1
|
Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [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] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
Collapse
Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
| | | |
Collapse
|
2
|
Challoumas D, Crosbie G, O'Neill S, Pedret C, Millar NL. Effectiveness of Exercise Treatments with or without Adjuncts for Common Lower Limb Tendinopathies: A Living Systematic Review and Network Meta-analysis. SPORTS MEDICINE - OPEN 2023; 9:71. [PMID: 37553459 PMCID: PMC10409676 DOI: 10.1186/s40798-023-00616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 07/16/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Exercise therapy is usually prescribed as first-line treatment for lower limb tendinopathies. The multitude of exercise- and non-exercise-based management options can be overwhelming for the treating sports professional and patient alike. We chose to investigate the comparative effectiveness of exercise therapy with or without adjuncts for managing the commonest lower limb tendinopathies. METHODS Through an extensive systematic literature search using multiple databases, we aimed to identify eligible randomised controlled trials (RCTs) on Achilles tendinopathy, patellar tendinopathy or greater trochanteric pain syndrome (GTPS) that included at least one exercise intervention in their treatment arms. Our primary outcomes were patient-reported pain and function (Victorian Institute of Sport Assessment; VISA). Follow-up was defined as short-term (≤ 12 weeks), mid-term (> 12 weeks to < 12 months) and long-term (≥ 12 months). The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE-NMA tools, respectively. Analyses were performed separately for each one of the three tendinopathies. RESULTS A total of 68 RCTs were included in the systematic review. All pairwise comparisons that demonstrated statistically and clinically significant differences between interventions were based on low or very low strength of evidence. Based on evidence of moderate strength, the addition of extracorporeal shockwave therapy to eccentric exercise in patellar tendinopathy was associated with no short-term benefit in pain or VISA-P. From the network meta-analyses, promising interventions such as slow resistance exercise and therapies administered alongside eccentric exercise, such as topical glyceryl trinitrate for patellar tendinopathy and high-volume injection with corticosteroid for Achilles tendinopathy were based on low/very low strength of evidence. CONCLUSION In this network meta-analysis, we found no convincing evidence that any adjuncts administered on their own or alongside exercise are more effective than exercise alone. Therefore, we recommend that exercise monotherapy continues to be offered as first-line treatment for patients with Achilles and patellar tendinopathies and GTPS for at least 3 months before an adjunct is considered. We provide treatment recommendations for each tendinopathy. PROSPERO registration number CRD42021289534.
Collapse
Affiliation(s)
- Dimitris Challoumas
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, UK
| | - Gearoid Crosbie
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, UK
| | - Seth O'Neill
- Department of Physiotherapy, School of Allied Health Professionals, University of Leicester, Leicester, UK
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Diagonal,, C/San Mateu, Esplugues de Llobregat, Spain
| | - Neal L Millar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, UK.
| |
Collapse
|
3
|
Mulder CFL, van der Vlist AC, van Middelkoop M, van Oosterom RF, van Veldhoven PLJ, Weir A, Verhaar JAN, de Vos RJ. Do physical tests have a prognostic value in chronic midportion Achilles tendinopathy? J Sci Med Sport 2023; 26:421-428. [PMID: 37482492 DOI: 10.1016/j.jsams.2023.06.014] [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: 11/14/2022] [Revised: 05/18/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. DESIGN Prospective cohort study, secondary analysis of data from a randomized trial. METHODS Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment-Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0-100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment-Achilles scores) were determined using a Mixed Linear Model. RESULTS 80 patients were included. The mean Victorian Institute of Sports Assessment-Achilles score improved 20 points (95 % confidence interval, 16-25, P < .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (β 0.2, 95 % confidence interval 0.001 to 0.3, P = .049), the baseline pain provocation tests (Visual Analogue Scale palpation: β -0.2; 95 % confidence interval: -0.4 to -0.1; P < .001, Visual Analogue Scale-10-hops: β -0.3; 95 % confidence interval: -0.4 to -0.2; P < .001) and the change in the Victorian Institute of Sports Assessment-Achilles score. CONCLUSIONS In patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24 weeks than patients with high baseline pain scores.
Collapse
Affiliation(s)
- Céline F L Mulder
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands
| | - Arco C van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands; Department of General Practice, Erasmus MC University Medical Center, the Netherlands
| | | | | | | | - Adam Weir
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, the Netherlands.
| |
Collapse
|
4
|
Wei B, Ji M, Lin Y, Wang S, Liu Y, Geng R, Hu X, Xu L, Li Z, Zhang W, Lu J. Mitochondrial transfer from bone mesenchymal stem cells protects against tendinopathy both in vitro and in vivo. Stem Cell Res Ther 2023; 14:104. [PMID: 37101277 PMCID: PMC10134653 DOI: 10.1186/s13287-023-03329-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/05/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Although mesenchymal stem cells (MSCs) have been effective in tendinopathy, the mechanisms by which MSCs promote tendon healing have not been fully elucidated. In this study, we tested the hypothesis that MSCs transfer mitochondria to injured tenocytes in vitro and in vivo to protect against Achilles tendinopathy (AT). METHODS Bone marrow MSCs and H2O2-injured tenocytes were co-cultured, and mitochondrial transfer was visualized by MitoTracker dye staining. Mitochondrial function, including mitochondrial membrane potential, oxygen consumption rate, and adenosine triphosphate content, was quantified in sorted tenocytes. Tenocyte proliferation, apoptosis, oxidative stress, and inflammation were analyzed. Furthermore, a collagenase type I-induced rat AT model was used to detect mitochondrial transfer in tissues and evaluate Achilles tendon healing. RESULTS MSCs successfully donated healthy mitochondria to in vitro and in vivo damaged tenocytes. Interestingly, mitochondrial transfer was almost completely blocked by co-treatment with cytochalasin B. Transfer of MSC-derived mitochondria decreased apoptosis, promoted proliferation, and restored mitochondrial function in H2O2-induced tenocytes. A decrease in reactive oxygen species and pro-inflammatory cytokine levels (interleukin-6 and -1β) was observed. In vivo, mitochondrial transfer from MSCs improved the expression of tendon-specific markers (scleraxis, tenascin C, and tenomodulin) and decreased the infiltration of inflammatory cells into the tendon. In addition, the fibers of the tendon tissue were neatly arranged and the structure of the tendon was remodeled. Inhibition of mitochondrial transfer by cytochalasin B abrogated the therapeutic efficacy of MSCs in tenocytes and tendon tissues. CONCLUSIONS MSCs rescued distressed tenocytes from apoptosis by transferring mitochondria. This provides evidence that mitochondrial transfer is one mechanism by which MSCs exert their therapeutic effects on damaged tenocytes.
Collapse
Affiliation(s)
- Bing Wei
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Mingliang Ji
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Yucheng Lin
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Shanzheng Wang
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Yuxi Liu
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Rui Geng
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Xinyue Hu
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Li Xu
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Zhuang Li
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Weituo Zhang
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China
| | - Jun Lu
- School of Medicine, Southeast University, No. 87 Dingjiaqiao Road, Gulou District, Jiangsu Province, 210009, Nanjing, People's Republic of China.
- Department of Orthopaedic Surgery/Joint and Sports Medicine Center, Zhongda Hospital, Southeast University, Nanjing, 210009, Jiangsu Province, People's Republic of China.
| |
Collapse
|
5
|
Effects of a single exercise session on pain intensity in adults with chronic pain: a systematic review and meta-analysis. Musculoskelet Sci Pract 2022; 62:102679. [PMID: 36332334 DOI: 10.1016/j.msksp.2022.102679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/11/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic pain is prevalent amongst society, making it necessary to find strategies to manage chronic pain. Regular exercise is efficacious; however, pain is a barrier to initiating exercise. A single exercise session is also believed to acutely reduce pain, however, the evidence for this is less robust. OBJECTIVES This systematic review and meta-analysis aimed to identify the effect of a single exercise session on pain intensity in adults with chronic pain. METHODS We searched eight databases and trial registries to identify randomised controlled trials evaluating the effect of a single exercise session on pain intensity in adults with chronic pain compared to a non-exercise control. Literature screening, data extraction, risk of bias (Cochrane 2.0) and quality assessment (GRADE) were conducted independently and in duplicate. Random-effects meta-analyses were performed using the metafor package in R. RESULTS We included 17 trials (46 study arms with 664 adults [44% female]). There were no significant differences in pain intensity (mean difference on a 0-10 scale) immediately post-exercise -0.02 (95% CI = -0.06, 0.62; I2 = 77.1%) or up to 45-min post-exercise -0.17 (95% CI = -0.49, 0.16; I2 = 34.2%). All trials were at high risk of bias and the overall confidence in these findings was very low. CONCLUSION A single exercise session did not reduce pain intensity up to 1-h post-exercise. Notably, increases in pain were not observed either, suggesting that while pain can be a barrier to initiating exercise, clinicians can educate patients on the unlikelihood of exercise acutely increasing pain intensity.
Collapse
|
6
|
Krogh TP, Jensen TT, Madsen MN, Fredberg U. An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:6268590. [PMID: 38655172 PMCID: PMC11022783 DOI: 10.1155/2022/6268590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/13/2022] [Indexed: 04/26/2024]
Abstract
Background Achilles tendinopathy (AT) is a common musculoskeletal disorder, and its management remains challenging. Hypothesis/Purpose. By conducting a pilot study, we aimed to assess the feasibility, safety, and clinical improvement of a new home-based 4-stage rehabilitation program with progressive loading including isometric exercises on a small scale prior to setting up a randomized controlled trial. Methods Ten recreational athletes with chronic midportion AT were included. The primary outcome was change in VISA-A score after 1, 2, 3, 6, and 12 months. Secondary outcomes included tenderness on palpation of the tendon and ultrasonographic changes after 6 months. Results Average VISA-A improvements of 26.9 points (P=0.004) and 35.4 points (P=0.006) were observed at 6- and 12-month follow-up, respectively. Tenderness on palpation of the tendon (0-10) was reduced from 5.5 to 2.5 (P < 0.001). Color Doppler ultrasound activity (0-4) was reduced by 50%, from an average of grade 2 to grade 1 (P=0.023). The hypoechoic cross-sectional area of the Achilles tendon was reduced from an average of 29.1% to 8.5% (P=0.001). Tendon thickness showed no statistically significant change (P=0.415). Conclusion Following the 4-stage rehabilitation program for AT based on isometric training and progressive loading, we observed improvement in both VISA-A score and ultrasonography in a group of athletes who had previously failed to benefit from standard AT rehabilitation. The study was feasible in terms of high adherence to the program and with no observed safety issues. The results of this pilot study support a further assessment of this specific approach for rehabilitation in a future randomized controlled trial.
Collapse
Affiliation(s)
- Thøger Persson Krogh
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Sports Medicine, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Center for Sports Medicine, Regional Hospital of Northern Denmark, Hjørring, Denmark
| | - Thomas Theis Jensen
- Department of Sports Medicine, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Merete Nørgaard Madsen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg 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 Denmark, Odense University Hospital, Odense, Denmark
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, UK
| | | |
Collapse
|
8
|
Grävare Silbernagel K, Malliaras P, de Vos RJ, Hanlon S, Molenaar M, Alfredson H, van den Akker-Scheek I, Antflick J, van Ark M, Färnqvist K, Haleem Z, Kaux JF, Kirwan P, Kumar B, Lewis T, Mallows A, Masci L, Morrissey D, Murphy M, Newsham-West R, Norris R, O'Neill S, Peers K, Sancho I, Seymore K, Vallance P, van der Vlist A, Vicenzino B. ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy. Sports Med 2022; 52:613-641. [PMID: 34797533 PMCID: PMC8891092 DOI: 10.1007/s40279-021-01588-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. OBJECTIVE To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. DESIGN Systematic review. DATA SOURCES Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. RESULTS 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. CONCLUSION 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. PROSPERO REGISTRATION CRD42020156763.
Collapse
Affiliation(s)
- Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA.
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, VIC, Australia
| | - Robert-Jan de Vos
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Shawn Hanlon
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Mitchel Molenaar
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Håkan Alfredson
- Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jarrod Antflick
- Department of Bioengineering, School of Engineering, Imperial College, London, UK
| | - Mathijs van Ark
- Department of Physiotherapy, School of Health Care Studies, Hanze University of Applied Sciences and Peescentrum, Centre of Expertise Primary Care Groningen (ECEZG), Groningen, The Netherlands
| | | | - Zubair Haleem
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Arsenal Football Club, London, UK
| | - Jean-Francois Kaux
- Department of Physical and Rehabilitation Medicine and Sports Traumatology, University and University Hospital of Liège, Liège, Belgium
| | - Paul Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhavesh Kumar
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Trevor Lewis
- Aintree University Hospital, Liverpool Foundation Trust, Liverpool, UK
| | - Adrian Mallows
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Lorenzo Masci
- Institute of Sport Exercise and Health (ISEH), University College London, London, UK
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
| | - Myles Murphy
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Richard Newsham-West
- School of Allied Health, Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia
| | - Richard Norris
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Liverpool University Hospitals, NHS Foundation Trust, Liverpool, UK
| | - Seth O'Neill
- School of Allied Health, University of Leicester, Leicester, UK
| | - Koen Peers
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Igor Sancho
- Sports and Exercise Medicine, Queen Mary University of London, London, UK
- Physiotherapy Department, University of Deusto, San Sebastian, Spain
| | - Kayla Seymore
- Department of Physical Therapy, University of Delaware, 540 South College Avenue, Newark, DE, 19713, USA
| | - Patrick Vallance
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, VIC, Australia
| | - Arco van der Vlist
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
9
|
Matthews W, Ellis R, Furness J, Hing WA. The clinical diagnosis of Achilles tendinopathy: a scoping review. PeerJ 2021; 9:e12166. [PMID: 34692248 PMCID: PMC8485842 DOI: 10.7717/peerj.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.
Collapse
Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James Furness
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wayne A Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| |
Collapse
|
10
|
Mitham K, Mallows A, Yeowell G, Littlewood C. Management of recent onset tendon-related pain in a primary contact setting: A survey of practice. Musculoskeletal Care 2021; 20:86-98. [PMID: 33934483 DOI: 10.1002/msc.1556] [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: 03/22/2021] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Tendon-related pain is a common and debilitating condition that affects a wide range of people. To inform future research, it is important to understand healthcare professional's current practice. OBJECTIVES To describe the practice of First Contact Practitioners (FCPs) and Other Clinicians (OCs) for recent onset tendon pain in a primary contact setting. The secondary aim was to understand if practice differed between the locations of pain. DESIGN Cross-sectional online survey METHOD: The online survey asked for responses relating to one scenario of shoulder pain and one of Achilles pain. Except location of pain, the scenarios were identical. Responses were collected over a four-week period to December 2020. The Chi-Square test was used to analyse the difference in proportion of responses between FCPs and OCs, and between locations of pain. RESULTS 118 responses were received. Rotator Cuff Related Shoulder Pain (RCRSP) was preferred by 64/118 (54.2%) for the shoulder scenario. Achilles tendinopathy was the preferred term by 86/103 (83.5%) for the Achilles. FCPs were more likely to advise NSAIDs for both shoulder (p = 0.006) and Achilles (p = 0.046) scenarios than OCs. Amended duties were more likely to be advised for manual workers for the shoulder scenario compared to Achilles (p = <0.0001). CONCLUSION There were similarities in the management of recent onset tendon-related pain; the majority of respondents recommended against further investigations, steroid injections, and recommended exercise. Understanding whether these approaches are clinically effective requires further investigation.
Collapse
Affiliation(s)
- Kieran Mitham
- Dynamic Health, Physiotherapy Department, Cambridgeshire Community Services NHS Trust, Huntingdon, Cambridgeshire, UK
| | - Adrian Mallows
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Colchester, UK
| | - Gillian Yeowell
- Department of Health Professions, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| | - Chris Littlewood
- Department of Health Professions, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
11
|
Mantovani L, Maestroni L, Bettariga F, Gobbo M, Lopomo NF, McLean S. "Does isometric exercise improve leg stiffness and hop pain in subjects with Achilles tendinopathy? A feasibility study". Phys Ther Sport 2020; 46:234-242. [PMID: 32998087 DOI: 10.1016/j.ptsp.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In Achilles tendinopathy (AT) the ability to store and recycle elastic energy during ground contact phase is often altered. A measure of this function is represented by leg stiffness (LS). Immediate responses in LS following therapeutic intervention have not been examined. OBJECTIVE The aim of this paper was to examine the feasibility of the protocol in participants with AT. DESIGN Single cohort feasibility study. PARTICIPANTS Adults with persistent AT pain, symptoms on palpation and less than 80 points on the Visa-A questionnaire. INTERVENTION heavy isometric exercise sequence in plantarflexion. OUTCOME MEASURES Feasibility was assessed by evaluating: the willingness of participants to enroll into the study, the number of eligible participants, the recruitment rate, adherence to the intervention, the drop-out rate, the tolerability of the protocol. LS, reactive strength index, pain and rate of perceived effort were secondary outcomes. RESULTS 22 AT were eligible for data collection and 19 entered the statistical analysis. The intervention was well tolerated, no withdrawals. Pain scores were low during both the intervention and the assessment. Immediate improvements in LS and pain were recorded. CONCLUSIONS The isometric exercise protocol was feasible. Future research should investigate its effectiveness.
Collapse
Affiliation(s)
- Lisa Mantovani
- Studioerre, Via della Badia 18, 25127, Brescia, BS, Italy.
| | - Luca Maestroni
- Studioerre, Via della Badia 18, 25127, Brescia, BS, Italy; Smuoviti, Viale Giulio Cesare, 29, 24121, Bergamo, BG, Italy; London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, United Kingdom.
| | | | - Massimiliano Gobbo
- Laboratory of Clinical Integrative Physiology, University of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy.
| | - Nicola Francesco Lopomo
- Department of Information Engineering, University of Brescia, Italy; Laboratory of Clinical Integrative Physiology, University of Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Italy.
| | - Sionnadh McLean
- School of Health, Wellbeing and Life Sciences, Sheffield Hallam University, Broomhall Road, Sheffield, United Kingdom.
| |
Collapse
|
12
|
van der Vlist AC, van Veldhoven PLJ, van Oosterom RF, Verhaar JAN, de Vos RJ. Isometric exercises do not provide immediate pain relief in Achilles tendinopathy: A quasi-randomized clinical trial. Scand J Med Sci Sports 2020; 30:1712-1721. [PMID: 32474979 PMCID: PMC7496962 DOI: 10.1111/sms.13728] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022]
Abstract
Background Isometric exercises may provide an immediate analgesic effect in patients with lower‐limb tendinopathy and have been proposed as initial treatment and for immediate pain relief. Current evidence is conflicting, and previous studies were small. Objective To study whether isometric exercises result in an immediate analgesic effect in patients with chronic midportion Achilles tendinopathy. Methods Patients with clinically diagnosed chronic midportion Achilles tendinopathy were quasi‐randomized to one of four arms: isometric calf‐muscle exercises (tiptoes), isometric calf‐muscle exercises (dorsiflexed ankle position), isotonic calf‐muscle exercises, or rest. The primary outcome was pain measured on a visual analogue scale (VAS) score (0‐100) during a functional task (10 unilateral hops) both before and after the intervention. Between‐group differences were analyzed using a generalized estimation equations model. Results We included 91 patients. There was no significant reduction in pain on the 10 hop test after performing any of the four interventions: isometric (tiptoes) group 0.2, 95%CI −11.2 to 11.5; isometric (dorsiflexed) group −1.9, 95%CI −13.6 to 9.7; isotonic group 1.4, 95%CI −8.3 to 11.1; and rest group 7.2, 95%CI −2.4 to 16.7. There were also no between‐group differences after the interventions. Conclusion The isometric exercises investigated in this study did not result in immediate analgesic benefit in patients with chronic midportion Achilles tendinopathy. We do not recommend isometric exercises if the aim is providing immediate pain relief. Future research should focus on the use of isometric or isotonic exercise therapy as initial treatment as all exercise protocols used in this study were well‐tolerated.
Collapse
Affiliation(s)
- Arco C van der Vlist
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Robert F van Oosterom
- Department of Sports Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robert-Jan de Vos
- Department of Orthopedic Surgery and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|