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Razian M, Hosseinzadeh M, Behm DG, Sardroodian M. Effect of leg dominance on ipsilateral and contralateral limb training adaptation in middle-aged women after unilateral sensorimotor and resistance exercise training. Res Sports Med 2024; 32:345-362. [PMID: 36036379 DOI: 10.1080/15438627.2022.2113878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
The aim was to examine the directionality of global training effects in middle-aged women after unilateral training. Thirty-nine middle-aged female volunteers (59.4 ± 5.4 years) were randomly assigned to one of three groups: 1. Unilateral Dominant Lower Limb Training (UDLT); 2. Unilateral Non-Dominant Lower Limb Training (UNDLT) or 3. Control group. Outcome measures assessing isometric strength, static and dynamic balance were recorded at baseline, and 1 week after 12 weeks (post-test) of training or no-intervention. The net cross education adaptation changes of the contralateral quadriceps isometric maximum voluntary (MVC) force (F2,34 = 4.33; p = 0.022), Stork balance score (F2,34 = 4.26; p = 0.023) and the Star Excursion Balance test score (F2,34 = 11.80; p = 0.001) were asymmetrical in the UNDLT group and on average, exceeded the UDLT group. The results demonstrated asymmetrical cross education training adaptations with unilateral training of non-dominant leg (UNDLT) to contralateral homologous and heterologous muscles, with the exception of knee flexor MVC. The results of this study provide a novel exercise or rehabilitation strategy that can be employed when one of the limbs is affected.
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Affiliation(s)
- Mina Razian
- Department of Sport Science, University of Bojnord, Bojnord, North Khorasan, Iran
| | - Mahdi Hosseinzadeh
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran, Iran
| | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, Newfoundland and Labrador, St. John's, Canada
| | - Mahta Sardroodian
- Department of Sport Science, University of Bojnord, Bojnord, North Khorasan, Iran
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Bezuglov E, Pirmakhanov B, Ussatayeva G, Emanov A, Valova Y, Kletsovskiy A, Khaitin V, Usmanova E, Butovskiy M, Morgans R. The mid-term effect of Osgood-Schlatter disease on knee function in young players from elite soccer academies. PHYSICIAN SPORTSMED 2023; 51:590-595. [PMID: 36413052 DOI: 10.1080/00913847.2022.2148492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the effect of Osgood-Schlatter disease (OSD) on knee joint function in elite young soccer players. Our hypothesis was that knee joint function in elite young soccer players was impaired following OSD compared with soccer players with no history of OSD. METHOD In young male soccer players (n = 36) from elite academies (mean ±SD, age: age: 15,3 ± 1,7 years; height: 1,7 ± 0,06 m; weight: 63,5 ± 8 kg; BMI: 20,7 ± 2). The duration between the completion of treatment or the last complaint to the study commencement was 31 ± 19 months. RESULTS The average treatment duration of OSD among study participants was 18,5 ± 12 days (95%, 14-23), and the disease most often manifested in winter and spring, 33% and 31% of cases, respectively. Soccer players with a history of OSD were statistically different in IKDC and KOOS scores when compared with soccer players with no previously reported OSD (Mann-Whitney, p < 0,0001). The soccer players with a history of OSD also use NSAIDs more frequently compared with soccer players with no history of OSD (36% vs 3% respectively). CONCLUSIONS OSD among young soccer players, when symptoms resolve, continue about one month and they can return to regular training and participation in games. Wherein, the negative effects in knee joint function were significantly more likely in soccer players with previous OSD history when compared with their peers with no history of OSD. While oral non-steroidal anti-inflammatory drugs was also more widely employed in soccer players with previous OSD history. Potentially this may lead to performance deficits and disadvantages for their future careers and coaches and physicians should be informed.
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Affiliation(s)
- E Bezuglov
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
- High Performance Sports Laboratory, Moscow Witte University, Moscow, Russian Federation
- The Academy of the Russian Football Union, Moscow, Russia
| | - B Pirmakhanov
- Faculty of Medicine and Health Care, Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
- Football Club Kairat, Almaty, Kazakhstan
| | - G Ussatayeva
- Faculty of Medicine and Health Care, Department of Epidemiology, Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - A Emanov
- Academy of Talents, Moscow, Russian Federation
- Sports medicine clinic "Smart Recovery", Moscow, Russian Federation
| | - Yu Valova
- Kuban State Medical University, Krasnodar, Russian Federation
- Academy of Football Club "Krasnodar", Krasnodar, Russian Federation
| | - A Kletsovskiy
- Kuban State Medical University, Krasnodar, Russian Federation
| | - V Khaitin
- Pavlov First Saint Petersburg State Medical University, Department of Physical Methods of Treatment and Sports Medicine, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation
| | - E Usmanova
- Sports medicine clinic "Smart Recovery", Moscow, Russian Federation
| | - M Butovskiy
- Department Neurology and Rehabilitation, Kazan State Medical University, Kazan, Russian Federation
- Football Club "Rubin" Kazan, Russian Federation
| | - R Morgans
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Theodorou A, Komnos G, Hantes M. Patellar tendinopathy: an overview of prevalence, risk factors, screening, diagnosis, treatment and prevention. Arch Orthop Trauma Surg 2023; 143:6695-6705. [PMID: 37542006 PMCID: PMC10541843 DOI: 10.1007/s00402-023-04998-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023]
Abstract
Patellar tendinopathy (PT), or jumper's knee, is an overuse injury that occurs in professional, as well as recreational, athletes. This condition is a noncontact injury, typically characterized by gradually increasing pain in the patellar tendon. It is prevalent in participants of several sports, but it occurs mostly in jumping sports. The diagnosis of PT is primarily clinical; however, imaging techniques can be useful as well. Risk factors differ between sexes, playing conditions, the kind of sport, playing level and personal characteristics. Screening is an essential tool to assess PT. This condition affects athletic performance and often persists for years. The use of preventative methods is imperative because of the persistence of this condition, especially in elite athletes who sometimes end their career after long and failed treatments. There are a wide variety of treatment and rehabilitation options available, the majority of which are non-operative, such as eccentric exercises, cryotherapy, platelet-rich plasma (PRP) injections, and anti-inflammatory strategies. If conservative treatment fails, surgery is the next most preferable step. Even though there are many surgical treatment methods, there is no clear evidence on what is the most effective approach to address PT. Taking this into consideration, as well as the extent of this clinical entity, novel therapeutic techniques, as well as screening and prevention methods, are expected to emerge in the near future.
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Affiliation(s)
- Andreas Theodorou
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece.
| | - Georgios Komnos
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
| | - Michael Hantes
- Faculty of Medicine, University of Thessaly, 41500, Larissa, Greece
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Hosseinzadeh M, Sardroodian M, Razian M, Benoit C, Hoogenboom BJ. Rehabilitative exercise scheduling: Effects on balance, functional movement performance, and pain perception in middle-aged women with knee pain: A randomized controlled trial. PM R 2023; 15:1223-1238. [PMID: 36655413 DOI: 10.1002/pmrj.12951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND The scheduling of clinical rehabilitative exercise should combine best possible delivery of exercise with the most efficient use of time, facilities, equipment, and personnel. However, it is not clear whether distribution of a fixed amount of exercise volume is more efficient over a longer time period in a week (distributed manner) than over a shorter time period in a week (massed manner). OBJECTIVE To evaluate the effects of distributed versus massed within- and between-session exercise scheduling on balance, exercise performance, and pain perception in middle-aged women with knee pain. PARTICIPANTS Thirty-four middle-aged female volunteers (mean age ± SD, 56.0 ± 5.2 years old; mean weight ± SD, 66.9 ± 7.6 kg; mean body mass index [BMI] ± SD, 27.7 ± 2.8 kg/m2 ) were randomly assigned to one of the three groups consisting of Rehabilitative Massed Scheduling (RMS); Rehabilitative Distributed Scheduling (RDS); or Control group (CG). MAIN OUTCOME MEASURES Isometric strength, balance, functional movement performance, and pain perception were assessed at baseline (pre), at week 8 (mid), and 1 week after the full 12 weeks (post) of exercise training or no intervention (CG). RESULTS Significant improvements in balance, functional movement performance, and pain perception were found after both RDS and RMS after 8 and 12 weeks compared to the control group (p ˂ .05). Examination of the net changes (% ∆) between RDS and RMS showed a statistically significant difference only in the right 30-second arm curl records of individuals in the RDS group, which were significantly higher than the RMS group at the post-test (p ˂ .05). CONCLUSION Rehabilitative training providers are advised to distribute the drills of rehabilitative exercise training within and between the sessions of exercise per week only when a positive Bottom-Up Rise Strength Transfer effect (BURST) effect of exercise training is needed. Otherwise, if the whole amount of rehabilitative exercise work is identical the benefit of going five versus three times per week to the rehabilitation centers would be similar.
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Affiliation(s)
- Mahdi Hosseinzadeh
- Department of Sport Injuries and Corrective Exercises, Sport Sciences Research Institute, Tehran, Iran
| | | | - Mina Razian
- Department of Sport Sciences, University of Bojnord, Bojnord, Iran
| | - Colleen Benoit
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Barbara J Hoogenboom
- Department of Physical Therapy and Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
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Acaröz Candan S, Sözen H, Arı E. Electromyographic activity of quadriceps muscles during eccentric squat exercises: implications for exercise selection in patellar tendinopathy. Res Sports Med 2023; 31:517-527. [PMID: 34856831 DOI: 10.1080/15438627.2021.2010200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
This study investigated the quadriceps muscle activity during eccentric squat exercises (ESE) with different decline angles and arcs of motion regarding the proper exercise selection for patellar tendinopathy management. Electromyographic activity of the rectus femoris, vastus lateralis, and vastus medialis obliquus (VMO) muscles was measured during ESE on 0°, 5°, 10°, 15°, and 20° decline in 20 recreationally active participants. The eccentric phase was divided into 0-30°, 30-60°, 60-90°, 0-60°, 30-90°, and 0-90° of knee flexion simultaneously via motion-analysis system. The analyses showed that there was a significant decline angle × arc interaction effect on electromyographic activity of all muscles during knee flexion movement. The main effect was found for the arc of motion of knee flexion, and the main effect for the decline angle also was present for each muscle, except for VMO. This study demonstrated that most selective quadriceps eccentric activation occurred during ESE performed on 20° decline throughout 60-90° of knee flexion.
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Affiliation(s)
- Sevim Acaröz Candan
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Ordu University, Ordu, Turkey
| | - Hasan Sözen
- School of Physical Education and Sport, Ordu University, Ordu, Turkey
| | - Erdal Arı
- School of Physical Education and Sport, Ordu University, Ordu, Turkey
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Sharif F, Ahmad A, Gilani SA. Effectiveness of ultrasound guided dry needling in management of jumper's knee: a randomized controlled trial. Sci Rep 2023; 13:4736. [PMID: 36959393 PMCID: PMC10036476 DOI: 10.1038/s41598-023-31993-y] [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: 08/23/2022] [Accepted: 03/21/2023] [Indexed: 03/25/2023] Open
Abstract
Jumper's knee is highly prevalent condition in athletes. Very limited evidence is available on clinical effects of tendon dry needling. Therefore, the objective of this study is to compare the effects of ultrasound-guided dry needling (UG-DN) combined with conventional physical therapy and conventional physical therapy alone in patients with jumper's knee. A total of 96 patients with pre-diagnosed jumper's knee were randomly assigned to experimental group (UG-DN + CPT) and conventional group (CPT alone) with 48 participants each. Pain intensity and functional disability were recorded using visual Analogue Scale (VAS), Victorian Institute of Sports Assessment-Patellar Tendinopathy (VISA-P) questionnaire, Lysholm Scale, Knee Injury and Osteoarthritis Outcome Score (KOOS) respectively at baseline, at 1st, 2nd, and 4th week. Whereas ultrasonographic features of patellar tendon were measured through musculoskeletal ultrasound (MSKUS) at baseline and 4th week. Total 8 sessions of treatment were provided. Mann Whitney U test and Friedman test were used to compute between and within group differences respectively. P value was significant at 0.05. Results showed that patients in both groups had improvement in signs of jumper's knee but the improvement in UG-DN + CPT group was more significant (p ≤ 0.05). Significant difference was seen after 4 weeks of intervention in UG-DN + CPT group in VAS (Median ± I.Q.R = 3 ± 1, p = 0.000), VISA-P (Median ± I.Q.R = 83.5 ± 7, p = 0.000), KOOS (Median ± I.Q.R = 83.5 ± 8, p = 0.000), , Lysholm (Median ± I.Q.R = 84 ± 5, p = 0.000) than CPT group VAS (Median ± I.Q.R = 1.5 ± 1, p = 0.000), VISA-P (Median ± I.Q.R = 92 ± 2, p = 0.000), KOOS (Median ± I.Q.R = 92 ± 3, p = 0.000), Lysholm (Median ± I.Q.R = 92 ± 4, p = 0.000) and ultrasonographic features of jumper's knee were more significant in experimental group(p-value ≤ 0.05). The Ultrasound guided dry needling with conventional physical therapy of patellar tendon had been found an effective treatment for jumper's knee and helps in reducing pain intensity, improving function and ultrasonographic features in patients with jumper's knee. UG-DN + CPT group showed more significant results as compared to CPT.Trial registration: (IRCT20210409050913N1). Dated: 17.04.2021.
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Affiliation(s)
- Faiza Sharif
- University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan.
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
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Carvalho RM, Machado J, Santos MJ, Matos LC. Can Acupuncture Improve the Flexibility of Hamstring Muscles? A Randomized, Blinded, and Controlled Pilot Study. Healthcare (Basel) 2023; 11:healthcare11040490. [PMID: 36833023 PMCID: PMC9956164 DOI: 10.3390/healthcare11040490] [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: 12/02/2022] [Revised: 01/25/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
(1) Background: The lack of flexibility is frequently reported as a risk factor for hamstring muscle damage. Acupuncture, a therapeutic tool of traditional Chinese medicine (TCM), may play a role in both treatment and prevention by improving muscle strength, microcirculation, and reducing muscle soreness. The primary objective of this pilot study was to examine the immediate effects of acupuncture on hamstring muscle stretching and on the pain or discomfort reported during stretching. (2) Methods: To mitigate heterogeneity effects, and due to the small sample size, the study employed a crossover design in which each participant was tested at three different moments of the experimental period with verum (true acupuncture in selected acupoints), sham (fake acupuncture in zones of the skin not corresponding to any known acupoint but near the selected acupoints), and placebo (stimulation of the selected acupoints with a stainless steel wire and cannula, without puncturing) stimulations. Flexibility and pain or discomfort were assessed using the seat and reach test (SR) and a visual analogic scale (VAS). (3) Results: Significant changes in flexibility were observed after verum acupuncture (p = 0.03), while no significant changes were seen in sham and placebo (p = 0.86 and p = 0.18, respectively). No significant differences were found in pain or discomfort during any of the stimulations (verum, p = 0.55; sham, p = 0.50; placebo, p = 0.58). (4) Conclusions: The results of this pilot study suggest that acupuncture may improve flexibility in the hamstring muscles, though it does not significantly affect pain or discomfort during stretching.
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Affiliation(s)
- Rui Miguel Carvalho
- ICBAS—Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
| | - Jorge Machado
- ICBAS—Institute of Biomedical Sciences Abel Salazar, University of Porto, 4050-313 Porto, Portugal
- CBSin—Center of BioSciences in Integrative Health, 4405-604 Vila Nova de Gaia, Portugal
- LABIOMEP—Porto Biomechanics Laboratory, University of Porto, 4200-450 Porto, Portugal
| | - Maria João Santos
- Escola Superior de Saúde Jean Piaget, 4405-678 Vila Nova de Gaia, Portugal
| | - Luís Carlos Matos
- CBSin—Center of BioSciences in Integrative Health, 4405-604 Vila Nova de Gaia, Portugal
- Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal
- CTEC—Centro Transdisciplinar de Estudos da Consciência, Universidade Fernando Pessoa, 4249-004 Porto, Portugal
- Correspondence:
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Wright L, Hernlund E, Fjordbakk C, Ytrehus B, Law E, Uhlhorn M, Rhodin M. Patellar ligament desmopathy in the horse – a review and comparison to human patellar tendinopathy (‘Jumper’s knee’). COMPARATIVE EXERCISE PHYSIOLOGY 2022. [DOI: 10.3920/cep220011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patellar ligament desmopathy in horses is regarded as an uncommon condition with unclear aetiology. Of the three patellar ligaments in the horse, the intermediate is the one most often diagnosed with desmopathy in horses presenting with chronic lameness. This structure corresponds to the patellar tendon in humans. As diagnostic imaging modalities continuously improve, changes in echogenicity of the patellar ligaments are identified ultrasonographically with increasing frequency. However, disruption of the normal fibre pattern may be present also in patellar ligaments in horses that show no signs of lameness. Similarly, there is a poor correlation between pain and diagnostic imaging findings in human patellar tendinopathy. Consequently, there appears to be a knowledge gap pertaining to normal ultrasonographic variation and diagnostic criteria for disease of the patellar ligaments in horses. Furthermore, local anaesthetic techniques to verify the diagnosis are poorly described, and due to the low number of treated cases, no specific treatment modality can be recommended on a scientific basis. The aim of this paper is to review the current knowledge regarding the pathogenesis, diagnosis and management of patellar ligament desmopathy in horses, compare this condition with patellar tendinopathy in humans, and identify areas for further research to increase the diagnostic accuracy in horses. We conclude that there is a profound need for better descriptions of ultrasonographic variation and pathological changes of the equine patellar ligaments. Identification of areas of maximal ligament strain and descriptions of early histopathological changes could render more information on the possible aetiology, preventive measurements and treatment options of desmopathy. Description of regional innervation could aid in development of methods for diagnostic anaesthesia to verify pain originating from the ligaments.
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Affiliation(s)
- L. Wright
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - E. Hernlund
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
| | - C.T. Fjordbakk
- Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oluf Thesens vei 24, 1432 Ås, Norway
| | - B. Ytrehus
- Department of Biomedicine and Veterinary Public Health, Swedish University of Agricultural Sciences, P.O. Box 7028, 750 07 Uppsala, Sweden
| | - E. Law
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Uhlhorn
- University Animal Hospital, P.O. Box 7040, 750 07 Uppsala, Sweden
| | - M. Rhodin
- Department of Anatomy, Physiology and Biochemistry, Swedish University of Agricultural Sciences, P.O. Box 7011, 750 07 Uppsala, Sweden
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Sharif F, Ahmad A, Gilani SA, Bacha R, Hanif A, Arif MA. Efficacy of ultrasound guided dry needling as an adjunct to conventional physical therapy for patients with jumper’s knee: A randomized controlled trial. Front Surg 2022; 9:1023902. [PMID: 36406368 PMCID: PMC9672502 DOI: 10.3389/fsurg.2022.1023902] [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] [Received: 08/20/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Jumper’s knee is a degenerative condition among athletes, and it has been treated with conventional physical therapy (CPT). Ultrasound guided dry needling (USG-DN) is a relatively new technique to explore clinical outcomes in patients with tendinopathy. Methods This parallel group, single-blinded randomized controlled trial was carried out involving 94 athletes with clinically diagnosed jumper’s knee, divided into an intervention group (USG-DN + CPT, n = 47) and a control group (CPT, n = 47). Participants received a 4-week programme; the intervention group received ultrasound guided patellar tendon dry needling (DN) in conjunction with CPT. The control group received only CPT. The visual analog scale (VAS), Victorian institute of sports assessment-Patellar tendinopathy (VISA-P) questionnaire, Lysholm scale, Knee injury and osteoarthritis outcome score (KOOS) and ultrasonographic features of patellar tendinopathy were evaluated at baseline,1 week, 2 weeks, and 4 weeks. The data were analyzed through SPSS-26. Results The study found statistically significant differences (P < 0.05) regarding VAS, Lysholm, VISA-P, and KOOS scales at baseline, 1st, 2nd, and 4th week post-intervention. Within-group differences also showed statistically significant results after the intervention. There were significant results observed in ultrasonographic outcomes between both groups at 1 month post-intervention (all P < 0.05). Conclusion The results of the current study suggest, ultrasound guided DN of patellar tendon in combination with CPT reduced pain, improved function, and showed a tendency to decrease tendon thickness in patients with patellar tendinopathy. Clinical Trial Registration Number (IRCT20210409050913N1). Dated: 17.04.2021. https://www.irct.ir/user/trial/55607/view.
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Affiliation(s)
- Faiza Sharif
- University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
- Correspondence: Faiza Sharif Ashfaq Ahmad
| | - Ashfaq Ahmad
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
- Correspondence: Faiza Sharif Ashfaq Ahmad
| | - Syed Amir Gilani
- Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Raham Bacha
- University Institute of Radiological Sciences and Medical Imaging Technology, University of Lahore, Lahore, Pakistan
| | - Asif Hanif
- University Institute of Public Health, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Muhammad Asim Arif
- University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
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Patellar Tendon Injury: A Bibliometric Analysis of the Most-Cited Articles Demonstrates Relatively High Overall Level of Evidence. Arthrosc Sports Med Rehabil 2022; 4:e1747-e1757. [DOI: 10.1016/j.asmr.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
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Wheeler PC. Novel interventions for recalcitrant patella tendinopathy: Results may favour autologous blood injection (ABI) over radial-extra-corporeal shockwave therapy (r-ESWT) - A prospective cohort study. J Clin Orthop Trauma 2022; 26:101781. [PMID: 35211372 PMCID: PMC8851283 DOI: 10.1016/j.jcot.2022.101781] [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: 05/27/2021] [Revised: 01/11/2022] [Accepted: 01/24/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Patella tendinopathy is a common condition in a number of sports and can have a significant impact on activity and quality of life. Whilst rehabilitation leads to improvements in the majority of cases, a number of adjunct treatments are available for resistant cases with limited evidence supporting the use of one treatment over another.Hypothesis/Purpose: To compare the outcomes for patients with chronic patella tendinopathy, following either radial-Extra-Corporeal Shockwave Therapy (r-ESWT) or Autologous Blood Injection (ABI). STUDY DESIGN Prospective cohort study. METHODS 28 consecutive patients with chronic patella tendinopathy, treated with radial-ESWT (n = 14) or ABI (n = 14), with minimum three-month follow-up. Mean age 34.2 years, mean duration of symptoms 32.8 months. Patients received either three sessions of radial-Extra-Corporeal Shockwave Therapy (one session per week for 3 weeks), or two ultrasound-guided Autologous Blood Injections (2 injections performed 2-4 weeks apart). All patients received standardised after-care, including continuation of a structured home exercise programme of flexibility and progressive loading (eccentric strengthening) exercises. Main Outcome Measures were Victoria Institute of Sport - Patella questionnaire (VISA-P), plus 0-10 Visual Analogue Scale (VAS) for self-reported levels of "average pain". RESULTS There were statistically significant improvements in self-reported measures of pain/function following either procedure at 6-weeks and at 3-months, but only in the ABI group at 6-months. At 3-months: VISA-P was improved from 32.4% ± 11.7%-60.0% ± 20.7% (p < 0.01) in the ABI group, and from 34.2% ± 14.6%-48.9% ± 17.8% (p < 0.001) in the r-ESWT group. CONCLUSIONS Patients with chronic patella tendinopathy improved at 6-weeks and 3-months following either ABI or r-ESWT procedure, with significant benefits at 6-months seen only in the ABI group. Between group analysis demonstrated improved outcomes favouring ABI compared to r-ESWT at the 6-month timepoint using VISA-P, and at all time-points using VAS as outcome measures. The small sample sizes in this pragmatic study are however noted, which limit interpretation, and larger more robust studies are required to investigate this further. This pragmatic prospective cohort study demonstrates improvements following either r-ESWT or ABI procedures, with results potentially favouring ABI over r-ESWT for patients with chronic patella tendinopathy.
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Affiliation(s)
- Patrick C. Wheeler
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK,National Centre for Sport and Exercise Medicine, Loughborough, UK,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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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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Uzun Akkaya K, Akkaya HE, Ozdamar HC, Elbasan B. The acute effects of different hamstring muscle stretching techniques on reducing muscle resistance to movement by ultrasound elastography. J Bodyw Mov Ther 2022; 30:112-117. [DOI: 10.1016/j.jbmt.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/08/2021] [Accepted: 01/15/2022] [Indexed: 11/16/2022]
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Kim DK, Ahn J, Kim SA, Go EJ, Lee DH, Park SC, Shetty AA, Kim SJ. Improved Healing of Rabbit Patellar Tendon Defects After an Atelocollagen Injection. Am J Sports Med 2021; 49:2924-2932. [PMID: 34343026 DOI: 10.1177/03635465211030508] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellar tendinopathy is a common cause of limitations in daily life activities in young and/or active people. The patellar tendon consists of a complex of collagen fibers; therefore, collagen could be used as a scaffold in the treatment of patellar tendinopathy. PURPOSE To evaluate the healing capacity of injected atelocollagen as a treatment scaffold for patellar tendon defect and, hence, its potential for the treatment of patellar tendinopathy. STUDY DESIGN Controlled laboratory study. METHODS After receiving a full-thickness patellar tendon defect, 24 New Zealand White rabbits were divided into a control group (without treatment) and an experimental group that received an atelocollagen injection into the defect. Six rabbits from each group were subsequently used for either histologic scoring or biomechanical testing. The Mann-Whitney U test was used to compare histologic evaluation scores and load to failure between the 2 groups. Statistical significance was set at P < .05. RESULTS The experimental group showed excellent repair of the damaged patellar tendon and good remodeling of the defective area. In contrast, the control group showed defective healing with loose, irregular matrix fibers and adipose tissue formation. A statistically significant difference was found between the 2 groups in both histologic scores and biomechanical tests at postoperative week 12. CONCLUSION Injection of atelocollagen significantly improved the regeneration of damaged patellar tendons. CLINICAL RELEVANCE Atelocollagen gel injections could be used to treat patellar tendinopathy in outpatient clinic settings.
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Affiliation(s)
- Duck Kyu Kim
- Department of Orthopaedic Surgery, Barosun Hospital, Seoul, Republic of Korea
| | - Jiyong Ahn
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Seon Ae Kim
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Jeong Go
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Hwan Lee
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Chan Park
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Asode Ananthram Shetty
- Institute of Medical Sciences, Faculty of Medicine and Social Care, Canterbury Christ Church University, Canterbury, Kent, UK
| | - Seok Jung Kim
- Department of Orthopaedic Surgery, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
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Burton I. Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes. Front Physiol 2021; 12:704306. [PMID: 34421641 PMCID: PMC8375597 DOI: 10.3389/fphys.2021.704306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023] Open
Abstract
Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.
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Affiliation(s)
- Ian Burton
- National Health Service (NHS) Grampian, Aberdeen, United Kingdom
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Ruffino D, Malliaras P, Marchegiani S, Campana V. Inertial flywheel vs heavy slow resistance training among athletes with patellar tendinopathy: A randomised trial. Phys Ther Sport 2021; 52:30-37. [PMID: 34384941 DOI: 10.1016/j.ptsp.2021.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare the efficacy of inertial flywheel and heavy slow resistance training in reducing pain and improving function in patellar tendinopathy. DESIGN Randomised clinical trial. METHODS Fourty two participants (1 woman, 41 men) with longstanding (>3 months) patellar tendinopathy were randomised into inertial flywheel resistance (N = 21) or heavy slow resistance (N = 21) group. Both programmes consisted of three supervised inertial flywheel or heavy slow resistance exercise sessions per week in a fitness center during 12 weeks. Primary outcome was pain and function, assessed by the Spanish Victorian Institute of Sport Assessment for Patella (VISA-P) score at 6 and 12 weeks. Secondary outcomes were activity limitation using Patient Specific Functional Scale (PSFS), health status (EuroQol-5D), patient impression of change on pain and function, adherence, adverse events, pain provocation test for the patellar tendon (numerical rating score of pain between 0 and 10), physical test, patellar tendon thickness and doppler signal on ultrasound. Secondary outcomes were taken at 0 and 12 weeks. RESULTS Both groups showed significant improvements in VISA-P scores from 0 to 12 weeks but there was not statistically significant between-group difference (P = 0.506). No adverse events or side effects occurred in any of the groups during the intervention period. CONCLUSIONS Inertial flywheel resistance three times a week during 12 weeks resulted in similar pain and function benefit at 12 weeks compared with the heavy slow resistance training among people with patellar tendinopathy. Flywheel training is another exercise option for managing people with patellar tendinopathy. CLINICALTRIALS. GOV REGISTRY NCT03917849.
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Affiliation(s)
- Diego Ruffino
- Escuela de Kinesiología y Fisioterapia, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Enrique Barros, Ciudad Universitaria, 5000, Córdoba, Argentina.
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, 3199, Australia.
| | | | - Vilma Campana
- Cátedra Física Biomédica, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Santa Rosa 1085, 5000, Cordoba, Argentina.
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Michael Lazaro R, Souza RB, Luke AC. Patellar mobility and lower limb kinematics during functional activities in individuals with and without patellar tendinopathy. Knee 2021; 30:241-248. [PMID: 33957465 PMCID: PMC8880291 DOI: 10.1016/j.knee.2021.04.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
STUDY DESIGN Case-control. OBJECTIVE To examine whether patients with patellar tendinopathy (PT) display greater patellar mobility and different lower body kinematics than patients without PT. BACKGROUND PT is a common overuse condition of the patellar tendon that can cause pain and impair function. Subjects with overuse knee problems display different hip and knee functional mechanics, specifically valgus collapse. Patellar hypermobility has not been specifically studied as a possible risk factor for PT. METHODS 11 patients with PT and 11 controls without PT, age 18 to 40, were studied. Using a patellofemoral arthrometer (PFA), maximal lateral and medial patellar displacement was measured. 3-D motion analysis was performed to determine lower extremity joint motions during single-leg step down and drop vertical jump tests. RESULTS Patients with PT had significantly increased lateral patellar mobility compared to controls (12.21 ± 3.33 mm vs. 9.19 ± 1.92 mm, P = .017). PT patients showed significantly greater peak hip adduction with both drop vertical jump (2.7° ± 6.3° vs. -5.6° ± 4.2°; P = .003) and step down (17.0° ± 3.8° vs. 12.5° ± 4.4°, P = .024). PT patients demonstrated increased peak ankle external rotation with drop vertical jump (-21.1° ± 5.9° vs. -14.8° ± 5.5°, P = .023) and step down (-15.6° ± 5.5° vs. -9.0° ± 6.0°, P = .017). CONCLUSIONS Patients with PT exhibit increased lateral patellar mobility, hip adduction, and ankle external rotation. The effects of increased patellar mobility deserve further study in the development, management, and prevention of PT.
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Affiliation(s)
- Rondy Michael Lazaro
- Department of Physical Medicine and Rehabilitation, University of Rochester, 601 Elmwood Ave., Box 664, Rochester, NY 14642, USA
| | - Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 185 Berry Street, Suite 350, San Francisco, CA 94107, USA
| | - Anthony C. Luke
- Department of Orthopaedic Surgery, University of California, San Francisco, Orthopaedic Institute, 1500 Owens St., San Francisco, CA 94158, USA,Corresponding author. (A.C. Luke)
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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: 12] [Impact Index Per Article: 4.0] [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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Niering M, Muehlbauer T. Effects of Physical Training on Physical and Psychological Parameters in Individuals with Patella Tendon Myopathy: A Systematic Review and Meta-Analysis. Sports (Basel) 2021; 9:sports9010012. [PMID: 33477955 PMCID: PMC7835831 DOI: 10.3390/sports9010012] [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: 11/18/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
The effectiveness of physical training on physical and psychological parameters in individuals with patella tendinopathy has not been investigated in a systematic review and meta-analysis. The aim of the present study was to determine the effects of physical exercise interventions for measures of physical and psychological performance in subjects with patella tendinopathy. A computerised systematic literature search was conducted in the electronic databases PubMed, Medline, and Web of Science from January 1960 to July 2020. Initially, 506 articles were identified for review of which eleven articles met the inclusion criteria. Our results revealed a small effect (weighted mean standardized mean difference (SMD) = 0.12; nine studies) of physical training on the psychological measure Victorian Institute of Sport Assessment–Patellar tendon scale and a medium effect (weighted mean SMD = 0.61; five studies) on the psychological measure visual analogue scale—both in favour of the intervention group. In contrast, a small effect (weighted mean SMD = −0.05; two studies) in favour of the control group was detected for the physical measure muscle power. Compared to the control condition, physical training seems to be an effective means to improve psychological but not physical parameters in individuals with patella tendinopathy; although conclusions on the latter could have been biased by the small amount of eligible studies (n = 2). In addition, the predetermined cut-off value of ≥6 for the Physiotherapy Evidence Database scale score (i.e., assessment of methodological quality) was only achieved by six out of eleven studies. Thus, further research of high methodological quality is needed to verify whether there is or is not an effect of physical training on physical parameters in persons with patella tendinopathy.
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Affiliation(s)
- Marc Niering
- Department of Health and Social Affairs, FHM Hannover—University of Applied Sciences, 30163 Hannover, Germany
- Correspondence: ; Tel.: +49-(0)511-533-5880
| | - Thomas Muehlbauer
- Division of Movement and Training Sciences/Biomechanics of Sport, University of Duisburg-Essen, 45141 Essen, Germany;
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Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers 2021; 7:1. [PMID: 33414454 DOI: 10.1038/s41572-020-00234-1] [Citation(s) in RCA: 275] [Impact Index Per Article: 91.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molecular features of tendinopathy include disorganization of collagen fibres, an increase in the microvasculature and sensory nerve innervation, dysregulated extracellular matrix homeostasis, increased immune cells and inflammatory mediators, and enhanced cellular apoptosis. Although diagnosis is mostly achieved based on clinical symptoms, in some cases, additional pain-provoking tests and imaging might be necessary. Management consists of different exercise and loading programmes, therapeutic modalities and surgical interventions; however, their effectiveness remains ambiguous. Future research should focus on elucidating the key functional pathways implicated in clinical disease and on improved rehabilitation protocols.
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Affiliation(s)
- Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
| | | | - Kristian Thorborg
- Institute of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leesa M Galatz
- Department of Orthopaedic Surgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Muaidi QI. Rehabilitation of patellar tendinopathy. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:535-540. [PMID: 33265081 PMCID: PMC7716685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/07/2020] [Indexed: 11/02/2022]
Abstract
Patellar tendinopathy is a common musculoskeletal disorder characterized by progressive activity-related anterior knee pain and patellar tendon dysfunction. It is highly prevalent in sports which involve running and jumping. Various treatment methods are used in the management of PT including rest, activity modification, anti-inflammatory medication, injection therapies, taping, eccentric exercises, extra corporeal shock wave therapy, percutaneous electrolysis, and surgery. Even though various treatment options are available for patellar tendinopathy, no single method has proven to result in a consistent and near complete recovery in patients. Conservative management is considered to be the first line of treatment. This study presents an overview of the current practice about the management of patellar tendinopathy with an emphasis on rehabilitation. This review can act as a guide to sports medicine and rehabilitation professionals' decision making in the management of this disorder.
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Affiliation(s)
- Qassim I. Muaidi
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, K.SA
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22
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Aicale R, Oliviero A, Maffulli N. Management of Achilles and patellar tendinopathy: what we know, what we can do. J Foot Ankle Res 2020; 13:59. [PMID: 32993702 PMCID: PMC7523300 DOI: 10.1186/s13047-020-00418-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Tendinopathies are challenging conditions frequent in athletes and in middle-aged overweight patients with no history of increased physical activity. The term “tendinopathy” refers to a clinical condition characterised by pain, swelling, and functional limitations of tendons and nearby structures, the effect of chronic failure of healing response. Tendinopathies give rise to significant morbidity, and, at present, only limited scientifically proven management modalities exist. Achilles and patellar tendons are among the most vulnerable tendons, and among the most frequent lower extremity overuse injuries. Achilles and patellar tendinopathies can be managed primarily conservatively, obtaining good results and clinical outcomes, but, when this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions, and, if performed well, they lead to a relatively high rate of success with few complications. The purpose of this narrative review is to critically examine the recent available scientific literature to provide evidence-based opinions on these two common and troublesome conditions.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Antonio Oliviero
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy.,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy. .,Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy. .,Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England. .,Institute of Science and Technology in Medicine, Keele University, School of Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
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Mitham K, Mallows A, Debenham J, Seneviratne G, Malliaras P. Conservative management of acute lower limb tendinopathies: A systematic review. Musculoskeletal Care 2020; 19:110-126. [PMID: 32979021 DOI: 10.1002/msc.1506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most knowledge regarding conservative management for lower limb tendinopathy (LLT) is for persistent symptoms, with less known about conservative management of acute LLT. Sub-optimal management of acute LLT is detrimental in many regards, not least the likely conversion to persistent symptoms. OBJECTIVES To synthesise existing literature on conservative management of acute LLTs. DESIGN Systematic review of relevant literature (PROSPERO [ID: CRD42018117882]). METHOD A search was made of multiple databases (MEDLINE, CINAHL and EMBASE) using relevant search terms. Titles, abstracts and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction and quality assessment, using the Grading of Recommendations Assessment, Development and Evaluation, were done independently by two authors. To understand how the interventions impacted the duration of reported symptoms, results were split into three time points: short-term (<4 weeks), medium-term (4-12 weeks) and long-term (>12 weeks). RESULTS Thirteen studies (n = 534) met the criteria for inclusion. There was very low level of certainty for the effectiveness of interventions at short-term, medium-term and long-term follow ups. However, there were large effects seen across a number of different treatments on pain intensity and disability in LLTs. CONCLUSIONS This review demonstrates that limited evidence currently exists to guide the management of acute LLT, and the quality of the existing evidence is collectively low. These findings inform the discussion of different treatment options with patients in a shared decision-making process to empower and enable the patient.
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Affiliation(s)
| | - Adrian Mallows
- School of Sport, Rehabilitation & Exercise Sciences, University of Essex, Colchester, UK
| | - James Debenham
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | | | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
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Pietrosimone LS, Blackburn JT, Wikstrom EA, Berkoff DJ, Docking SI, Cook J, Padua DA. Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial. Phys Ther Sport 2020; 46:177-185. [PMID: 32957034 DOI: 10.1016/j.ptsp.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To a) determine the acute effects of a single-dose patellar tendon isometric exercise protocol on involved limb landing biomechanics in individuals with patellar tendinopathy and asymptomatic patellar tendon pathology, and b) determine if individuals with patellar tendinopathy demonstrated changes in pain following a single-dose patellar tendon isometric exercise protocol. DESIGN Single-blinded randomized cross-over trial. SETTING Laboratory; PARTICIPANTS: 28 young male athletes with symptomatic (n = 13, age: 19.62 ± 1.61) and asymptomatic (n = 15, age: 21.13 ± 1.88) patellar tendinopathy. MAIN OUTCOME MEASURES Participants completed a single-dose patellar tendon isometric exercise protocol and a sham-TENS protocol, randomized and separated by 7-10 days. Pain-levels during a single-limb decline squat (SLDS) and three-dimensional biomechanics were collected during a double-limb jump-landing task before and after each intervention protocol. A mixed-model repeated measures ANOVA was conducted to compare change scores for all dependent variables. RESULTS There were no group × intervention interactions for change in pain (F(1, 26) = 0.555, p = 0.463). There was one significant group × intervention interaction for vertical ground reaction force (VGRF) (F(1, 26) = 5.33, p = 0.029). However, post-hoc testing with Bonferroni correction demonstrated no statistical significance for group (SYM: t = -1.679, p = 0.119; ASYM: t = -1.7, p = 0.107) or intervention condition (isometric: t = -2.58, p = 0.016; sham-TENS: 0.72, p = 0.460). There were no further significant group × intervention interactions (p > 0.05). CONCLUSIONS A single-dose patellar tendon isometric exercise protocol did not have acute effects on landing biomechanics or pain levels in male athletes with patellar tendinopathy or asymptomatic patellar tendon pathology.
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Affiliation(s)
- Laura S Pietrosimone
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, NC, USA.
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David J Berkoff
- Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean I Docking
- La Trobe Sports and Exercise Research Centre, LaTrobe University, Bundooram, Australia
| | - Jill Cook
- La Trobe Sports and Exercise Research Centre, LaTrobe University, Bundooram, Australia
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Holden S, Lyng K, Graven-Nielsen T, Riel H, Olesen JL, Larsen LH, Rathleff MS. Isometric exercise and pain in patellar tendinopathy: A randomized crossover trial. J Sci Med Sport 2020; 23:208-214. [DOI: 10.1016/j.jsams.2019.09.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 11/15/2022]
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Effects of Multimodal Intervention Program Among Elite Weightlifters with Knee Pain. Asian J Sports Med 2020. [DOI: 10.5812/asjsm.95220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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López-Royo MP, Gómez-Trullén EM, Ortiz-Lucas M, Galán-Díaz RM, Bataller-Cervero AV, Al-Boloushi Z, Hamam-Alcober Y, Herrero P. Comparative study of treatment interventions for patellar tendinopathy: a protocol for a randomised controlled trial. BMJ Open 2020; 10:e034304. [PMID: 32066608 PMCID: PMC7045155 DOI: 10.1136/bmjopen-2019-034304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Patellar tendinopathy is a degenerative disease of the patellar tendon, which affects athletes from a variety of sports, and is especially predominant in sports involving high-impact jumping. The aim of this study is to determine the additional effect of two interventions combined with eccentric exercise and compare which one is the most effective at short-term and long-term follow-up for patients with patellar tendinopathy. METHODS AND ANALYSIS This study is a randomised controlled trial with blinded participants. Measurements will be carried out by a specially trained blinded assessor. A sample of 57 patients with a medical diagnosis of patellar tendinopathy will participate in this study and will be divided into three treatment groups. Eligible participants will be randomly allocated to receive either: (a) treatment group with percutaneous needle electrolysis, (b) treatment group with dry needling or (c) treatment group with placebo needling. In addition, all groups will perform eccentric exercise. Functionality and muscle strength parameters, pain, ultrasound appearances and patient perceived quality of life shall be evaluated using the Victorian Institute of Sports Assessment for patellar (VISA-P), jump tests, Visual Analogue Scale, ultrasound images and Short Form-36 (SF-36), respectively. Participants will be assessed at baseline, at 10 weeks and at 22 weeks after baseline. The expected findings will allow us to advance in the treatment of this injury, as they will help determine whether a needling intervention has additional effects on an eccentric exercise programme and whether any of the needling modalities is more effective than the other. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee of Aragon (N° PI15/0017). The trial will be conducted in accordance with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT02498795.
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Affiliation(s)
- Maria Pilar López-Royo
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Aragón, Spain
| | - Eva Maria Gómez-Trullén
- Facultad de Ciencias de la Salud y del Deporte, Universidad de Zaragoza, Campus de Huesca, Aragón, Spain
| | - Maria Ortiz-Lucas
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Rita Maria Galán-Díaz
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Ana Vanessa Bataller-Cervero
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Zaid Al-Boloushi
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Aragón, Spain
- Kuwait Ministry of Health, Safat, Al Asimah, Kuwait
| | - Yasmina Hamam-Alcober
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
| | - Pablo Herrero
- iPhysio Research Group, Facultad de Ciencias de la Salud. Universidad San Jorge, Villanueva de Gallego, Aragón, Spain
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Lopezosa-Reca E, Gijon-Nogueron G, Morales-Asencio JM, Cervera-Marin JA, Luque-Suarez A. Is There Any Association Between Foot Posture and Lower Limb-Related Injuries in Professional Male Basketball Players? A Cross-Sectional Study. Clin J Sport Med 2020; 30:46-51. [PMID: 31855912 DOI: 10.1097/jsm.0000000000000563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several studies have shown that foot posture is related to the incidence of ankle sprains in athletes and in nonathletic populations, but this association has not previously been considered in basketball players. This study investigates the relationship between foot posture and lower limb injuries in elite basketball players. DESIGN AND METHOD Two hundred twenty participants were recruited as a convenience sample. The players had a mean age of 22.51 ± 3.88 years and a body mass index of 23.98 ± 1.80. The players' medical records were accessed from the preceding 10 years, and injuries were recorded according to their location (knee, foot, and/or ankle). In addition, the Foot Posture Index (FPI) was scored for each player, and their playing positions were noted. RESULTS An average FPI score of 2.66 was obtained across all players, with guards presenting a significantly lower average FPI of -0.48 (P < 0.001) compared with the rest of playing positions, indicating a more supinated foot. However, center players presented an average FPI of 5.15 (P < 0.001), indicating a more pronated foot. The most common injuries observed were lateral ankle sprain (n = 214) and patellar tendinopathy (n = 126). Patellar tendinopathy was more common in supinated feet (30.08%) compared with 20.7% and 19.8% in pronated and neutral feet, respectively. CONCLUSIONS The most common lower limb injuries observed in basketball players were lateral ankle sprain and patellar tendinopathy. Patellar tendinopathy was more commonly associated with the supinated feet. Guard players tended to have a more supinated foot, whereas centers presented a more pronated foot.
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Chen PC, Wu KT, Chou WY, Huang YC, Wang LY, Yang TH, Siu KK, Tu YK. Comparative Effectiveness of Different Nonsurgical Treatments for Patellar Tendinopathy: A Systematic Review and Network Meta-analysis. Arthroscopy 2019; 35:3117-3131.e2. [PMID: 31699265 DOI: 10.1016/j.arthro.2019.06.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the functional improvement and pain reduction of different nonsurgical treatments for patellar tendinopathy (PT), a systematic review with network meta-analysis was performed. METHODS Studies were comprehensively searched for without language restrictions in the CENTRAL, MEDLINE, EMBASE, Web of Science, Physiotherapy Evidence Database, and SPORTDiscus databases from inception to May 2018. Randomized controlled trials about nonsurgical treatments for PT were included. The outcome measurements were the Victorian Institute of Sports Assessment (VISA) scale and pain scores (such as the visual analog scale or Numerical Rating Scale). Study quality was evaluated using the Physiotherapy Evidence Database score. Direct comparisons were performed using pairwise meta-analysis, whereas network meta-analysis was performed using a frequentist method in a multivariate random-effects model. RESULTS Eleven studies with 430 affected patellar tendons were included in the systematic review. The summary mean difference of improvement in the VISA scale versus the control group for corticosteroid injection was -23.00 (95% confidence interval [CI] -36.73 to -9.27), for leukocyte-rich platelet-rich plasma (LR-PRP) was 13.22 (95% CI 2.37-24.07), for focused extracorporeal shockwave therapy (ESWT) was -1.28 (95% CI -6.25 to 3.68), for radial ESWT was -6.68 (95% CI -20.20 to 6.84), for ultrasound was -0.70 (95% CI -11.23 to 9.83), for autologous blood injection was -0.60 (95% CI -9.30 to 8.10), for dry needling was 17.51 (95% CI -2.57 to 37.60), for topical glyceryl trinitrate was -0.90 (95% CI -13.07 to 11.27), and for skin-derived tendon-like cells was 10.40 (95% CI -1.59 to 22.39). LR-PRP (Surface Under the Cumulative Ranking curve [SUCRA] = 87.5%) or dry needling (SUCRA = 90.5%) was most likely to be ranked the best in terms of improvement on the VISA scale. Compared with the control group, the summary mean difference of the change in pain score for corticosteroid injection was 0.80 (95% CI -3.48 to 5.08), for LR-PRP was -1.87 (95% CI -3.28 to -0.46), for focused ESWT was 0.13 (95% CI -0.68 to 0.93), for radial ESWT was 0.03 (95% CI -1.92 to 1.98), for ultrasound was -0.20 (95% CI -1.49 to 1.09), for autologous blood injection was 0.60 (95% CI -0.73 to 1.93), for dry needling was -0.37 (95% CI -2.71 to 1.97), and for topical glyceryl trinitrate was -0.50 (95% CI -2.55 to 1.55). The treatment most likely to be ranked the best in terms of change in pain score was LR-PRP (SUCRA = 94.9%). CONCLUSIONS The network meta-analysis demonstrated that LR-PRP has the greatest functional improvement and pain reduction for PT compared with other treatment options. However, the treatment effect estimates can be biased by the possible intransitivity and should not be overestimated. LEVEL OF EVIDENCE Level I, meta-analysis of Level I studies.
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Affiliation(s)
- Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Ting Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Yi Chou
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Medical Mechatronic Engineering Program, Cheng Shiu University, Kaohsiung, Taiwan
| | - Yu-Chi Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Lin-Yi Wang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hsun Yang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ka-Kit Siu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Jelinek HF, Khalaf K, Poilvet J, Khandoker AH, Heale L, Donnan L. The Effect of Ankle Support on Lower Limb Kinematics During the Y-Balance Test Using Non-linear Dynamic Measures. Front Physiol 2019; 10:935. [PMID: 31402873 PMCID: PMC6669792 DOI: 10.3389/fphys.2019.00935] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/09/2019] [Indexed: 12/23/2022] Open
Abstract
Background: According to dynamical systems theory, an increase in movement variability leads to greater adaptability, which may be related to the number of feedforward and feedback mechanisms associated with movement and postural control. Using Higuchi dimension (HDf) to measure complexity of the signal and Singular Value Decomposition Entropy (SvdEn) to measure the number of attributes required to describe the biosignal, the purpose of this study was to determine the effect of kinesiology and strapping tape on center of pressure dynamics, myoelectric muscle activity, and joint angle during the Y balance test. Method: Forty-one participants between 18 and 34 years of age completed five trials of the Y balance test without tape, with strapping tape (ST), and with kinesiology tape (KT) in a cross-sectional study. The mean and standard errors were calculated for the center of pressure, joint angles, and muscle activities with no tape, ST, and KT. The results were analyzed with a repeated measures ANOVA model (PA < 0.05) fit and followed by Tukey post hoc analysis from the R package with probability set at P < 0.05. Results: SvdEn indicated significantly decreased complexity in the anterior-posterior (p < 0.05) and internal-external rotation (p < 0.001) direction of the ankle, whilst HDf for both ST and KT identified a significant increase in ankle dynamics when compared to no tape (p < 0.0001) in the mediolateral direction. Taping also resulted in a significant difference in gastrocnemius muscle myoelectric muscle activity between ST and KT (p = 0.047). Conclusion: Complexity of ankle joint dynamics increased in the sagittal plane of movement with no significant changes in the possible number of physiological attributes. In contrast, the number of possible physiological attributes contributing to ankle movement was significantly lower in the frontal and transverse planes. Simply adhering tape to the skin is sufficient to influence neurological control and adaptability of movement. In addition, adaptation of ankle joint dynamics to retain postural stability during a Y Balance test is achieved differently depending on the direction of movement.
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Affiliation(s)
- Herbert F Jelinek
- School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Kinda Khalaf
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Julie Poilvet
- Department of Biology and Computer Science, University of Poitiers, Poitiers, France
| | - Ahsan H Khandoker
- Department of Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Lainey Heale
- School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Luke Donnan
- School of Community Health, Charles Sturt University, Albury, NSW, Australia
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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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Abstract
OBJECTIVE To investigate the effectiveness of an isometric squat exercise using a portable belt, on patellar tendon pain and function, in athletes during their competitive season. DESIGN Case series with no requirements to change any aspect of games or training. The object of this pragmatic study was to investigate this intervention in addition to "usual management." A control or sham intervention was considered unacceptable to teams. SETTING In-season. PARTICIPANTS A total of 25 male and female elite and subelite athletes from 5 sports. INTERVENTION 5 × 30-second isometric quadriceps squat exercise using a rigid belt completed over a 4-week period. MAIN OUTCOME MEASURES (1) single-leg decline squat (SLDS)-a pain provocation test for the patellar tendon (numerical rating score of pain between 0 and 10), (2) VISA-P questionnaire assessing patellar tendon pain and function, and (3) self-reported adherence with completing the exercise over a 4-week period. RESULTS Baseline SLDS pain was high for these in-season athletes, median 7.5/10 (range 3.5-9) and was significantly reduced over the 4-week intervention (P < 0.001, ES r = 0.580, median change 3.5). VISA-P scores improved after intervention (P < 0.001, ES r = 0.568, mean change 12.2 ± 8.9, percentage mean change 18.8%, where minimum clinical important difference of relative change for VISA-P is 15.4%-27%). Adherence was high; athletes reported completing the exercise 5 times per week. CONCLUSIONS This pragmatic study suggests that a portable isometric squat reduced pain in-season for athletes with patellar tendinopathy (PT). This form of treatment may be effective, but clinical trials with a control group are needed to confirm the results.
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Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis. Clin J Sport Med 2019; 29:181-187. [PMID: 31033610 DOI: 10.1097/jsm.0000000000000520] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Currently, no treatments exist for patellar tendinopathy (PT) that guarantee quick and full recovery. Our objective was to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments. DESIGN A secondary analysis was performed on the combined databases of 3 previously performed double-blind randomized controlled trials. PATIENTS In total, 138 patients with PT were included in the analysis. INTERVENTIONS Participants were divided into 5 groups, based on the treatment they received: Extracorporeal shockwave therapy (ESWT) (n = 31), ESWT plus eccentric training (n = 43), eccentric training (n = 17), topical glyceryl trinitrate patch plus eccentric training (n = 16), and placebo treatment (n = 31). MAIN OUTCOME MEASURES Clinical improvement (increase of ≥13 points on the Victorian Institute of Sport Assessment-Patella score) after 3 months of treatment. RESULTS Fifty-two patients (37.7%) improved clinically after 3 months of treatment. Odds ratios (ORs) for clinical improvement were significantly higher in the eccentric training group (OR 6.68, P = 0.009) and the ESWT plus eccentric training group (OR 5.42, P = 0.015) compared with the other groups. We found evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance). CONCLUSIONS Our study confirmed the importance of exercise, and eccentric training in particular, in the management of PT. The role of ESWT remains uncertain. Further research focusing on the identified prognostic factors is needed to be able to design patient-specific treatment protocols for the management of PT.
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Zellmer M, Kernozek TW, Gheidi N, Hove J, Torry M. Patellar tendon stress between two variations of the forward step lunge. JOURNAL OF SPORT AND HEALTH SCIENCE 2019; 8:235-241. [PMID: 31193251 PMCID: PMC6523035 DOI: 10.1016/j.jshs.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 08/23/2016] [Accepted: 10/08/2016] [Indexed: 06/09/2023]
Abstract
BACKGROUND Patellar tendinopathy (PT) or "jumper's knee" is generally found in active populations that perform jumping activities. Graded exposure of patellar tendon stress through functional exercise has been demonstrated to be effective for the treatment of PT. However, no studies have compared how anterior knee displacement variations during the commonly performed forward step lunge (FSL) affect patellar tendon stress. METHODS Twenty-five subjects (age: 22.69 ± 0.74 years; height: 169.39 ± 6.44 cm; mass: 61.55 ± 9.74 kg) performed 2 variations of an FSL with the anterior knee motion going in front of the toes (FSL-FT) and the knee remaining behind the toes (FSL-BT). Kinematic and kinetic data were used with an inverse-dynamics based static optimization technique to estimate individual muscle forces to determine patellar tendon stress during both lunge techniques. A repeated measures multivariate analysis was used to analyze these data. RESULTS The peak patellar tendon stress, stress impulse, quadriceps force, knee moment, knee flexion, and ankle dorsiflexion angle were significantly greater (p < 0.001) during the FSL-FT as compared to the FSL-BT. The peak patellar tendon stress rate did not differ between the FSL-FT and FSL-BT. CONCLUSION The use of an FSL-FT as compared to an FSL-BT increased the load and stress on the patellar tendon. Because a graded exposure of patellar tendon loading with other closed kinetic chain exercises has proven to be effective in treating PT, consideration for the prescription of variations of the FSL and further clinical evaluation of this exercise is warranted in individuals with PT.
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Affiliation(s)
- Matthew Zellmer
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin–La Crosse, La Crosse, WI 54601, USA
| | - Thomas W. Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin–La Crosse, La Crosse, WI 54601, USA
| | - Naghmeh Gheidi
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin–La Crosse, La Crosse, WI 54601, USA
| | - Jordan Hove
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin–La Crosse, La Crosse, WI 54601, USA
| | - Michael Torry
- Department of Kinesiology and Recreation, Illinois State University, Normal, IL 61761, USA
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FIRMINGER COLINR, BRUCE OLIVIAL, WANNOP JOHNW, STEFANYSHYN DARRENJ, EDWARDS WBRENT. Effect of Shoe and Surface Stiffness on Lower Limb Tendon Strain in Jumping. Med Sci Sports Exerc 2019; 51:1895-1903. [DOI: 10.1249/mss.0000000000002004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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King D, Yakubek G, Chughtai M, Khlopas A, Saluan P, Mont MA, Genin J. Quadriceps tendinopathy: a review, part 2-classification, prognosis, and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:72. [PMID: 30963067 DOI: 10.21037/atm.2019.01.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Overuse injuries of the extensor mechanism of the knee are common in both athletes and non-athletes and usually occur during activities associated with repetitive loading, stress, and knee extension. Numerous reports have been published describing extensor mechanism injuries in athletes, but there is a paucity of studies that focus on quadriceps tendinopathy in the non-athlete population. In addition, there is no universally accepted classification system for tendon pathology. Therefore, we performed a comprehensive literature review of these studies. This review consists of 2 parts. In the previous part we reviewed: (I) epidemiology and (II) diagnosis of quadriceps tendinopathy in the athlete as well as the general population. In this part we discuss: (I) classification; (II) prognosis; and (III) treatment results.
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Affiliation(s)
- Dominic King
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - George Yakubek
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Paul Saluan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.,Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Jason Genin
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
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Clinical Measures and Their Contribution to Dysfunction in Individuals With Patellar Tendinopathy. J Sport Rehabil 2019; 28:165-170. [PMID: 29140160 DOI: 10.1123/jsr.2017-0196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Patellar tendinopathy (PT) is prevalent in physically active populations, and it affects their quality of living, performance of activity, and may contribute to the early cessation of their athletic careers. A number of previous studies have identified contributing factors for PT; however, their contributions to self-reported dysfunction remain unclear. OBJECTIVE The purpose of this investigation was to determine if strength, flexibility, and various lower-extremity static alignments contributed to self-reported function and influence the severity of PT. DESIGN Cross-sectional research design. SETTING University laboratory. PARTICIPANTS A total of 30 participants with PT volunteered for this study (age: 23.4 [3.6] y, height: 1.8 [0.1] m, mass: 80.0 [20.3] kg, body mass index: 25.7 [4.3]). MAIN OUTCOME MEASURES Participants completed 7 different patient-reported outcomes. Isometric knee extension and flexion strength, hamstring flexibility and alignment measures of rearfoot angle, navicular drop, tibial torsion, q-angle, genu recurvatum, pelvic tilt, and leg length differences were assessed. Pearson's correlation coefficients were assessed to determine significantly correlated outcome variables with each of the patient-reported outcomes. The factors with the highest correlations were used to identify factors that contribute the most to pain and dysfunction using backward selection, linear regression models. RESULTS Correlation analysis found significant relationships between questionnaires and body mass index (r = -.35-.46), normalized knee extension (r = .38-.50) and flexion strength (r = -.34-.50), flexibility (r = .32-.38, q-angle (r = .38-.56), and pelvic tilt (r = -.40). Regression models (R2 = .22-.54) identified thigh musculature strength and supine q-angle to have greatest predictability for severity in patient-reported outcomes. CONCLUSIONS These findings put an emphasis of bodyweight management, improving knee extensor and flexor strength, and posterior flexibility in PT patients.
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Arthroscopic patellar release allows timely return to performance in professional and amateur athletes with chronic patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2018; 26:3553-3559. [PMID: 29806056 DOI: 10.1007/s00167-018-4985-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Return to sports rates in amateur and professional athletes with chronic patellar tendinopathy following arthroscopic patellar release are unpredictable. The present study aims to analyse the effectiveness of arthroscopic patellar release in professional compared to amateur athletes. METHODS A total of 34 amateur and 20 professional athletes with chronic patellar tendinopathy, refractory to conservative treatment, were studied prospectively and underwent arthroscopic tendon release at the inferior patellar pole. Impact of grouped sports on clinical and functional outcome, subjective patient satisfaction and return to sports rates were assessed. Additionally, preoperative MRI-scans of the knee were evaluated and correlated with clinical outcome. RESULTS In 40 patients (74.1%) arthroscopic patellar release resulted in complete recovery and return to preinjury exercise levels. Full return to sports was achieved after a median of 3.0 (range 0.5-12.0) months. Functional outcome measures VISA-P (Victorian Institute of sport assessment for patella) and modified Blazina scores improved significantly from pre- to postoperatively (VISA-P: 48.8 vs. 94.0 pts., respectively, p < 0.0001; Blazina: 4.47 vs. 0.5, respectively, p < 0.0001). CONCLUSION As rapid recovery and timely return to sports are crucial for professional athletes, arthroscopic patellar release should be considered after failed conservative treatment. LEVEL OF EVIDENCE IV.
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Ross MH, Smith MD, Mellor R, Vicenzino B. Exercise for posterior tibial tendon dysfunction: a systematic review of randomised clinical trials and clinical guidelines. BMJ Open Sport Exerc Med 2018; 4:e000430. [PMID: 30271611 PMCID: PMC6157513 DOI: 10.1136/bmjsem-2018-000430] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 12/25/2022] Open
Abstract
Objective To systematically review all randomised clinical trials to determine the efficacy of local strengthening exercises compared with other forms of conservative management for adults with posterior tibial tendon dysfunction. Design Systematic review. Data sources Four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase and PubMed) were searched up to June 2018. Eligibility criteria for selecting studies The study included randomised clinical trials investigating individuals with posterior tibial tendon dysfunction where local strengthening was compared with other forms of conservative management with respect to pain, function and/or physical impairment outcome measures. Standardised mean differences (SMDs) were used to compare change scores between groups and descriptors of exercise prescription assessed according to the Template for Intervention Description and Replication and the Toigo and Boutellier recommendations. Results 3 studies (n=93) were eligible for inclusion in the review. Varying strengthening exercises were compared with stretching and foot orthoses (n=2) or no intervention (n=1). Moderate effects (SMD 0.6-1.2) were found for reducing pain and disability with eccentric strengthening in conjunction with stretching and orthoses compared with concentric exercises, stretching and orthoses combined, and stretching and orthoses alone. Evaluation of exercise prescription parameters demonstrated minimal reporting, with the only consistent parameters being the number of sets and repetitions of the exercises, and the duration of the experimental period. Conclusion This review demonstrates the paucity of high-quality research for the conservative management of posterior tibial tendon dysfunction, and highlights the lack of exercise prescription parameters reported in clinical trials. Trial registration number CRD42017076156.
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Affiliation(s)
- Megan H Ross
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Michelle D Smith
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Mellor
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Bill Vicenzino
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Basas Á, Cook J, Gómez MA, Rafael MA, Ramirez C, Medeiros B, Lorenzo A. Effects of a strength protocol combined with electrical stimulation on patellar tendinopathy: 42 months retrospective follow-up on 6 high-level jumping athletes. Phys Ther Sport 2018; 34:105-112. [PMID: 30265995 DOI: 10.1016/j.ptsp.2018.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/11/2018] [Accepted: 09/11/2018] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN A retrospective study. INTRODUCTION Patellar tendinopathy (PT) or jumper's knee (JK) in elite athletes is a challenging condition for sports medicine professionals. This study analyzes the development of a protocol using eccentric, isometric, concentric exercises, and electrostimulation to treat elite athletes suffering from JK. The semiannual strength protocol was completed during a total of 36 months by six high-level jumping athletes with chronic painful JK. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS). Upon protocol completion, promising clinical results were evidenced by significant pain reduction during tendon loading activity. MATERIAL AND METHODS Six high level jumping athletes with chronic painful JK completed a semiannual strength program using eccentric, isometric, concentric and electrical stimulation exercises. The protocol was done 12 weeks in the winter pre-season and 10 weeks in the summer pre-season, for altogether 36 months, with an interruption of the protocol at 24 months for 6 months. Pain during patellar tendon loading activity was evaluated on a visual analogue pain scale (VAS), before the first session and then every 6 months, coinciding with the competitive phase, the time of maximum pain. RESULTS There was a significant (p < 0.01) decrease in the VAS from start to the 18, 24 and 48 months follow-ups. CONCLUSIONS In a small group of high level jumping athletes with chronic painful JK, a strength protocol combined with electrical stimulation showed promising clinical results with significant pain reduction during tendon loading activity.
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Affiliation(s)
- Ángel Basas
- Royal Spanish Athletics Federation's Medical Department, Madrid, Spain.
| | - Jill Cook
- La Trobe Sport and Exercise Research Centre, La Trobe University, Melbourne, Australia.
| | - Miguel A Gómez
- Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Spain
| | - Manuel A Rafael
- Royal Spanish Athletics Federation's Medical Department, Madrid, Spain
| | | | | | - Alberto Lorenzo
- Faculty of Physical Activity and Sport Science, Polytechnic University of Madrid, Spain
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Affiliation(s)
- Alexandre D Lopes
- University of Massachusetts Lowell; Department of Physical Therapy; 3 Solomont Way Room 208 Lowell Massachusetts USA 01854-5124
| | - Luiz Carlos Hespanhol Junior
- VU University Medical Center; Department of Public and Occupational Health, EMGO Institute for Health and Care Research; Van der Boechorststraat 7 Amsterdam Noord-Holland Brazil 1081 BT
| | - Steven J Kamper
- The George Institute for Global Health; Musculoskeletal Division; PO Box M201 Missenden Road, Camperdown Sydney NSW Australia 2050
| | - Leonardo OP Costa
- Universidade Cidade de São Paulo; Masters and Doctoral Programs in Physical Therapy; Rua Cesário Galeno 448 São Paulo Brazil 03071-000
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Lim HY, Wong SH. Effects of isometric, eccentric, or heavy slow resistance exercises on pain and function in individuals with patellar tendinopathy: A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 23:e1721. [PMID: 29972281 DOI: 10.1002/pri.1721] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/15/2018] [Accepted: 05/06/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study is to evaluate current evidence and provide a review on the effects of isometric, eccentric, or heavy slow resistance (HSR) exercises on pain and function in individuals with patellar tendinopathy (PT). METHODS Academic journals from CINAHL, Embase, MEDLINE, Scopus, SPORTDiscus™, and The Cochrane Library were searched from inception to August 2017. Screening of reference lists was also performed. Human interventional studies investigating outcomes of pain and function in PT using either isometric, eccentric, or HSR training exercises were included. The McMaster Critical Review Form-Quantitative Studies was used to assess for risk of bias. Levels of evidence were obtained using the National Health and Medical Research Council (NHMRC) evidence hierarchy. The NHMRC Body of Evidence Framework was utilized to formulate recommendations for clinical practice. Extraction of data was performed by two independent reviewers according to predefined data criterion, data were then tabulated, and a descriptive, qualitative data synthesis was performed. RESULTS Fifteen studies (3 isometric, 2 HSR, and 10 eccentric) were included for this review. Mean quality score across all studies was 81.6% (range 70% to 93%). Nine studies were of high quality, whereas six studies were of moderate quality. Nine studies were randomized controlled trials, which provided good Level II evidence; four studies were of satisfactory Level III evidence; and two studies were case series (Level IV evidence). CONCLUSIONS Findings from isometric exercises can be trusted to guide clinical practice (Grade A), whereas eccentric exercises can be trusted to guide clinical practice in most clinical situations (Grade B). It is recommended that HSR exercises should be applied carefully to individual clinical circumstances (Grade C) and interpreted with care. Isometric exercises appear to be more effective during competitive seasons for short-term pain relief, whereas HSR or eccentric exercises are more suitable for long-term pain reduction and improvement in knee function.
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Affiliation(s)
- Hui Yin Lim
- School of Physiotherapy, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department Physiotherapy, Rehabilitative Services, Changi General Hospital, Singapore
| | - Shi Hui Wong
- School of Physiotherapy, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Department Physiotherapy, Rehabilitative Services, Changi General Hospital, Singapore
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Bell R, Gendron NR, Anderson M, Flatow EL, Andarawis-Puri N. A potential new role for myofibroblasts in remodeling of sub-rupture fatigue tendon injuries by exercise. Sci Rep 2018; 8:8933. [PMID: 29895865 PMCID: PMC5997675 DOI: 10.1038/s41598-018-27196-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/30/2018] [Indexed: 12/14/2022] Open
Abstract
Tendons are ineffective at repairing sub-rupture fatigue injuries. Accordingly, we evaluated whether an exercise protocol that we have previously found to decrease structural damage kinks in fatigue damaged tendons, leads to improvement in mechanical properties. We hypothesized that exercise that promotes repair of fatigue damage will decrease apoptosis and increase the population of myofibroblasts. Rat patellar tendons underwent in vivo fatigue loading for 500 or 7200 cycles. Animals resumed cage activity for 2-weeks, then either remained cage active or began treadmill running until sacrifice at 4- or 10-weeks post-fatigue loading. Exercise following fatigue damage increased the stiffness back towards naïve levels, decreased apoptosis and increased the population of myofibroblasts. Next, proteins associated with inhibition of apoptosis (Collagen VI) or activation of myofibroblast (pSmad 2/3, fibrillin, integrin subunits αV and α5) were evaluated. Data suggests that collagen VI may not be integral to inhibition of apoptosis in this context. Exercise increased pSmad 2/3 and fibrillin in the insertion region for the 7200-cycles group. In addition, exercise decreased integrin αV and increased integrin α5 in fatigue damaged tendons. Data suggests that a decrease in apoptosis and an increase in population of myofibroblasts may be integral to remodeling of fatigue damaged tendons.
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Affiliation(s)
- Rebecca Bell
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA
| | - N Remi Gendron
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Anderson
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Evan L Flatow
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nelly Andarawis-Puri
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA. .,Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA. .,Hospital for Special Surgery, New York, NY, USA.
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Abstract
Zusammenfassung. Sportliche Aktivitäten mit Sprungabläufen stellen für die Kniegelenke eine mechanische Herausforderung dar. Häufig projizieren sich chronisch auftretende, atraumatische Beschwerden auf den Patellaunterpol, welcher pathomorphologisch eine patellare Tendinopathie entspricht. Extrinsische und intrinsische Risikofaktoren können unterschieden werden. In der klinischen Untersuchung zeigt sich ein meist unauffälliges Knie mit einer Druckdolenz am kaudalen Teil der Kniescheibe beim Übergang zum Ligamentum patellae. In der Bildgebung ist sonografisch ein degenerierter Sehnenanteil der tiefen Patellarsehne zu erkennen, der magnettomografisch mit Hyperintensität des Hoffa-Körpers einhergehen kann. Abhängig von der klinischen Entwicklung wird das Jumper’s Knee nach Blazina Grad I–IV eingeteilt. Bis zu 90 % der Patienten können konservativ therapiert werden. Operativ stehen offene und arthroskopische Verfahren mit ordentlichem Resultat zur Verfügung.
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Affiliation(s)
| | - Method Kabelitz
- 1 Abteilung für Orthopädie, Universitätsklinik Balgrist, Zürich
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45
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Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Joint Surg Am 2018; 100:251-263. [PMID: 29406349 DOI: 10.2106/jbjs.17.00661] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Daniel Moya
- Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Silvia Ramón
- Hospital Quirón, Barcelona, Fundación García Cugat, Spain
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COMPARISON OF FUNCTIONAL ACTIVITIES ON STRUCTURAL CHANGES OF THE INFERIOR PATELLAR POLE. Int J Sports Phys Ther 2017; 12:1095-1102. [PMID: 29234561 DOI: 10.26603/ijspt20171095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background It is well known that eccentric and concentric exercise produce varied amounts of stress on the connective tissues. Diagnostic ultrasound has been used to measure these structural changes by observing fascicle length, angle, and thickness; however, there is a lack of evidence comparing the structural changes as it relates to eccentric, concentric, and stretching protocols. Purpose The purpose of this study was to compare the acute effects of static stretching, eccentric, concentric, and a combination of eccentric/concentric exercises on structural changes of the muscle tendon unit at the inferior patellar pole utilizing the diagnostic ultrasound. Study Design A repeated measures 2 × 4 within factorial study design with repeated measures on both factors was used to determine the differences in patellar tendon thickness within and between groups. Methods Forty-seven healthy subjects were screened for any lower extremity deficits or orthopaedic pathology. Forty-four (N=44) subjects completed all four protocols; the attrition was due to injuries to the lower extremity, occurring unrelated to the study. A baseline measurement of the anterior inferior patellar tendon was performed with the diagnostic ultrasound prior to each participant completing one of the four interventions per week over a four-week period. Interventions completed by each participant included static stretching, concentric, eccentric, and combined concentric and eccentric exercises. Immediately following each intervention, a post-intervention inferior patellar tendon measurement was recorded using the diagnostic ultrasound. Results Significant differences in anterior to posterior tendon thickness of the inferior patellar tendon were observed between pre (4.983 ± 0.041mm) and post (5.198 ± 0.055mm) measurements (p<0.0005) for the main effect of time. However, no differences in tendon thickness were noted comparing each intervention to one another (p=0.351). Conclusion Differences in tendon thickness were noted acutely for pre- to post measurements across all interventions. Further research is needed to determine if differences in tendon thickness exist with a longer duration of exercise over time and with different types of intervention.
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Sanz-López F, Berzosa C, Hita-Contreras F, Martínez-Amat A. Effects of eccentric overload training on patellar tendon and vastus lateralis in three days of consecutive running. Knee 2017; 24:570-579. [PMID: 28342723 DOI: 10.1016/j.knee.2017.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/31/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The analysis of structural changes in patellar tendon and muscle of healthy subjects in response to mechanical loads provides useful insight into the mechanism underlying overuse injuries. METHODS Changes produced in tendon and muscles structures after eccentric overload training and three consecutive running days were examined. Twenty healthy subjects were recruited and divided into two groups. One group (ECC) performed eccentric overload squat training (six weeks). After such training, the ECC group performed three running sessions on consecutive days, as did the control group (CONT). The structure of their patellar tendons and vastus lateralis muscles was quantified using ultrasound and Doppler imaging. Images were obtained before and after eccentric training for the ECC group and on every day of running performance for both groups. RESULTS After eccentric training, the ECC group experienced an increase in cross-sectional area (CSA) of patellar tendon (P=0.012). After every day of running, the ECC group experienced a decrease in CSA (P=0.027). In the CONT group, after one day of running a significant increase was observed in anteroposterior width of their patellar tendon (P=0.028), as well as a decrease in pennation angle of vastus lateralis muscle (P=0.028) within three days of running sessions. CONCLUSIONS Eccentric overload training brought about changes in the patellar tendon consistent with an improvement in the quality of the tissue. The ECC group in our study showed a more normalised pattern than the CONT group in the running performance, in agreement with previous research. LEVEL OF EVIDENCE Level 3, controlled trial.
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Affiliation(s)
- Fernando Sanz-López
- ValorA Research Group, Health Sciences Faculty, Universidad San Jorge, Zaragoza, Spain.
| | - César Berzosa
- ValorA Research Group, Health Sciences Faculty, Universidad San Jorge, Zaragoza, Spain
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain; Research Group CTS-026: Study Group on Physical Activity, Physiotherapy and Health, Jaén, Spain
| | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain; Research Group CTS-026: Study Group on Physical Activity, Physiotherapy and Health, Jaén, Spain
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Abat F, Alfredson H, Cucchiarini M, Madry H, Marmotti A, Mouton C, Oliveira JM, Pereira H, Peretti GM, Romero-Rodriguez D, Spang C, Stephen J, van Bergen CJA, de Girolamo L. Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. J Exp Orthop 2017; 4:18. [PMID: 28560707 PMCID: PMC5449348 DOI: 10.1186/s40634-017-0092-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/12/2017] [Indexed: 12/05/2022] Open
Abstract
Chronic tendinopathies represent a major problem in the clinical practice of sports orthopaedic surgeons, sports doctors and other health professionals involved in the treatment of athletes and patients that perform repetitive actions. The lack of consensus relative to the diagnostic tools and treatment modalities represents a management dilemma for these professionals. With this review, the purpose of the ESSKA Basic Science Committee is to establish guidelines for understanding, diagnosing and treating this complex pathology.
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Affiliation(s)
- F Abat
- Department of Orthopaedic Sports Medicine, ReSport Clinic, Passeig Fabra i Puig 47, 08030, Barcelona, Spain.
| | - H Alfredson
- Sports Medicine Unit, University of Umeå, Umeå, Sweden.,Alfredson Tendon Clinic Inc, Umeå, Sweden.,Pure Sports Medicine Clinic, ISEH, UCLH, London, UK
| | - M Cucchiarini
- Molecular Biology, Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr Bldg 37, 66421, Homburg/Saar, Germany
| | - H Madry
- Lehrstuhl für Experimentelle Orthopädie und Arthroseforschung, Universität des Saarlandes, Gebäude 37, Kirrbergerstr 1, 66421, Homburg, Germany
| | - A Marmotti
- Department of Orthopaedics and Traumatology, San Luigi Gonzaga Hospital, Orbassano, University of Turin, Turin, Italy
| | - C Mouton
- Department of Orthopedic Surgery, Clinique d'Eich-Centre Hospitalier de Luxembourg, 76, rue d'Eich, L-1460, Luxembourg, Luxembourg
| | - J M Oliveira
- 3B's Research Group - Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Zona Industrial da Gandra, 4805-017, Barco, GMR, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - H Pereira
- 3B's Research Group University of Minho, ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal.,Orthopedic Department Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal.,Ripoll y De Prado Sports Clinic - FIFA Medical Centre of Excellence, Murcia, Madrid, Spain
| | - G M Peretti
- IRCCS Istituto Ortopedico Galeazzi, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - D Romero-Rodriguez
- Department of Physical Therapy and Sports Rehabilitation, ReSport Clinic Barcelona, Barcelona, Spain.,EUSES Sports Science, University of Girona, Girona, Spain
| | - C Spang
- Department of Integrative Medical Biology, Anatomy Section, Umeå University, Umeå, Sweden
| | - J Stephen
- Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.,The Biomechanics Group, Department of Mechanical Engineering, Imperial College, London, UK
| | - C J A van Bergen
- Department of Orthopedic Surgery, Amphia Hospital Breda, Breda, The Netherlands
| | - L de Girolamo
- Orthopaedic Biotechnology Laboratory, Galeazzi Orthopaedic Institute, Milan, Italy
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Barker-Davies RM, Nicol A, McCurdie I, Watson J, Baker P, Wheeler P, Fong D, Lewis M, Bennett AN. Study protocol: a double blind randomised control trial of high volume image guided injections in Achilles and patellar tendinopathy in a young active population. BMC Musculoskelet Disord 2017; 18:204. [PMID: 28532478 PMCID: PMC5441076 DOI: 10.1186/s12891-017-1564-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 05/09/2017] [Indexed: 01/06/2023] Open
Abstract
Background Chronic tendinopathy is a significant problem particularly in active populations limiting sporting and occupational performance. The prevalence of patellar tendinopathy in some sports is near 50% and the incidence of lower limb tendinopathy is 1.4% p.a. in the UK Military. Management includes isometric, eccentric, heavy slow resistance exercises and extracorporeal shockwave therapy (ESWT). Often these treatments are inadequate yet there is no good evidence for injection therapies and success rates from surgery can be as low as 50%. High Volume Image Guided Injection (HVIGI) proposes to strip away the neovascularity and disrupt the nerve ingrowth seen in chronic cases and has shown promising results in case series. This study aims to investigate the efficacy of HVIGI in a randomised controlled trial (RCT). Methods RCT comparing 40ml HVIGI, with or without corticosteroid, with a 3ml local anaesthetic sham-control injection. Ninety-six participants will be recruited. Inclusion criteria: male, 18–55 years old, chronic Achilles or patellar tendinopathy of at least 6 months, failed conservative management including ESWT, and Ultrasound (US) evidence of neovascularisation, tendon thickening and echogenic changes. Outcome measures will be recorded at baseline, 6 weeks, 3, 6 and 12 months. Primary outcome measures include The Victoria Institute of Sport Assessments for Achilles and patellar tendinopathy (VISA-A and VISA-P) and VAS pain. Secondary outcome measures include Modified Ohberg score, maximum tendon diameter and assessment of hypoechoic appearance on US, and Functional Activity Assessment. Discussion Despite previous interventional trials and reviews there is still insufficient evidence to guide injectable therapy for chronic tendinopathy that has failed conservative treatment. The scant evidence available suggests HVIGI has the greatest potential however there is no level one RCT evidence to support this. Investigating the efficacy of HVIGI against control in a RCT and separating the effect of HVIGI and corticosteroid will add high level evidence to the management of chronic tendinopathy resistant to conservative treatment. Trial Registration EudraCT: 2015-003587-36 3 Dec 2015
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Affiliation(s)
- Robert M Barker-Davies
- Academic Department of Military Rehabilitation, DMRC Headley Court, Epsom, Surrey, KT18 6JW, UK. .,School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine-East Midlands, Loughboruough University, Leicestershire, LE11 3TU, UK.
| | - Alastair Nicol
- Academic Department of Military Rehabilitation, DMRC Headley Court, Epsom, Surrey, KT18 6JW, UK
| | - I McCurdie
- Academic Department of Military Rehabilitation, DMRC Headley Court, Epsom, Surrey, KT18 6JW, UK
| | - James Watson
- Academic Department of Military Rehabilitation, DMRC Headley Court, Epsom, Surrey, KT18 6JW, UK
| | - Polly Baker
- Academic Department of Military Rehabilitation, DMRC Headley Court, Epsom, Surrey, KT18 6JW, UK
| | - Patrick Wheeler
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine-East Midlands, Loughboruough University, Leicestershire, LE11 3TU, UK
| | - Daniel Fong
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine-East Midlands, Loughboruough University, Leicestershire, LE11 3TU, UK
| | - Mark Lewis
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine-East Midlands, Loughboruough University, Leicestershire, LE11 3TU, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, DMRC Headley Court, Epsom, Surrey, KT18 6JW, UK
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50
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Thijs KM, Zwerver J, Backx FJG, Steeneken V, Rayer S, Groenenboom P, Moen MH. Effectiveness of Shockwave Treatment Combined With Eccentric Training for Patellar Tendinopathy: A Double-Blinded Randomized Study. Clin J Sport Med 2017; 27:89-96. [PMID: 27347857 DOI: 10.1097/jsm.0000000000000332] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a combined treatment of focused shockwave therapy (ESWT) and eccentric training compared with sham-shockwave therapy (placebo) and eccentric training in participants with patellar tendinopathy (PT) after 24 weeks. DESIGN Randomized controlled trial. SETTING Sports medicine departments of a university hospital and a general hospital in the Netherlands. PARTICIPANTS Fifty-two physically active male and female participants with a clinical diagnosis of PT (mean age: 28.6 years; range, 18-45) were randomly allocated to the ESWT (n = 22) or sham shockwave (n = 30). INTERVENTIONS Extracorporeal shockwave therapy and sham shockwave were applied in 3 sessions at 1-week intervals with a piezoelectric device. All participants were instructed to perform eccentric exercises (3 sets of 15 repetitions twice a day) for 3 months on a decline board at home. MAIN OUTCOME MEASURES The Victorian Institute of Sport Assessment-Patella (VISA-P) scores (primary), pain scores during functional knee loading tests, and Likert score (secondary) were registered at baseline and at 6, 12, and 24 weeks after the start with the ESWT or sham-shockwave treatment. RESULTS No significant differences for the primary and secondary outcome measures were found between the groups. In the ESWT/eccentric group, the VISA-P increased from 54.5 ± 15.4 to 70.9 ± 17.8, whereas the VISA-P in the sham-shockwave/eccentric group increased from 58.9 ± 14.6 to 78.2 ± 15.8 (between-group change in VISA-P at 24 weeks -4.8; 95% confidence interval, -12.7 to 3.0, P = 0.150). CONCLUSIONS This study showed no additional effect of 3 sessions ESWT in participants with PT treated with eccentric exercises. The results should be interpreted with caution because of small sample size and considerable loss to follow-up, particularly in the ESWT group.
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Affiliation(s)
- Karin M Thijs
- *Department of Rehabilitation, Nursing Science and Sport, University Medical Centre Utrecht, Utrecht, the Netherlands; †Center for Sports Medicine Groningen, University Medical Center Groningen, University of Groningen, the Netherlands; ‡Department of Physical Therapy, Orthopedic Centre Annatommie MC, Utrecht, the Netherlands; §Department of Physical Therapy, Rayer Health Care Physical Therapy, Zoetermeer, the Netherlands; ¶Department of Sports Medicine, Medical Centre Haaglanden, Leidschendam, the Netherlands; ‖Department of Sports Medicine, Bergman Clinics, Naarden, the Netherlands; and **The Sportsphysician Group, OLVG West, Amsterdam, the Netherlands
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