face validity of the VISA-P-Ch. Significantly higher scores were found in the control group than in the patellar tendinopathy group (98.47 ± 3.04 vs 65 ± 11.9; P < .001). Concurrent validity showed a high correlation between VISA-P-Ch and the Blazina classification system (r = -0.899; P < .01). The test-retest reliability was excellent (ICC = 0.964). Internal consistency was found to be good for both the first and second assessments (Cronbach α = 0.834 and 0.851). Conclusion The VISA-P-Ch was proven to be a reliable and valid questionnaire with similar psychometric properties as the original VISA-P.
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Affiliation(s)
- Fang-Yu Syu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Physical Therapy, Sargent College, Boston University, Boston, Massachusetts, USA
| | - Yin-Liang Lin
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Andy Chien
- Research and Development Center for Medical Devices, National Taiwan University, Taipei, Taiwan
| | - Chao-Ying Chen
- School of Physical Therapy, Chang Gung University, Taipei, Taiwan
| | - Benjamin Yung-Thing Hsieh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Yi-Fen Shih
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Moonot P, Dakhode S. Current concept review of Achilles tendinopathy. J Clin Orthop Trauma 2024; 50:102374. [PMID: 38463138 PMCID: PMC10918259 DOI: 10.1016/j.jcot.2024.102374] [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: 10/25/2023] [Revised: 02/04/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Achilles tendinopathy is a common overuse injury affecting the ankle and foot. It manifests as a clinical condition that includes pain, edema, and decreased functionality. This condition can be broadly categorized into two main types based on anatomical location: insertional and noninsertional tendinopathy. The development of Achilles tendinopathy involves various factors, both internal and external. Patients with Achilles tendinopathy often experience stiffness worsened by prolonged rest, and pain exacerbated by physical activity. These symptoms can limit work activity and sports participation, with many patients facing discomfort while wearing shoes due to heel sensitivity. Diagnosis is primarily clinical, although MRI and ultrasound imaging can aid in differential diagnosis. Identifying risk factors and understanding the patient's biomechanics assist in accurate diagnosis and subsequent management. Management of Achilles tendinopathy involves a range of conservative and surgical options. However, due to varying results in clinical studies, a definitive gold standard treatment has not emerged. Eccentric exercises are a valuable tool in managing the condition. The recommend treatments such as shock wave therapy or nitric oxide patches are sought if symptoms do not improve. Peritendinous injections could be options if physical therapy proves ineffective. Surgical intervention is required after six months of conservative treatment. Recent research on Achilles tendinopathy emphasizes the need for individualized treatment plans that address its multifaceted nature. Combining biomechanical analysis, advanced imaging, and patient-specific factors is key to achieving optimal outcomes. Additionally, preventive strategies focusing on proper training techniques, load management, and addressing modifiable risk factors play a critical role in reducing the incidence of this condition. In conclusion, this article provides a current overview of Achilles tendinopathy. It highlights the importance of a comprehensive approach to understanding its causes, pathophysiology, diagnosis, and management strategies.
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Di Gesù M, Alito A, Borzelli D, Romeo D, Bonomolo F, Calafiore D, de Sire A. Efficacy of ultrasound-guided galvanic electrolysis technique and physical therapy in patients with Achilles' tendinopathy: A pilot randomised controlled trial. J Back Musculoskelet Rehabil 2024:BMR230255. [PMID: 38517770 DOI: 10.3233/bmr-230255] [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] [Indexed: 03/24/2024]
Abstract
BACKGROUND Ultrasound-guided galvanic electrolysis technique (USGET) is an innovative mini-invasive intervention with the potential to optimise outcomes in the treatment of Achille's tendinopathy (AT). OBJECTIVE The aim of this pilot study is to evaluate the efficacy of adding USGET to conventional eccentric exercise treatment in patients with chronic AT. METHODS Inclusion criteria were patients with unilateral non-insertional AT, pain lasting > 3 months, aged 25-60 years. Patients were randomised in two groups receiving the same physiotherapy treatment (2 sessions per week for 8 weeks). In addition, the experimental group received three USGET stimulations, one every 15 days. Outcome measures were assessment of Achilles tendinopathy severity using the Victorian Institute of Sport Assessment-Achilles (VISA-A) and pain intensity using the Visual Analogue Scale (VAS). Assessment points occurred at the onset of treatment (T0), its conclusion (T1), and subsequent follow-ups at one (T2) and two months (T3). RESULTS Out of the 52 patients who met the study inclusion criteria, two participants withdrew from the study, resulting in a total of 50 subjects who completed the research. None of the parameters showed a different distribution at T1 (p> 0.337). At T2, there was a statistical difference in VISA-A (p= 0.010) and its subscales and VAS (p= 0.002) in the USGET group. At T3, both groups improved with a statistical difference observed in VISA-A (p< 0.001) and its subscales Pain (p= 0.004), Function (p= 0.003) and Sport (p= 0.002), but the EG patients showed a greater improvement. No adverse events were reported. CONCLUSION The effect of USGET combined with eccentric exercise appears to be a safe and effective technique for achieving pain relief and functional recovery in the medium term, supporting the integrated use of USGET as a rehabilitative treatment option for patients with chronic AT.
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Affiliation(s)
| | - Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Daniele Borzelli
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Domenico Romeo
- Physiocare: Physiotherapy Rehabilitation Center, Augusta, Italy
| | | | - Dario Calafiore
- Department of Neurosciences, Physical Medicine and Rehabilitation Unit, ASST Carlo Poma, Mantova, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Physical and Rehabilitative Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Van Hooren B, van Rengs L, Meijer K. Per-step and cumulative load at three common running injury locations: The effect of speed, surface gradient, and cadence. Scand J Med Sci Sports 2024; 34:e14570. [PMID: 38389144 DOI: 10.1111/sms.14570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024]
Abstract
Understanding how loading and damage on common running injury locations changes across speeds, surface gradients, and step frequencies may inform training programs and help guide progression/rehabilitation after injuries. However, research investigating tissue loading and damage in running is limited and fragmented across different studies, thereby impairing comparison between conditions and injury locations. This study examined per-step peak load and impulse, cumulative impulse, and cumulative weighted impulse (hereafter referred to as cumulative damage) on three common injury locations (patellofemoral joint, tibia, and Achilles tendon) across different speeds, surface gradients, and cadences. We also explored how cumulative damage in the different tissues changed across conditions relative to each other. Nineteen runners ran at five speeds (2.78, 3.0, 3.33, 4.0, 5.0 m s-1 ), and four gradients (-6, -3, +3, +6°), and three cadences (preferred, ±10 steps min-1 ) each at one speed. Patellofemoral, tibial, and Achilles tendon loading and damage were estimated from kinematic and kinetic data and compared between conditions using a linear mixed model. Increases in running speed increased patellofemoral cumulative damage, with nonsignificant increases for the tibia and Achilles tendon. Increases in cadence reduced damage to all tissues. Uphill running increased tibial and Achilles tendon, but decreased patellofemoral damage, while downhill running showed the reverse pattern. Per-step and cumulative loading, and cumulative loading and cumulative damage indices diverged across conditions. Moreover, changes in running speed, surface gradient, and step frequency lead to disproportional changes in relative cumulative damage on different structures. Methodological and practical implications for researchers and practitioners are discussed.
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Affiliation(s)
- Bas Van Hooren
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Lars van Rengs
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Kenneth Meijer
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Zhang X, Deng L, Xiao S, Fu W. Effects of a 12-week gait retraining program on the Achilles tendon adaptation of habitually shod runners. Scand J Med Sci Sports 2024; 34:e14516. [PMID: 37817483 DOI: 10.1111/sms.14516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE This study investigated the effects of a 12-week gait retraining program on the morphological and mechanical properties of the Achilles tendon (AT) during running on the basis of real-time dynamic ultrasound imaging. METHODS A total of 30 male recreational runners who were used to wearing cushioned shoes with a rearfoot strike (RFS) pattern were recruited. They were randomized into a retraining group (RG, n = 15) and a control group (CG, n = 15). The RG group was asked to run in five-fingered minimalist shoes with a forefoot strike (FFS) pattern, and the CG group was asked to keep their strike pattern. Three training sessions were performed per week. All the participants in RG uploaded running tracks obtained through a mobile application (.jpg) after each session for training supervision. The ground reaction force, kinematics, and kinetics of the ankle joint at 10 km/h were collected using an instrumented split-belt treadmill and a motion capture system. The morphological (length and cross-sectional area) and mechanical characteristics (force, stress, strain, etc.) of AT in vivo were recorded and calculated with a synchronous ultrasonic imaging instrument before and after the intervention. Repeated two-way ANOVA was used to compare the aforementioned parameters. RESULTS A total of 28 participants completed the training. The strike angle of RG after training was significantly smaller than that before training and significantly smaller than that of CG after training (F (1, 13) = 23.068, p < 0.001, partial η2 = 0.640). The length (F (1, 13) = 10.086, p = 0.007, partial η2 = 0.437) and CSA (F (1, 13) = 7.475, p = 0.017, partial η2 = 0.365) of AT in RG increased after training. A significant main effect for time was observed for the time-to-peak AT force (F (1, 13) = 5.225, p = 0.040, partial η2 = 0.287), average (F (1, 13) = 7.228, p = 0.019, partial η2 = 0.357), and peak AT loading rate (F (1, 13) = 11.687, p = 0.005, partial η2 = 0.473). CONCLUSION Preliminary evidence indicated that a 12-week gait retraining program could exert a beneficial effect on AT. 57% (8/14) runners in RG shifted from RFS to FFS pattern. Although not all runners were categorized as FFS pattern after the intervention, their foot strike angle was reduced. Retraining primarily positively promoted AT morphological properties (i.e., CSA and length) to strengthen AT capability for mechanical loading.
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Affiliation(s)
- Xini Zhang
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Research Academy of Grand Health, Ningbo University, Ningbo, China
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Liqin Deng
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Songlin Xiao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
| | - Weijie Fu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, Shanghai University of Sport, Shanghai, China
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Lyng KD, Sørensen LB, Platzer OJ, Pedersen SK, Gürühan S, Vasconcelos G, de Vos RJ, Rathleff MS. There is a Lack of Clinical Homogeneity in Lower-Limb Tendinopathy Trials: A Scoping Review. J Orthop Sports Phys Ther 2024; 54:1-10. [PMID: 38051676 DOI: 10.2519/jospt.2023.11722] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVE: It is unclear if clinical trials of treatments for lower-limb tendinopathies include clinically homogeneous participant populations (an assumption for pooling in meta-analyses). We assessed the recruitment setting and participant characteristics used in randomized controlled trials (RCTs) that were investigating any treatment for lower-limb tendinopathies. DESIGN: Scoping review. METHODS: We conducted a systematic literature search in the PubMed, Embase, Cochrane CENTRAL, and Web of Science databases. All RCTs that were investigating treatments for lower-limb tendinopathies in an adult population (≥18 years) were eligible for inclusion. At least 2 authors conducted independent screening and selection of full-text papers, and extracted data from included studies. RESULTS: Of 18 341 records, 342 RCTs (21 897 participants) were eligible for inclusion and data extraction. The most common diagnoses were plantar fasciopathy (n = 195, 57%), Achilles tendinopathy (n = 82, 24%), and patellar tendinopathy (n = 41, 12%). Secondary care (n = 144, 42%) was the most reported recruitment setting, followed by an open setting (n = 44, 13%). In 93 (27%) RCTs, the recruitment setting was not described. We found high heterogeneity in participant characteristics (eg, symptom duration, age, body mass index, and the Victorian Institute of Sport Assessment [VISA] questionnaire score) within and between recruitment settings. CONCLUSION: Our results question whether clinical homogeneity can be adequately assumed in clinical trials of lower-limb tendinopathies due to the lack of clear reporting of the recruitment setting and the variability within and between recruitment settings of key participant characteristics. These findings threaten assumptions for meta-analyses in lower-limb tendinopathies. J Orthop Sports Phys Ther 2024;54(1):1-10. Epub 5 December 2023. doi:10.2519/jospt.2023.11722.
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7
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Steffen D, Avey A, Mienaltowski MJ, Baar K. The rat Achilles and patellar tendons have similar increases in mechanical properties but become transcriptionally divergent during postnatal development. J Physiol 2023; 601:3869-3884. [PMID: 37493407 DOI: 10.1113/jp284393] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
The molecular events that drive post-natal tendon development are poorly characterized. In this study, we profiled morphological, mechanical, and transcriptional changes in the rat Achilles and patellar tendon before walking (P7), shortly after onset of walking (P14), and at motor maturity (P28). The Achilles and patellar tendons increased collagen content and mechanical strength similarly throughout post-natal development. However, at P28 the patellar tendon tended to display a higher maximal tensile load (MTL) (P = 0.0524) than the Achilles tendon, but a similar ultimate tensile strength (UTS; load relative to cross-sectional area) probably due to its increased cross-sectional area during development. The tendons started transcriptionally similar, with overlapping PCA clusters at P7 and P14, before becoming transcriptionally distinct at P28. In both tendons, there was an increase in extracellular matrix (ECM) gene expression and a concomitant decrease in cell cycle and mitochondrial gene expression. The transcriptional divergence at P28 suggested that STAT signalling was lower in the patellar tendon where MTL increased the most. Treating engineered human ligaments with the STAT inhibitor itacitinib increased collagen content and MTL. Our results suggest that during post-natal development, cellular resources are initially allocated towards cell proliferation before shifting towards extracellular matrix development following the onset of mechanical load and provide potential targets for improving tendon function. KEY POINTS: Little is known about mechanisms of post-natal tendon growth. We characterized morphological, mechanical, and transcriptional changes that occur before (P7), and early (P14) and late after (P28) rats begin to walk. From P7 to P28, the Achilles tendon increased in length, whereas the patellar tendon increased in cross-sectional area. Mechanical and material properties of the Achilles and patellar tendon increased from P7 to P28. From P7 to P28, the Achilles and patellar tendons increased expression of ECM genes and decreased mitochondrial and cell cycle gene expression. Ribosomal gene expression also significantly decreased in the Achilles and tended to decrease in the patellar tendon. At P28, STAT1 signalling tended to be lower in the patellar tendon which had grown by increasing cross-sectional area and inhibiting STAT activation in vitro improved mechanical properties in engineered human ligaments.
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Affiliation(s)
- Danielle Steffen
- Department of Neurobiology, Physiology & Behavior, University of California Davis, Davis, CA, USA
| | - Alec Avey
- Department of Neurobiology, Physiology & Behavior, University of California Davis, Davis, CA, USA
| | | | - Keith Baar
- Department of Neurobiology, Physiology & Behavior, University of California Davis, Davis, CA, USA
- Physiology and Membrane Biology, University of California Davis, Davis, CA, USA
- VA Northern California Health Care System, Mather, CA, USA
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Ko VMC, He X, Fu SC, Yung PSH, Ling SKK. Clinical effectiveness of pulsed electromagnetic field therapy as an adjunct treatment to eccentric exercise for Achilles tendinopathy: a randomised controlled trial. Trials 2023; 24:394. [PMID: 37308969 DOI: 10.1186/s13063-023-07434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/05/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The Achilles tendon is the largest and strongest tendon in the human body. Achilles tendinopathy (AT) is a common clinical problem with Achilles overuse. Eccentric exercise is often used as an initial treatment for these patients. Most patients with AT experienced moderate to severe pain, limiting the incentive to perform eccentric exercise. It is difficult for them to complete eccentric exercise for 3 months consecutively to obtain significant improvements. Using PEMF as an adjunct, there could be immediate pain relief and improved response to eccentric exercise by modulating the mechanical properties of the Achilles tendon. Participants may experience less pain while performing eccentric exercises to increase compliance with the rehabilitation programme. METHODS This prospective randomised double-blinded, placebo-controlled trial aims to investigate the treatment effects of PEMF for participants with AT. All participants are randomised into two groups: the intervention group (n = 20; active PEMF treatment and eccentric exercise) and the control group (n = 20; sham treatment and eccentric exercise). Researchers perform self-reported, functional and ultrasonographic outcomes during baseline assessment, 4 weeks, 8 weeks follow-ups, and 3 and 6 months follow-ups after the commencement of the PEMF treatment. DISCUSSION AT is a common clinical condition affecting athletes and sedentary populations. It is essential to investigate treatment adjuncts to improve rehabilitation outcomes for these patients. This trial may demonstrate the effectiveness of PEMF in relieving pain, improving function, and restoring mechanical changes of the tendon in participants with AT. TRIAL REGISTRATION ClinicalTrials.gov NCT05316961. Registered on 7th April 2022.
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Affiliation(s)
- Violet Man-Chi Ko
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Shatin, Hong Kong SAR, China
| | - Xin He
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Shatin, Hong Kong SAR, China
| | - Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Shatin, Hong Kong SAR, China
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Shatin, Hong Kong SAR, China
| | - Samuel Ka-Kin Ling
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Shatin, Hong Kong SAR, China.
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Nutarelli S, da Lodi CMT, Cook JL, Deabate L, Filardo G. Epidemiology of Patellar Tendinopathy in Athletes and the General Population: A Systematic Review and Meta-analysis. Orthop J Sports Med 2023; 11:23259671231173659. [PMID: 37347023 PMCID: PMC10280536 DOI: 10.1177/23259671231173659] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/09/2023] [Indexed: 06/23/2023] Open
Abstract
Background Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes' careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures. Purpose To determine the prevalence and incidence of PT in athletes and the general population. Design Systematic review; Level of evidence, 3. Methods A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population. Results A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes' populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes <18 years was 10.1%, while it was 21.3% in athletes ≥18 years (P = .004). The prevalence of PT was 6.1% in soccer players, 20.8% in basketball players, and 24.8% in volleyball players. Heterogeneous PT diagnostic approaches were observed. Higher prevalence values were found when PT diagnoses were made using patient-reported outcomes versus clinical evaluations (P = .004). Conclusion This review demonstrated that PT is a common problem in the male and female sport-active populations. There are twice as many athletes aged ≥18 years than there are <18 years. Volleyball and basketball players are most affected by PT.
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Affiliation(s)
- Sebastiano Nutarelli
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- School of Public Health, Physiotherapy
and Sports Science, University College Dublin, Dublin, Ireland
| | | | - Jill L. Cook
- La Trobe University Sport and Exercise
Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury
Drive, Bundoora, Victoria, Australia
| | - Luca Deabate
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences,
Università della Svizzera Italiana, Lugano, Switzerland
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10
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Tabarestani TQ, Anastasio AT, Duruewuru A, Taylor JR, Bethell MA, Adams SB. Analyzing the quality and educational value of Achilles tendinopathy-related videos on TikTok. Foot Ankle Surg 2023; 29:350-354. [PMID: 37019747 DOI: 10.1016/j.fas.2023.03.007] [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: 10/27/2022] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND Social media platforms, like TikTok, have become popular options for the consumption and distribution of healthcare information. Due to the lack of scientific oversight, the consistency of healthcare-related videos has become a focus of the current literature. However, orthopaedic surgery has lagged behind other specialties in acknowledging the widespread utilization of TikTok videos for medical information. This study aims to assess the quality and educational benefits of Achilles tendinopathy-related TikTok videos. METHODS TikTok was queried using the hashtags "#achillestendonexercises", "achillestendonitisexercises", "achillestendinosisexercises", and "achillestendinopathyexercises". 100 videos (25 for each term) were included after applying the exclusion criteria. The number of views, likes, shares, comments, and favorites was recorded. The content was graded using DISCERN (a well-validated informational analysis tool) and ATEES (a self-designed tool for exercise evaluation). RESULTS The total number of views of the 100 videos was 1647,148, with a median of 7562.5 (IQR = 2,281- 19,575). The videos collectively received 73,765 likes, 1125 comments, 14,491 favorites and 6897 shares with a median of 283 (IQR= 73.8-957.8), 7 (IQR= 1.8-16.0), 61.5 (IQR= 8.8-184.3), and 18.5 (IQR= 2.0-49.8), respectively. General users uploaded slightly less (48%) when compared to healthcare professionals (52%). Healthcare professionals had more videos graded as "very poor" (43.4%) in comparison to the general users (36.2%). General users had more videos graded as "poor" (63.8%) in comparison to healthcare professionals (54.7%). However, there were no significant differences between the groups on either of the video grading scales. CONCLUSION Although TikTok is a powerful tool for information distribution, the educational value of the videos related to Achilles tendinopathy exercises was poor. With only 1% of videos receiving a grade of 'fair,' and no videos reaching a score of 'good' or 'excellent', healthcare professionals should be aware of the high viewership of low-quality content easily accessible on TikTok. LEVEL OF EVIDENCE: 3
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Affiliation(s)
| | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA.
| | | | | | | | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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11
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Prudêncio DA, Maffulli N, Migliorini F, Serafim TT, Nunes LF, Sanada LS, Okubo R. Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:9. [PMID: 36698184 PMCID: PMC9878810 DOI: 10.1186/s13102-023-00618-2] [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: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented "some concerns", and 37.5% (five and three articles, respectively) presenting "high risk" of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was - 1.21 (- 2.72 to - 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.
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Affiliation(s)
- Diego Ailton Prudêncio
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Orthopaedics, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy ,grid.9757.c0000 0004 0415 6205School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, UK ,grid.4464.20000 0001 2161 2573Centre for Sports and Exercise Medicine at Queen, Mary University of London, London, UK
| | - Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Thiago Teixeira Serafim
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Luis Felipe Nunes
- grid.411237.20000 0001 2188 7235Department of Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Luciana Sayuri Sanada
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Rodrigo Okubo
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
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Park J, Lee SH, Seo BS, Kim DH, So YH, Kim M, Lee JH, Kim HC, Cho SB, Kim YJ, Choi W. Clinical Outcomes of Transarterial Embolization for Chronic Achilles Tendinopathy Refractory to Conservative Treatment: A Pilot Study. J Vasc Interv Radiol 2023; 34:63-70.e1. [PMID: 36216276 DOI: 10.1016/j.jvir.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of transarterial embolization (TAE) for chronic Achilles tendinopathy (AT) refractory to conservative treatment. MATERIALS AND METHODS This retrospective study included 20 patients (12 men and 8 women; mean age, 30.3 years) who received TAE using imipenem/cilastatin sodium for refractory chronic AT from May 2019 to April 2021. Nine patients had bilateral involvement. A total of 29 procedures were performed (8 for nonathletes and 21 for athletes). If feasible, embolization was performed superselectively of the arterial branch demonstrating hypervascularity, early venous drainage, and/or supplying the pain site noted using a radiopaque marker. The visual analog scale (VAS, 0-10) score was used to assess pain symptoms at baseline and during the follow-up period (1 day; 1 week; 1, 3, and 6 months; and open period). Clinical success was defined as a decrease of >50% in the VAS score at 6 months when compared with baseline. RESULTS In 25 (86.2%) of 29 procedures, clinical success was achieved. Significant decreases in the VAS scores were noted at 1 day, 1 week, 1 month, 3 months, and 6 months (6.86 at the baseline vs 3.48, 3.41, 3.10, 2.55, and 1.62, respectively; all P < .01). For patients available for the 12- and 24-month follow-ups (n = 19 and 6, respectively), the mean VAS scores significantly decreased (6.84 vs 2.00 and 7.33 vs 1.17, respectively; all P < .01). No serious adverse events were observed during follow-up. CONCLUSIONS TAE may alleviate pain for patients with chronic AT refractory to the conservative treatment with a low risk of adverse events.
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Affiliation(s)
- Juil Park
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hwan Lee
- Department of Radiology, H Plus Yangji Hospital, Seoul, Republic of Korea.
| | - Beom-Seok Seo
- Department of Radiology, H Plus Yangji Hospital, Seoul, Republic of Korea
| | - Dong Hyun Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Ho So
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Minuk Kim
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jae Hwan Lee
- Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Young Jae Kim
- Department of Biomedical Engineering, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woosun Choi
- Department of Radilogy, Chung-Ang University Hospital, Chung-Ang College of Medicine, Seoul, Republic of Korea
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Siddiqui R, Mriza EH, Javed R, Al-Qahtani M. Investigation of the Tissue Degenerative Impact of Increased BMI in Achilles Tendon via Strain Elastography and Finite Element Analysis. Curr Med Imaging 2023; 19:587-595. [PMID: 36125819 DOI: 10.2174/1573405618666220805101527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/24/2022] [Accepted: 05/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study is focused on establishing a relationship between poor muscle activity faced by obese individuals due to the change in stiffness of the intramuscular mass of the lower limb. This issue is also common among athletes and physically active teenagers. OBJECTIVE The study is aimed at a subject assessment diagnosis technique named as Strain Elastography (SE) to measure muscle strain. Further, Finite Element Modelling (FEM) technique is used to investigate the strain and/or deformations generated in the Achilles Tendon (AT) models, which were categorized according to their Body Mass Index (BMI) through computationally applied loadings. METHODS Total 54 volunteers with an average age of 21.85 ± 1.28 years were categorized into three groups according to their BMI (kg/m2); under BMI < 18.5 (n=14), normal BMI = 18.5-24.9 (n=20) and over BMI/obese > 25.0 (n=20). Additionally, multiple correlational analyses were performed between full range of BMI values and SE outcome. RESULTS The presence of significant difference (p<0.05) was measured between different categories for BMI, BFMI, FFMI, DLFC, tendon length, tendon thickness and SR. Moreover, multiple correlational analyses and scatter plot strengthen the results. For FEM simulations, the maximum deformation was observed at the proximal end of the tendon in all three groups. CONCLUSION It can be concluded that change in tendon stiffness and the resulting change in tendon structure was visualized with increased BMI. Moreover, obese individuals are more prone to tendon injury due to the increment in tendon thickness which causes bulging of the AT due to higher loads.
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Affiliation(s)
- Rimsha Siddiqui
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, Pakistan
| | - Eraj H Mriza
- Department of Biomedical Engineering, NED University of Engineering & Technology, Karachi, Pakistan
| | - Ravish Javed
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh-11433,
Kingdom of Saudi Arabia
| | - Mahdi Al-Qahtani
- Department of Biomedical Technology, College of Applied Medical Sciences, King Saud University, Riyadh-11433,
Kingdom of Saudi Arabia
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Plantarflexor neuromuscular performance in Insertional Achilles tendinopathy. Musculoskelet Sci Pract 2022; 62:102671. [PMID: 36219920 DOI: 10.1016/j.msksp.2022.102671] [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: 05/10/2022] [Revised: 09/08/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insertional Achilles tendinopathy (IAT) is a common and painful musculoskeletal condition. The management of IAT commonly involves strengthening of the plantarflexors, although there is currently a paucity of research investigating plantarflexor neuromuscular performance specific to people with IAT. OBJECTIVES To compare plantarflexor neuromuscular performance between men with IAT and controls, and to investigate the relationship between plantarflexor neuromuscular performance and patient reported outcome measures for men with IAT. DESIGN Case control. METHOD 34 men with IAT (age 43.7 years [SD 10.02], weight 89.6 kg [16.3]) were matched with 34 healthy men (age 42.8 years [SD 8.9], weight 87.2 kg [9.7]). Participants underwent a plantarflexion maximal voluntary isometric contraction (MVIC) task, and a target force matching task. Neuromuscular variables from these tasks include; MVIC, rate of torque development (RTD), electromechanical delay (EMD), and muscle force steadiness. Participants also completed questionnaires regarding; pain and function, and psychological factors. RESULTS The IAT group had reduced MVIC (p < 0.01) and RTD, (p < 0.01) compared to controls, however no significant difference in plantarflexor force steadiness (p = 0.08), or EMD (p = 0.71) was observed. Low strength correlations were detected between the VISA-A and RTD (r = 0.37, p = 0.04), kinesiophobia and EMD (r = 0.45, p = 0.03). CONCLUSIONS This study established impairments in plantarflexor strength and RTD among people with IAT. Plantarflexor force steadiness and EMD is not altered in IAT, which is in contrast to evidence from mid-portion Achilles tendinopathy. Plantarflexor RTD was the only neuromuscular outcome measure linked to symptom severity, which may indicate it is an important rehabilitation finding.
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Naterstad IF, Joensen J, Bjordal JM, Couppé C, Lopes-Martins RAB, Stausholm MB. Efficacy of low-level laser therapy in patients with lower extremity tendinopathy or plantar fasciitis: systematic review and meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e059479. [PMID: 36171024 PMCID: PMC9528593 DOI: 10.1136/bmjopen-2021-059479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We investigated the effectiveness of low-level laser therapy (LLLT) in lower extremity tendinopathy and plantar fasciitis on patient-reported pain and disability. DESIGN Systematic review and meta-analysis. DATA SOURCES Eligible articles in any language were identified through PubMed, Embase and Physiotherapy Evidence Database (PEDro) on the 20 August 2020, references, citations and experts. ELIGIBILITY CRITERIA FOR SELECTION OF STUDIES Only randomised controlled trials involving participants with lower extremity tendinopathy or plantar fasciitis treated with LLLT were included. DATA EXTRACTION AND SYNTHESIS Random effects meta-analyses with dose subgroups based on the World Association for Laser Therapy treatment recommendations were conducted. Risk of bias was assessed with the PEDro scale. RESULTS LLLT was compared with placebo (10 trials), other interventions (5 trials) and as an add-on intervention (3 trials). The study quality was moderate to high.Overall, pain was significantly reduced by LLLT at completed therapy (13.15 mm Visual Analogue Scale (VAS; 95% CI 7.82 to 18.48)) and 4-12 weeks later (12.56 mm VAS (95% CI 5.69 to 19.42)). Overall, disability was significantly reduced by LLLT at completed therapy (Standardised Mean Difference (SMD)=0.39 (95% CI 0.09 to 0.7) and 4-9 weeks later (SMD=0.32 (95% CI 0.05 to 0.59)). Compared with placebo control, the recommended doses significantly reduced pain at completed therapy (14.98 mm VAS (95% CI 3.74 to 26.22)) and 4-8 weeks later (14.00 mm VAS (95% CI 2.81 to 25.19)). The recommended doses significantly reduced pain as an add-on to exercise therapy versus exercise therapy alone at completed therapy (18.15 mm VAS (95% CI 10.55 to 25.76)) and 4-9 weeks later (15.90 mm VAS (95% CI 2.3 to 29.51)). No adverse events were reported. CONCLUSION LLLT significantly reduces pain and disability in lower extremity tendinopathy and plantar fasciitis in the short and medium term. Long-term data were not available. Some uncertainty about the effect size remains due to wide CIs and lack of large trials. PROSPERO REGISTRATION NUMBER CRD42017077511.
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Affiliation(s)
- Ingvill Fjell Naterstad
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
| | - Jon Joensen
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
| | - Jan Magnus Bjordal
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
| | - Christian Couppé
- Department of Physical Therapy, Institute of Sports Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Martin Bjørn Stausholm
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Hordaland, Norway
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Burton I, McCormack A. Inertial Flywheel Resistance Training in Tendinopathy Rehabilitation: A Scoping Review. Int J Sports Phys Ther 2022; 17:775-786. [PMID: 35949372 PMCID: PMC9340832 DOI: 10.26603/001c.36437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Inertial Flywheel Resistance Training (IFRT) has recently emerged as a beneficial rehabilitation option for some musculoskeletal disorders. Although the use of resistance training as treatment for tendinopathy has become widespread, it is unclear if IFRT has efficacy as a treatment option for tendinopathies. Objective To identify current evidence on IFRT in the treatment of tendinopathy, evaluating intervention parameters and outcomes. Methods This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title, abstract and full text. Following screening, data were extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of IFRT for tendinopathy were included. Data were extracted on intervention parameters and outcomes of IFRT interventions. Results Four studies on patellar tendinopathy were included. A variety of outcomes were assessed, including pain, function, strength, power, and tendon morphological and mechanical properties, particularly changes in tendon thickness. IFRT intervention parameters were largely homogenously prescribed, with slight variances. Conclusion Despite a paucity of studies to date on the effects of IFRT for treating tendinopathy, preliminary evidence for beneficial effects of IFRT on clinical outcomes in patellar tendinopathy is encouraging. As IFRT is a relatively new and unexplored method in tendinopathy rehabilitation, definitive conclusions, and recommendations cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review.
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Affiliation(s)
- Ian Burton
- Musculoskeletal physiotherapy, NHS Grampian
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Contreras-Hernandez I, Falla D, Martinez-Valdes E. Neuromuscular and structural tendon adaptations after 6 weeks of either concentric or eccentric exercise in individuals with non-insertional Achilles tendinopathy: protocol for a randomised controlled trial. BMJ Open 2022; 12:e058683. [PMID: 35906051 PMCID: PMC9345075 DOI: 10.1136/bmjopen-2021-058683] [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] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION There is limited evidence on the neural strategies employed by the central nervous system to control muscle force in the presence of non-insertional Achilles tendinopathy (NIAT). Additionally, the neuromuscular mechanisms by which exercise may help to resolve tendon pain remain unclear. OBJECTIVE This study aims to first establish changes in the gastrocnemius-soleus motor unit firing properties after applying a training protocol of 6 weeks based on either controlled eccentric or concentric contractions in individuals with NIAT. Second, we want to determine changes in the level of pain and function and mechanical and structural properties of the Achilles tendon after applying the same training protocol. Additionally, we want to compare these variables at baseline between individuals with NIAT and asymptomatic controls. METHODS AND ANALYSIS A total of 26 individuals with chronic (>3 months) NIAT and 13 healthy controls will participate in the study. Individuals with NIAT will be randomised to perform eccentric or concentric training for 6 weeks. Motor unit firing properties of the medial gastrocnemius, lateral gastrocnemius and soleus muscles will be assessed using high-density surface electromyography, as well as Achilles tendon length, cross-sectional area, thickness and stiffness using B-mode ultrasonography and shear wave elastography. Moreover, participants will complete a battery of questionnaires to document their level of pain and function. ETHICS AND DISSEMINATION Ethical approval (ERN-20-0604A) for the study was obtained from the Science, Technology, Engineering and Mathematics Ethical Review Committee of the University of Birmingham. The results of the study will be published in peer-review journals. TRIAL REGISTRATION NUMBER ISRCTN46462385.
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Affiliation(s)
- Ignacio Contreras-Hernandez
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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Martínez F, Abián P, Jiménez F, Abián-Vicén J. The Effects of Eccentric Contraction Execution Time on the Properties of the Patellar Tendon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159296. [PMID: 35954651 PMCID: PMC9367933 DOI: 10.3390/ijerph19159296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to assess the effects of eccentric contraction execution time on the morphological and elastic properties of the patellar tendon (PT) in a six-week, single-leg decline squat (SLDS) exercise training program. In addition, the effects of a six-week detraining period on the same variables were evaluated. Fifty participants were randomized into the control group (CG; n = 15), experimental group 1 (EG6s; n = 17; eccentric contraction execution time = 6 s) and experimental group 2 (EG3s; n = 18; eccentric contraction execution time = 3 s). The thickness and elastographic index (EI) in different regions of interest (ROIs) in the PT were measured after 6 weeks of eccentric training using the single-leg decline squat exercise (three sessions per week, 80% of the eccentric one-repetition maximum) and after 6 weeks of detraining. There was an increase in the thickness of the PT in the different ROIs analyzed in both experimental groups at the end of the training period. Especially worth noting was the increase in the thickness of the PT at the proximal level in EG3s (p = 0.001), and the increase at the distal level in EG6s (p = 0.001). On the other hand, there was a reduction in EI in EG6S at the end of the intervention program (p = 0.021), and both experimental groups increased EI in the three regions of interest analyzed after the detraining period (p < 0.01). In conclusion, the execution time of the eccentric contraction in the SLDS exercise determines the anatomical level of the morphological adaptations in the PT. These morphological adaptations are lost after 6 weeks of detraining, producing an increase in tendon stiffness.
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Affiliation(s)
- Fernando Martínez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain;
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
- Correspondence: ; Tel.: +34-925268800 (ext. 5522)
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Schröder P, Molsberger A, Drabik A, Karst M, Merk H. Percutaneous Bioelectric Current Stimulation (PBCS) in the Treatment of Chronic Achilles tendinopathy. Protocol for a Double-Blind, Placebo-Controlled Randomized Multicenter Trial (Preprint). JMIR Res Protoc 2022; 11:e40894. [DOI: 10.2196/40894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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Sahota B, Howes M, Rio E, Docking S, Cook J. Association between knee pain location and abnormal imaging or arthroscopic findings: A systematic review. Ann Phys Rehabil Med 2022; 65:101638. [PMID: 35093586 DOI: 10.1016/j.rehab.2022.101638] [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: 12/15/2019] [Revised: 11/19/2021] [Accepted: 12/30/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND Assessment of pain location is an essential component of the differential diagnosis of knee pain because pain location is thought to indicate pathology. Previous studies have questioned whether abnormal imaging findings are related to the presence of pain, but none has systematically reviewed the association between knee pain location and the location of abnormal imaging or arthroscopic findings. OBJECTIVE To systematically review the association between the location of knee pain and the location of abnormal imaging or arthroscopic findings. METHODS Databases were searched up to November 2021 for articles in English that investigated the association between pain location reported using pain mapping and the location of abnormal imaging or arthroscopic findings. Risk of bias was assessed with the modified Newcastle-Ottawa scale. Results were sub-grouped by pathology and data analysis was performed as appropriate. RESULTS Among 7730 articles identified, 10 (n = 2034 participants) met the inclusion criteria. Three sub-pathologies were evaluated: patellar tendinopathy (n = 2), knee osteoarthritis (n = 7), and degenerative meniscal tears (n = 1). The primary analysis found poor sensitivity and specificity of patellar tendon hypoechogenic areas and local patellar tendon pain in adult (n = 55) and adolescent athletes (n = 114). The location of pain and the location of abnormal imaging findings was associated in 2 studies of knee osteoarthritis (n = 166). Five articles reported no relationship (n = 1563). No association was reported between the location of pain and the location of arthroscopic findings in degenerative meniscus tears (n = 193). All articles included were rated at low risk of bias. CONCLUSION Sensitivity and specificity of the presence of patellar tendon hypoechogenic areas and localised patellar tendon pain was poor. Pain location was not associated with the location of abnormal imaging findings in knee osteoarthritis or to abnormal arthroscopic findings in degenerative meniscus tears.
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Affiliation(s)
- Brent Sahota
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia.
| | - Melissa Howes
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
| | - Ebonie Rio
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
| | - Sean Docking
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
| | - Jill Cook
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Melbourne, Victoria 3083, Australia
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Burton I, McCormack A. Assessment of the reporting quality of resistance training interventions in randomised controlled trials for lower limb tendinopathy: A systematic review. Clin Rehabil 2022; 36:831-854. [PMID: 35311606 DOI: 10.1177/02692155221088767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES 1. To describe what exercises and intervention variables are used in resistance training interventions in randomised controlled trials for lower limb tendinopathy 2. To assess completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework. 3. To assess the implementation of scientific resistance training principles. 4. To assess therapeutic quality of exercise interventions with the i-CONTENT tool. DATA SOURCES We searched MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, and the Cochrane library databases. REVIEW METHODS Systematic review of randomised controlled trials that reported using resistance exercises for lower limb tendinopathies. RESULTS We included 109 RCTs. Eccentric heel drops were the most common exercise (43 studies), followed by isotonic heel raises (21), and single leg eccentric decline squats (18). Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0-13, with an average score of 9/13, and only 7 studies achieved a full 13/13. Reporting of items from the CERT ranged from 0-18, with an average score of 14/19. No study achieved a full 19/19, however 5 achieved 18/19. Scoring for resistance training principles ranged from 1-10, with only 11 studies achieving 10/10. Reporting across studies for the i-CONTENT tool ranged from 2-7, with an average score of 5 across included studies. A total of 19 studies achieved a full 7/7 score. Less than 50% of studies achieved an overall low risk of bias, highlighting the methodological concerns throughout studies. CONCLUSION The reporting of exercise descriptors and intervention content was generally high across RCTs for lower limb tendinopathy, with most allowing exercise replication. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.
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Affiliation(s)
- Ian Burton
- Specialist Musculoskeletal Physiotherapist, MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, 1015NHS Grampian, Aberdeen
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22
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Burton I, McCormack A. Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2561142. [PMID: 38655173 PMCID: PMC11023730 DOI: 10.1155/2022/2561142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 04/26/2024]
Abstract
The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy, (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.
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Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, UK
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23
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Burton I. Interventions for prevention and in-season management of patellar tendinopathy in athletes: A scoping review. Phys Ther Sport 2022; 55:80-89. [DOI: 10.1016/j.ptsp.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
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24
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Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice. Dis Mon 2022; 68:101314. [PMID: 34996610 DOI: 10.1016/j.disamonth.2021.101314] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tendinopathy is labeled by many authors as a troublesome, common pathology, present in up to 30% medical care consultations involving musculoskeletal conditions. Despite the lasting interest for addressing tendon pathology, current researchers agree that even the exact definition of the term tendinopathy is unclear. Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Tendons are complex structures that unite muscles and bones with two main objectives: to transmit forces and storage and release energy. Regarding the tensile properties of the tendons, several authors argued that tendons have higher tensile strength compared with muscles, however, are considered less flexible. Tendinopathy is an accepted term which is used to indicated a variety of tissue conditions that appear in injured tendons and describes a non-rupture damage in the tendon or paratendon, which is intensified with mechanical loading Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms. The purpose of this article is to review and provide an overview about the currently research of the tendon diagnosis, management and etiology.
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25
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Nezu S, Saito T, Yoshida A, Narazaki S, Shimamura Y, Furumatsu T, Ozaki T. Effect of difference in fixation methods of tendon graft and the microfracture procedure on tendon-bone junction healing. JSES Int 2021; 6:155-166. [PMID: 35141691 PMCID: PMC8811408 DOI: 10.1016/j.jseint.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background There are generally two methods of fixation for tendon grafts used in ligament reconstruction: bone tunnel fixation and anchor fixation. The microfracture (Mf) procedure is a technique to induce bleeding from the bone marrow, and the bleeding may contain cells with differentiation potential. However, few studies have compared the effects of the Mf procedure with those of the fixation methods. This study aimed to evaluate the effectiveness of the Mf procedure on two tendon graft fixation methods: histological, gene expression, tendon graft thickness, and mechanical. We especially focused our investigation on junction healing of tendon grafts and bone in the two fixation methods. Methods We used 20 rabbits to evaluate tendon and bone healing in a peroneal tendon graft model. The rabbit models were divided into five groups according to the combination of peroneal tendon graft fixation method and Mf technique as follows: control group (C, n = 4), bone tunnel fixation without Mf procedure group (BT − Mf, n = 4), bone tunnel fixation with Mf procedure group (BT + Mf, n = 4), anchor fixation without Mf procedure group (A − Mf, n = 4), and anchor fixation with Mf procedure group (A + Mf, n = 4). All animals were sacrificed at 4 weeks postoperatively. The specimens underwent histological evaluation, mRNA analysis, tendon graft thickness at the tendon-bone junction, and biomechanical testing. Results Histological evaluation of the BT + Mf and A + Mf groups showed healing with fibrocartilage formation at the tendon graft-bone junction. The mRNA expression showed significant increase in type 2 collagen, Scleraxis, and SRY-box9 in the BT + Mf and A + Mf groups. In biomechanical tests, the BT + Mf and A + Mf groups showed significantly increased tensile strength compared with the BT − Mf and A − Mf groups (BT + Mf group, 21.6 ± 1.7 N; A + Mf group, 22.5 ± 2.3 N vs. BT − Mf group, 12.3 ± 2.4 N; A − Mf group, 11 ± 2.3 N). Conclusion The Mf procedure resulted in fibrocartilage formation at the tendon-bone junction in the BT and anchor fixation and improved the fixation strength at 4 weeks.
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Affiliation(s)
- Satoshi Nezu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Corresponding author: Taichi Saito, MD, PhD, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences, Okayama, Japan, 2-5-1, Shikatacho, Kitaku, Okayama City, 700-8558.
| | - Aki Yoshida
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinji Narazaki
- Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital, Okayama, Okayama, Japan
| | - Yasunori Shimamura
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takayuki Furumatsu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
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26
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Alfredson H, Masci L, Spang C. Sharp pain in a normal Achilles tendon of a professional female football player was related to a plantaris tendon in a rare position: a case report. J Med Case Rep 2021; 15:513. [PMID: 34657632 PMCID: PMC8522164 DOI: 10.1186/s13256-021-03131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plantaris tendinopathy and plantaris-associated Achilles tendinopathy can be responsible for chronic pain in the Achilles tendon midportion, often accompanied by medial tenderness. As conservative treatments are less successful for this patient group, proper diagnosis is important for decision making. This report presents a case with plantaris tendinopathy in a rare (superficial) location. CASE PRESENTATION This article describes a pain history and treatment timeline of a professional Swedish female soccer player (32 years old, Northern European ethnicity, white) who suffered from sharp pain in the Achilles tendon midportion and tenderness on the medial and superficial side for about 2 years. Conservative treatments, including eccentric exercises, were not successful and, to some extent, even caused additional irritation in that region. Ultrasound showed a wide and thick plantaris tendon located on the superficial side of the Achilles tendon midportion. The patient was surgically treated with local removal of the plantaris tendon. After surgery there was a relatively quick (4-6 weeks) rehabilitation, with immediate weight bearing, gradual increased loading, and return to running activities after 4 weeks. At follow-up at 8 weeks, the patient was running and had not experienced any further episodes of sharp pain during change of direction or sprinting. CONCLUSIONS The plantaris tendon should be considered as a possible source of Achilles tendon pain. This case study demonstrates that the plantaris tendon can be found in unexpected (superficial) positions and needs to be carefully visualized during clinical and imaging examinations.
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Affiliation(s)
- Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Sports Medicine Unit, Umeå University, 901 87, Umeå, Sweden.,Institute of Sports Exercise and Health, University College Hospital London, London, UK
| | - Lorenzo Masci
- Institute of Sports Exercise and Health, University College Hospital London, London, UK.,Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Christoph Spang
- Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden. .,Private Orthopaedic Spine Center Dr. Alfen, Schürerstraße 5, 97080, Würzburg, Germany.
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27
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Elgart B, Pietrosimone LS, Lucero A, Stafford HC, Berkoff DJ. Identifying achilles tendon structure differences by ultrasound tissue characterization in asymptomatic individuals. Scand J Med Sci Sports 2021; 31:1914-1920. [PMID: 34170573 DOI: 10.1111/sms.14003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023]
Abstract
Ultrasound Tissue Characterization (UTC) is a modality that can be utilized to characterize tendon tissue structure using ultrasonographic imaging paired with a computer algorithm to distinguish echo-types. Several studies have demonstrated UTCs ability to distinguish Achilles tendon morphology changes, but no study has established normative data of the Achilles tendon in the general population. The aim of this study was to determine UTC echo-type distribution in the Achilles tendon in an asymptomatic population. UTC scans were completed and analyzed on 508 participants without Achilles tendinopathy. Dedicated UTC-algorithms were used to distinguish and calculate echo-type percentages and the fiber type distribution was compared. The overall sample echo-type percentages demonstrated greater levels of Type I and II echo-types, 65.73% and 32.00%, respectively, and lower levels of Type III and IV echo-types, 1.74% and 0.57%, respectively. In addition, females had lower levels of Echo-type I compared to men and greater levels of echo-type II (p < 0.001). We also found that African-Americans had significantly greater amounts of echo-type I and lesser amounts of echo-type II when compared to Caucasians (p < 0.05). The results of this study create a normative data set for future UTC studies to utilize as a baseline for the evaluation of Achilles tendons. In addition, it demonstrated tendon type differences between sexes and races that need to be accounted for in future studies.
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Affiliation(s)
- Brian Elgart
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Laura S Pietrosimone
- Department of Orthopaedic Surgery, Doctor of Physical Therapy Division, Duke University, Durham, NC, USA
| | - Angela Lucero
- Anesthesiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - David J Berkoff
- Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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28
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Burton I, McCormack A. The implementation of resistance training principles in exercise interventions for lower limb tendinopathy: A systematic review. Phys Ther Sport 2021; 50:97-113. [PMID: 33965702 DOI: 10.1016/j.ptsp.2021.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The primary purpose of this systematic review is to examine the literature on resistance training interventions for lower limb tendinopathy to evaluate the proportion of interventions that implemented key resistance training principles (specificity, progression, overload, individualisation) and reported relevant prescription components (frequency, intensity, sets, repetitions) and reported intervention adherence. METHODS Two reviewers performed a systematic review after screening titles and abstracts based on eligibility criteria. Identified papers were obtained in full text, with data extracted regarding the implementation of resistance training principles. Included articles were evaluated by the Cochrane risk of bias tool, with a scoring tool out of 10 used for implementation and reporting of the 5 key principles. Scientific databases were searched in November 2020 and included Medline, CINAHL, AMED, and Sportsdiscus. RESULTS 52 randomised controlled trials investigating resistance training in five different lower limb tendinopathies were included. Although most studies considered the principles of progression (92%) and individualisation (88%), only 19 studies (37%) appropriately described how this progression in resistance was achieved, and only 18 studies (35%) reported specific instruction on how individualisation was applied. Adherence was considered in 27 studies (52%), with only 17 studies (33%) reporting the levels of adherence. In the scoring criteria, only 5 studies (10%) achieved a total maximum score of 10, with 17 studies (33%) achieving a maximum score of 8 for implementing and reporting the principles of specificity, overload, progression and individualisation. CONCLUSION There is meaningful variability and methodological concerns regarding the application and reporting of resistance training principles, particularly progression and individualisation, along with intervention adherence throughout studies. Collectively, these findings have important implications for the prescription of current resistance training interventions, including the design and implementation of future interventions for populations with lower limb tendinopathies.
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Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, United Kingdom.
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29
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Starbuck C, Bramah C, Herrington L, Jones R. The effect of speed on Achilles tendon forces and patellofemoral joint stresses in high-performing endurance runners. Scand J Med Sci Sports 2021; 31:1657-1665. [PMID: 33864288 DOI: 10.1111/sms.13972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/16/2021] [Accepted: 04/09/2021] [Indexed: 11/30/2022]
Abstract
Achilles tendinopathy and patellofemoral pain are common running injuries associated with increased Achilles tendon (AT) forces and patellofemoral joint (PFJ) stresses. This study examined AT forces and PFJ stresses at different running speeds in high-performing endurance runners. Twenty runners ran overground at four running speeds (3.3, 3.9, 4.8, and 5.6 m/s). AT forces and PFJ stresses were estimated from kinematic and kinetic data. Repeated measures ANOVA with partial eta squared effect sizes was conducted to assess differences between running speeds. Increased peak AT forces (19.5%; p < 0.001) and loading rates (57.3%; p < 0.001) from 3.3 m/s to 5.6 m/s were observed. Cumulative AT loading was greater in the faster speeds compared to the slower speeds. Faster running speeds resulted in increased peak plantar flexor moments, increased peak plantar flexion angles, and a more flexed knee and an anterior center of pressure position at touchdown. Peak PFJ stress was lower in the slowest speed (3.3 m/s) compared to the faster running speeds (3.9-5.6 m/s; p = 0.005). PFJ stress loading rate significantly increased (43.6%; p < 0.001). Greater AT loading observed could be associated with strategies such as increased plantar flexor moments and altered lower body position at touchdown which are commonly employed to generate greater ground contact forces. Greater AT and PFJ loading rates were likely due to shorter ground contact times and therefore less time available to reach the peak. Running at faster speeds could increase the risk of developing Achilles tendinopathy and patellofemoral pain or limit recovery from these injuries without sufficient recovery.
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Affiliation(s)
- Chelsea Starbuck
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK.,The Manchester Institute of Health and Performance, Manchester, UK
| | - Christopher Bramah
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK.,The Manchester Institute of Health and Performance, Manchester, UK
| | - Lee Herrington
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK.,The Manchester Institute of Health and Performance, Manchester, UK
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30
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Jacques T, Bini R, Arndt A. Bilateral in vivo neuromechanical properties of the triceps surae and Achilles tendon in runners and triathletes. J Biomech 2021; 123:110493. [PMID: 34000645 DOI: 10.1016/j.jbiomech.2021.110493] [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: 08/17/2020] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/17/2022]
Abstract
Inter-limb differences in Achilles tendon mechanical, material and morphological properties have previously been described in non-athletes and attributed to the preferential use of a given limb. Achilles tendon overuse tendon injury generally initiate unilaterally and alters triceps surae activation and Achilles tendon properties. The investigation of inter-limb differences in muscle activation and tendon properties may provide directions for injury prevention in habitual runners. In this study triceps surae and Achilles tendon properties were investigated bilaterally in habitual runners during unilateral maximal isometric contractions. Morphological, mechanical and material Achilles tendon properties were assessed using isokinetic dynamometry, motion capture and ultrasonography while triceps surae activation strategies were assessed using electromyography. Lower limb preference was assessed for inter-limb comparisons using the Waterloo questionnaire. Zero and one-dimensional statistical analysis and Cohen's d were employed to investigate possible inter-limb differences. Inter-limb associations in Achilles tendon properties and intra-limb associations between triceps surae activations were assessed using Pearson's correlation coefficients. No differences were observed between the preferred and non-preferred limb in terms of triceps surae muscle activation amplitude and Achilles tendon properties. However, intra-limb association among triceps surae activation ratios were not identical between limbs. Runners and triathletes present similar Achilles tendons properties between limbs, and thus initial observations of unilateral changes in the Achilles tendon properties might be used as a strategy to prevent the onset of overuse tendon injury. The non-similar associations within activation ratios between limbs should be further explored since triceps surae activation strategies may alter loading of the Achilles tendon.
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Affiliation(s)
- Tiago Jacques
- The Swedish School of Sport and Health Sciences, Lidingovägen 1, 114 33 Stockholm, Sweden.
| | - Rodrigo Bini
- La Trobe Rural Health School, Edwards Rd, Flora Hill, VIC 3552, Bendigo, Australia
| | - Anton Arndt
- The Swedish School of Sport and Health Sciences, Lidingovägen 1, 114 33 Stockholm, Sweden; Karolinska Institute, Alfred Nobels Allé 8, 11486 Stockholm, Sweden
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31
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Rabello LM, Dams OC, van den Akker-Scheek I, Zwerver J, O'Neill S. Substantiating the Use of Ultrasound Tissue Characterization in the Analysis of Tendon Structure: A Systematic Review. Clin J Sport Med 2021; 31:e161-e175. [PMID: 31241489 DOI: 10.1097/jsm.0000000000000749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/19/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the role of ultrasound tissue characterization (UTC) in predicting, diagnosing, and monitoring tendon structure and/or tendinopathy. In addition, this study aims to provide recommendations for standardized methodology of UTC administration and analysis. DATA SOURCE The PubMed, Embase, and Web of Science databases were searched (up to September 2018). All scientific literature concerning the use of UTC in assessing tendons was collected. The initial search resulted in a total of 1972 hits, and after screening by eligibility criteria, 27 articles were included. RESULTS In total, 18 investigating the Achilles tendon, 5 the patellar tendon, and 4 both Achilles and patellar tendons were included. The methods of UTC administration and analysis differed and were not uniform. The studies showed that the use of UTC to predict Achilles tendinopathy (AT) is inconclusive, but that a higher amount of tendon disorganization increases the risk of developing patellar tendinopathy (PT). In terms of diagnosis, UTC might provide additional information in AT cases. In addition, promising results were found for the use of UTC in both AT and PT in monitoring the effect of load or treatment on tendon structure. CONCLUSION More research regarding the use of UTC in predicting tendon pathology is required. Ultrasound tissue characterization seems useful as an adjunct diagnostic modality because it can be used to differentiate symptomatic from asymptomatic tendons. In addition, UTC is a promising device to be used to monitor changes in tendon structure in response to load or treatment. Moreover, we provide recommendations of a standardized protocol concerning the methods of UTC measurement and analysis.
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Affiliation(s)
| | | | - Inge van den Akker-Scheek
- Departments of Sports and Exercise Medicine; and
- Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands ; and
| | | | - Seth O'Neill
- Department of Life Sciences, School of Allied Health Professions, University of Leicester, Leicester, United Kingdom
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32
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Persson Krogh T, Kaae Astrup J, Kyed C, Fredberg U. Extracorporeal shockwave therapy in the treatment of patellar tendinopathy: A randomized, double‐blind, placebo‐controlled trial. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thøger Persson Krogh
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
- Center for Sports Medicine Regional Hospital of Northern Denmark Hjørring Denmark
| | - Jacob Kaae Astrup
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
| | - Charlotte Kyed
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
| | - Ulrich Fredberg
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
- Center for Sports Medicine Regional Hospital of Northern Denmark Hjørring Denmark
- Research Unit of Rheumatology Department of Clinical Research University of Southern DenmarkOdense University Hospital Odense Denmark
- Institute of Sports Medicine Copenhagen Bispebjerg Hospital Copenhagen Denmark
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33
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Burton I, McCormack A. Autoregulated and individualised resistance training versus predetermined and standardised resistance training in tendinopathy: A systematic review protocol. Musculoskeletal Care 2021; 19:533-539. [PMID: 33687141 DOI: 10.1002/msc.1551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 01/06/2023]
Abstract
REVIEW OBJECTIVE To synthesise the best available evidence on the effectiveness of interventions that have used autoregulated and individualised resistance training versus predetermined and standardised resistance training in treating any tendinopathy. INTRODUCTION Recent evidence suggests that individualised exercise may be more effective than standardised exercise for musculoskeletal disorders such as tendinopathy. However, no systematic reviews have been conducted on the topic and optimal treatment protocols and clinical recommendations are lacking. INCLUSION CRITERIA Randomised controlled trials assessing the effectiveness of autoregulated and individualised resistance training versus predetermined and standardised resistance training for tendinopathy in adults will be included. METHODS The authors will search for a wide range of sources to find both published and unpublished studies via EBSCOhost, including, but not limited to, MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials and Allied and Complementary Medicine Database. Studies published in a language other than English will only be considered if a translation is available. The Joanna Briggs Institute systematic review methodology will be followed when conducting the review. Data synthesis will be conducted using meta-analysis or narrative synthesis, where appropriate.
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Affiliation(s)
- Ian Burton
- Angus Physiotherapy Department, Arbroath Infirmary, NHS Tayside, Arbroath, UK
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34
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Epro G, König M, James D, Lambrianides Y, Werth J, Hunter S, Karamanidis K. Evidence that ageing does not influence the uniformity of the muscle-tendon unit adaptation in master sprinters. J Biomech 2021; 120:110364. [PMID: 33743395 DOI: 10.1016/j.jbiomech.2021.110364] [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: 04/17/2020] [Revised: 01/18/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Differences in the adaptation processes between muscle and tendon in response to mechanical loading can lead to non-uniform mechanical properties within the muscle-tendon unit (MTU), potentially increasing injury risk. The current study analysed the mechanical properties of the triceps surae (TS) MTU in 10 young (YS; 22 ± 3 yrs) and 10 older (OS; age 65 ± 8 yrs; i.e. master) (inter)national level sprinters and 11 young recreationally active adults (YC; 23 ± 3 yrs) to detect possible non-uniformities in muscle and tendon adaptation due to habitual mechanical loading and ageing. Triceps surae muscle strength, tendon stiffness and maximal tendon strain were assessed in both legs during maximal voluntary isometric plantarflexion contractions via dynamometry and ultrasonography. Irrespective of the leg, OS and YC in comparison to YS demonstrated significantly (P < 0.05) lower TS muscle strength and tendon stiffness, with no differences between OS and YC. Furthermore, no group differences were detected in the maximal tendon strain (average of both legs: OS 3.7 ± 0.8%, YC 4.4 ± 0.8% and YS 4.3 ± 0.9%) as well as in the inter-limb symmetry indexes in muscle strength, tendon stiffness and maximal tendon strain (range across groups: -5.8 to 4.9%; negative value reflects higher value for the non-preferred leg). Thus, the findings provide no clear evidence for a disruption in the TS MTU uniformity in master sprinters, demonstrating that ageing tendons can maintain their integrity to meet the increased functional demand due to elite sports.
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Affiliation(s)
- G Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, United Kingdom.
| | - M König
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, United Kingdom
| | - D James
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, United Kingdom
| | - Y Lambrianides
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, United Kingdom
| | - J Werth
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, United Kingdom
| | - S Hunter
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, United Kingdom
| | - K Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, United Kingdom
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35
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Krogh TP, Kjær SG, Blegvad‐Nissen J, Jensen P, Ellingsen T, Fredberg U. Ultrasound‐guided injection therapy with platelet‐rich plasma in recreational athletes with patellar tendinopathy: A randomized, single blinded, placebo‐controlled trial with 3 months follow‐up. TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Thøger Persson Krogh
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
- Center for Sports Medicine Regional Hospital of Northern Denmark Hjørring Denmark
| | - Søren Geill Kjær
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
| | - Jesper Blegvad‐Nissen
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
| | - Pia Jensen
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
| | - Torkell Ellingsen
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
- Research Unit of Rheumatology Department of Clinical Research University of Southern DenmarkOdense University Hospital Odense Denmark
| | - Ulrich Fredberg
- Diagnostic Centre University Research Clinic for Innovative Patient PathwaysSilkeborg Regional Hospital Silkeborg Denmark
- Research Unit of Rheumatology Department of Clinical Research University of Southern DenmarkOdense University Hospital Odense Denmark
- Institute of Sports Medicine Copenhagen Bispebjerg Hospital Copenhagen Denmark
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36
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Karamanidis K, Epro G. Monitoring Muscle-Tendon Adaptation Over Several Years of Athletic Training and Competition in Elite Track and Field Jumpers. Front Physiol 2020; 11:607544. [PMID: 33391022 PMCID: PMC7772406 DOI: 10.3389/fphys.2020.607544] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
Differences in muscle and tendon responsiveness to mechanical stimuli and time courses of adaptive changes may disrupt the interaction of the musculotendinous unit (MTU), increasing the risk for overuse injuries. We monitored training-induced alterations in muscle and tendon biomechanical properties in elite jumpers over 4 years of athletic training to detect potential non-synchronized adaptations within the triceps surae MTU. A combined cross-sectional and longitudinal investigation over 4 years was conducted by analyzing triceps surae MTU mechanical properties in both legs via dynamometry and ultrasonography in 67 elite track and field jumpers and 24 age-matched controls. Fluctuations in muscle and tendon adaptive changes over time were quantified by calculating individual residuals. The cosine similarity of the relative changes of muscle strength and tendon stiffness between sessions served as a measure of uniformity of adaptive changes. Our cross-sectional study was unable to detect clear non-concurrent differences in muscle strength and tendon stiffness in elite jumpers. However, when considering the longitudinal data over several years of training most of the jumpers demonstrated greater fluctuations in muscle strength and tendon stiffness and hence tendon strain compared to controls, irrespective of training period (preparation vs. competition). Moreover, two monitored athletes with chronic Achilles tendinopathy showed in their affected limb lower uniformity in MTU adaptation as well as higher fluctuations in tendon strain over time. Habitual mechanical loading can affect the MTU uniformity in elite jumpers, leading to increased mechanical demand on the tendon over an athletic season and potentially increased risk for overuse injuries.
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Affiliation(s)
- Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
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37
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Steinberg N, Tenenbaum S, Itzhak SN, Aviva Z. Can young dancers skip/recover from patellofemoral pain? A two-year follow-up. Res Sports Med 2020; 28:459-467. [PMID: 32449391 DOI: 10.1080/15438627.2020.1770249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aiming to follow the prevalence of patellofemoral pain (PFP) among young dancers over 2-years, and to assess the prevalence of re-injured/recovered dancers; 67 dancers (aged 12.8 ± 0.5) were screened for PFP at baseline, 65 dancers at 1st follow-up and 51 dancers at 2nd follow-up. All dancers (46) that took part in all the 3 screenings had at least one episode of PFP along the screenings. No dancers recovered in the 1st follow-up, yet 40.5% of the dancers with PFP at the 1st follow-up recovered in the 2nd follow-up. Along the 3 screenings, 23.9%, 34.8%, and 41.3% of the dancers had 1,2 or 3 PFP episodes, respectively. None of the dancers skipped PFP along the 3 screenings. A high prevalence of dancers had sustained PFP along the 2 follow-ups, with low recovery rate. Dancers and teachers should be alert to the need for devising modifications of training and injury prevention strategies from young age.
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Affiliation(s)
- Nili Steinberg
- Department of Human Movement and Sport Sciences, The Wingate College of Physical Education and Sports Sciences at the Wingate Institute , Netanya, Israel
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Siev-Ner Itzhak
- Orthopedic Rehabilitation Dept., Sheba Medical Center , Tel-Hashomer, Israel
| | - Zeev Aviva
- Department of Human Movement and Sport Sciences, The Wingate College of Physical Education and Sports Sciences at the Wingate Institute , Netanya, Israel
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Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train 2020; 55:438-447. [PMID: 32267723 DOI: 10.4085/1062-6050-356-19] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports. In addition to pain, Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties, altered lower extremity function, and fear of movement. Cumulatively, these impairments limit sport participation and performance. A thorough evaluation and comprehensive treatment plan, centered on progressive tendon loading, is required to ensure full recovery of tendon health and to minimize the risk of reinjury. In this review, we will provide an update on the evidence-based evaluation, outcome assessment, treatment, and return-to-sport planning for Achilles tendinopathy. Furthermore, we will provide the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.
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Affiliation(s)
| | - Shawn Hanlon
- Department of Physical Therapy, University of Delaware, Newark
| | - Andrew Sprague
- Department of Physical Therapy, University of Delaware, Newark
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FIRMINGER COLINR, ASMUSSEN MICHAELJ, CIGOJA SASA, FLETCHER JAREDR, NIGG BENNOM, EDWARDS WBRENT. Cumulative Metrics of Tendon Load and Damage Vary Discordantly with Running Speed. Med Sci Sports Exerc 2020; 52:1549-1556. [DOI: 10.1249/mss.0000000000002287] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Keefer Hutchison M, Patterson C, Cuddeford T, Dudley R, Sorenson E, Brumitt J. Low prevalence of patellar tendon abnormality and low incidence of patellar tendinopathy in female collegiate volleyball players. Res Sports Med 2019; 28:155-167. [PMID: 31663370 DOI: 10.1080/15438627.2019.1683559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The prevalence of patellar tendinopathy has been reported to be as high as 50% in elite male volleyball (VB) players; however, the rate of injury in female collegiate VB athletes is unknown. The purpose of this study was to 1) identify the prevalence of ultrasonographic evidence of patellar tendon abnormality at the start of the preseason in female collegiate VB players; 2) report the incidence of tendinopathy during the season; and 3) determine if the preseason presence of tendon abnormality is associated with onset of disease. One hundred and six female collegiate VB players had both patellar tendons imaged. Incidence of patellar tendinopathy was tracked during the course of the 4-month season. Twenty-two athletes presented with ultrasonographic evidence of patellar tendon abnormality in at least one knee at the start of the preseason. The incidence of time-loss patellar tendinopathy was 0.26 (95% CI: 0.04, 0.85) per 1000 athletic exposures. This study was unable to determine if preseason presence of tendon abnormality was associated with a greater risk of tendinopathy due to power. The prevalence of tendon abnormality in the preseason and the incidence of patellar tendinopathy in female collegiate VB players are lower than that observed in other populations.
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Affiliation(s)
| | | | - Tyler Cuddeford
- School of Physical Therapy, George Fox University, Newberg, OR, USA
| | | | | | - Jason Brumitt
- School of Physical Therapy, George Fox University, Newberg, OR, USA
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41
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dos Santos Franco YR, Miyamoto GC, Franco KFM, de Oliveira RR, Cabral CMN. Exercise therapy in the treatment of tendinopathies of the lower limbs: a protocol of a systematic review. Syst Rev 2019; 8:142. [PMID: 31202282 PMCID: PMC6570954 DOI: 10.1186/s13643-019-1058-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 05/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tendinopathies are specific degenerative conditions of the tendon characterized by pain and disability. The most common tendinopathies of the lower limbs are patellar, Achilles, gluteal, and proximal tendinopathy of the hamstring muscles. Exercise therapy has been studied for the treatment of these tendinopathies; however, different types of muscle contraction, exercise, dose, and intensity are found in the literature, which can make choosing the best treatment option difficult. The purpose of this systematic review is to analyze the available evidence about the effectiveness of exercise therapy in the treatment of patients with lower limb tendinopathies and the effects of different types of exercise therapy in the treatment of these patients. METHODS The search strategy will be performed in the following databases: CENTRAL, MEDLINE, EMBASE, PEDro, SPORTDiscus, and CINAHL. The inclusion criteria of the studies will be randomized controlled trials with patients with one of the following tendinopathies: patellar, Achilles, gluteal, and proximal tendinopathy of the hamstring muscles. The primary outcomes will be pain and disability. The intervention will be exercise therapy, and the comparators will be different types of exercise, control groups, or any other type of intervention. DISCUSSION Other systematic reviews have been published about the prescription of exercise therapy in the treatment of tendinopathies of the lower limbs. However, the results of these reviews are limited to only one type of tendinopathy or specific exercise. Because some of these reviews are also outdated, this systematic review will investigate whether exercise therapy is more effective than any other type of intervention and if there is a best form of exercise therapy, considering modality, dose, and intensity, for the treatment of lower limb tendinopathies. Furthermore, this study will present data related to the sample size, recruitment period, methodological quality, and visibility of the eligible studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO ( CRD42018093011 ).
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Affiliation(s)
- Yuri Rafael dos Santos Franco
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
| | - Gisela Cristiane Miyamoto
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
| | - Katherinne Ferro Moura Franco
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
| | | | - Cristina Maria Nunes Cabral
- Master’s and Doctoral Program in Physical Therapy of Universidade Cidade de São Paulo, Rua Cesário Galeno, 475, Tatuapé, SP Brazil
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Scott A, LaPrade RF, Harmon KG, Filardo G, Kon E, Della Villa S, Bahr R, Moksnes H, Torgalsen T, Lee J, Dragoo JL, Engebretsen L. Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. Am J Sports Med 2019; 47:1654-1661. [PMID: 31038979 DOI: 10.1177/0363546519837954] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A small number of randomized controlled trials have found ultrasound-guided injection of platelet-rich plasma (PRP) to be no more effective than saline for several tendinopathies; limited information exists for patellar tendinopathy. In addition, different PRP formulations that produce varying concentrations of leukocytes have not been directly compared for patellar tendinopathy. PURPOSE/HYPOTHESIS To determine if a single ultrasound-guided PRP injection, either leukocyte-rich PRP (LR-PRP) or leukocyte-poor PRP (LP-PRP), was superior to saline injection for the treatment of patellar tendinopathy. The null hypothesis was that no treatment would be superior to another for the treatment of patellar tendinopathy. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Athletes with patellar tendinopathy for ≥6 months (Blazina stage IIIB) were assessed for eligibility in a multisite single-blind controlled trial. There were 3 injection arms: LR-PRP, LP-PRP, and saline. Patients received a single ultrasound-guided injection, followed by 6 weeks of supervised rehabilitation (heavy slow resistance training, concentric and eccentric, 3 times per week). Outcome measures-Victorian Institute of Sport Assessment (patellar; VISA-P), pain during activity, and global rating of change-were assessed at 6 and 12 weeks and 6 and 12 months. VISA-P score at 12 weeks was the primary outcome. Fifty-seven patients (19 in each group) were included in an intention-to-treat analysis. Secondary outcome measures included pain during activity and patients' global rating of change. RESULTS Study retention was 93% at 12 weeks and 79% after 1 year. There was no significant difference in mean change in VISA-P score, pain, or global rating of change among the 3 treatment groups at 12 weeks or any other time point. After 1 year, the mean (SD) outcomes for the LR-PRP, LP-PRP, and saline groups were as follows, respectively: VISA-P-58 (29), 71 (20), and 80 (18); pain-4.0 (2.4), 2.4 (2.3), and 2.0 (1.9); global rating of change-4.7 (1.6), 5.6 (1.0), and 5.7 (1.2) ( P > .05 for all outcomes). CONCLUSION Combined with an exercise-based rehabilitation program, a single injection of LR-PRP or LP-PRP was no more effective than saline for the improvement of patellar tendinopathy symptoms. REGISTRATION NCT02116946 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | - Roald Bahr
- Department of Sports Medicine, Olympiatoppen, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Havard Moksnes
- Department of Sports Medicine, Olympiatoppen, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Jenny Lee
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Jason L Dragoo
- Stanford University, Department of Orthopaedic Surgery, Palo Alto, California, USA
| | - Lars Engebretsen
- Department of Sports Medicine, Olympiatoppen, Oslo, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Orthopedic Clinic, Oslo University Hospital, University of Oslo, Oslo, Norway
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43
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Epro G, Hunter S, König M, Schade F, Karamanidis K. Evidence of a Uniform Muscle-Tendon Unit Adaptation in Healthy Elite Track and Field Jumpers: A Cross Sectional Investigation. Front Physiol 2019; 10:574. [PMID: 31156457 PMCID: PMC6529647 DOI: 10.3389/fphys.2019.00574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/24/2019] [Indexed: 01/01/2023] Open
Abstract
Different adaptive responses to mechanical loading between muscle and tendon can lead to non-uniform biomechanical properties within the muscle-tendon unit. The current study aimed to analyze the mechanical properties of the triceps surae muscle-tendon unit in healthy male and female elite track and field jumpers in order to detect possible inter-limb differences and intra-limb non-uniformities in muscle and tendon adaptation. The triceps surae muscle strength and tendon stiffness were analyzed in both limbs during maximal voluntary isometric plantar flexion contractions using synchronous dynamometry and ultrasonography in sixty-seven healthy young male (n = 35) and female (n = 32) elite international level track and field jumpers (high jump, long jump, triple jump, pole vault). Triceps surae muscle-tendon unit intra-limb uniformity was assessed using between limb symmetry indexes in the muscle strength and tendon stiffness. Independent from sex and jumping discipline the take-off leg showed a significantly higher (p < 0.05) triceps surae muscle strength and tendon stiffness, suggesting different habitual mechanical loading between legs. However, despite these inter-limb discrepancies no differences were detected in the symmetry indexes of muscle strength (5.9 ± 9.4%) and tendon stiffness (8.1 ± 11.5%). This was accompanied by a significant correlation between the symmetry indexes of muscle strength and tendon stiffness (r = 0.44; p < 0.01; n = 67). Thus, the current findings give evidence for a uniform muscle-tendon unit adaptation in healthy elite track and field jumpers, which can be reflected as a protective mechanism to maintain its integrity to meet the functional demand.
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Affiliation(s)
- Gaspar Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Steve Hunter
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Matthias König
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
| | - Falk Schade
- Olympic Training Center Rheinland, Cologne, Germany
| | - Kiros Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, United Kingdom
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