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Gonzalez FM, Gleason CN, Tran A, Wasyliw C, Risk BB, Faulkner ES, Blackmon AM, Reiter DA. Differences in Achilles tendon mechanical properties between professional ballet dancers and collegiate athletes utilizing shear wave elastography. Skeletal Radiol 2024; 53:1381-1388. [PMID: 38277027 DOI: 10.1007/s00256-024-04564-z] [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: 08/30/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
PURPOSE To report normative stiffness parameters obtained using shear wave elastography in dorsiflexion from the Achilles tendons in asymptomatic professional ballet dancers and compare them with college-level athletes. METHODS An Institutional Review Board (IRB)-approved study consists of 28 professional ballet dancers and 64 asymptomatic collegiate athletes. The athletes were further subdivided into runner and non-runner disciplines. Shear wave elastography (SWE) measurements were made in maximum ankle dorsiflexion position. RESULTS AND DISCUSSION Forty-eight (52%) males and 44 (48%) females were examined with an overall mean age of 22.2 (± 3.8 years). There were no significant SWE differences between dominant and non-dominant legs in both groups and comparing spin vs. non-spin leg of ballet dancers (p > 0.05). Ballet dancers had significantly higher short-axis velocity values than runners and non-runners (2.34 m/s increase and 2.79 m/s increase, respectively, p < 0.001). Long-axis velocity was significantly higher in ballet dancers compared to non-runners (by 0.80 m/s, p < 0.001), but was not different between ballet dancers and runners (p > 0.05). Short-axis modulus was significantly higher in dancers compared to runners and non-runners (by 135.2 kPa and 159.2 kPa, respectively, p < 0.001). Long-axis modulus (LAM) was not significantly different in ballet dancers when compared to runners. CONCLUSION Asymptomatic professional ballet dancers exhibit greater short-axis tendon stiffness compared to athletes and greater long-axis tendon stiffness compared to non-runners but similar to runners. The functional benefit from elevated short-axis stiffness in dancers is not clear but may be related to greater axial loading and adaptations of the tendon matrix.
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Affiliation(s)
| | | | - Andrew Tran
- Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology, Thomas Jefferson Hospital, Philadelphia, PA, USA
| | | | - Benjamin B Risk
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | - David A Reiter
- Department of Orthopaedics, Emory School of Medicine, Atlanta, GA, USA
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Emory University and Georgia Tech, Atlanta, GA, USA
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Qureshi AU, Hameed M, Umar M, Yasir U, Abbas Z, Jamil S, Masroor L, Arshad A, Tahir S, Ibrahim Raza M. A Comparative Study of the Graston Technique and Alfredson Protocol in the Management of Achilles Tendinopathy. Cureus 2024; 16:e62249. [PMID: 39006664 PMCID: PMC11244946 DOI: 10.7759/cureus.62249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The Achilles tendon, the largest and strongest tendon in the human body, is frequently injured by overuse; this condition is known as Achilles tendinopathy (AT). It serves as a link between the heel bone and the calf muscles and is necessary for motions, such as walking, sprinting, and jumping. Evidence is presented to support the efficacy of the Graston technique and Alfredson protocol for pain reduction and improvement of function and calf muscle strength. The objective of this study is to compare the efficacy of the Graston technique versus the Alfredson protocol in patients with AT. Methods and data collection: After obtaining approval from the ethical review board of the Rawalpindi Medical University, all patients fulfilling the inclusion criteria are divided into two groups, A and B, by generating random identity numbers using Microsoft Excel for allocation. Group A comprises patients who undergo treatment with the Graston technique as conventional therapy with Alfredson protocol (12-week calf muscle eccentric exercises), while those in group B follow a Graston technique with sole heel lift. Individuals in the eccentric exercises group follow an Alfredson method-based 12-week eccentric exercise plan for their leg muscles. The workouts need to be done twice a day, seven days a week for 12 weeks. The plan includes two exercises: the first done with the knee straightened to work the gastrocnemius and the second done with the knee bent to work the soleus. Three sets of 15 repetitions with no rest interval for each exercise are completed twice a day on the affected limb to yield functional improvement. RESULTS The results showed that both the Alfredson protocol and the Graston technique were effective in managing AT symptoms. The study involved dividing 32 participants into two groups who received either treatment for four weeks. The main way to measure improvement was a score called the Villalta-Scanlon Achilles Tendonitis Index score. In both groups, these scores showed significant improvement (with a p-value less than 0.001, which means that the results are very statistically significant). For Group A (who received the Alfredson protocol), the average Villalta-Scanlon Achilles Tendonitis Index score before treatment was 29.25. This score increased to 31.25 at mid-treatment and 34.38 after the full four weeks of treatment. Group B (who received the Graston technique) started with an average Villalta-Scanlon Achilles Tendonitis Index score of 22.94. Their scores also increased throughout the treatment, reaching 34.94 at mid-treatment and 42.88 after four weeks. These findings provide evidence that both treatments can improve AT symptoms, with some suggestions that the Graston technique might be even more effective based on the higher average Villalta-Scanlon Achilles Tendonitis Index scores after treatment. CONCLUSIONS The Graston technique shows promising results, particularly in the mid- and post-treatment phases, indicating its potential efficacy in comparison to the Alfredson protocol in the treatment of AT.
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Affiliation(s)
| | - Muddsar Hameed
- Department of Clinical Psychology, Shifa Tameer-e-Millat University, Islamabad, PAK
| | - Muhammad Umar
- Department of Physiotherapy, Rawalpindi Medical University, Rawalpindi, PAK
| | - Umer Yasir
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, PAK
| | - Zamurd Abbas
- Department of Medicine, International European University, Bishkek, KGZ
| | - Sarem Jamil
- Department of Anatomy, Khyber Medical College, Peshawar, PAK
| | - Linta Masroor
- Department of Orthopaedics, Shifa Tameer-e-Millat University, Islamabad, PAK
| | - Arusa Arshad
- Department of Medicine, Fazaia Medical College, Islamabad, PAK
| | - Saima Tahir
- Department of Medicine, International European University, Bishkek, KGZ
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Tsai MS, Domroes T, Pentidis N, Koschinski S, Schroll A, Bohm S, Arampatzis A, Mersmann F. Effect of the temporal coordination and volume of cyclic mechanical loading on human Achilles tendon adaptation in men. Sci Rep 2024; 14:6875. [PMID: 38519507 PMCID: PMC10960029 DOI: 10.1038/s41598-024-56840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
Human tendons adapt to mechanical loading, yet there is little information on the effect of the temporal coordination of loading and recovery or the dose-response relationship. For this reason, we assigned adult men to either a control or intervention group. In the intervention group, the two legs were randomly assigned to one of five high-intensity Achilles tendon (AT) loading protocols (i.e., 90% maximum voluntary contraction and approximately 4.5 to 6.5% tendon strain) that were systematically modified in terms of loading frequency (i.e., sessions per week) and overall loading volume (i.e., total time under loading). Before, at mid-term (8 weeks) and after completion of the 16 weeks intervention, AT mechanical properties were determined using a combination of inverse dynamics and ultrasonography. The cross-sectional area (CSA) and length of the free AT were measured using magnetic resonance imaging pre- and post-intervention. The data analysis with a linear mixed model showed significant increases in muscle strength, rest length-normalized AT stiffness, and CSA of the free AT in the intervention group (p < 0.05), yet with no marked differences between protocols. No systematic effects were found considering the temporal coordination of loading and overall loading volume. In all protocols, the major changes in normalized AT stiffness occurred within the first 8 weeks and were mostly due to material rather than morphological changes. Our findings suggest that-in the range of 2.5-5 sessions per week and 180-300 s total high strain loading-the temporal coordination of loading and recovery and overall loading volume is rather secondary for tendon adaptation.
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Affiliation(s)
- Meng-Shiuan Tsai
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Theresa Domroes
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Nikolaos Pentidis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Sophia Koschinski
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Arno Schroll
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin School of Movement Science, Berlin, Germany
| | - Falk Mersmann
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.
- Berlin School of Movement Science, Berlin, Germany.
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Di Gesù M, Alito A, Borzelli D, Romeo D, Bonomolo F, Calafiore D, de Sire A. Efficacy of ultrasound-guided galvanic electrolysis technique and physical therapy in patients with Achilles' tendinopathy: A pilot randomised controlled trial. J Back Musculoskelet Rehabil 2024:BMR230255. [PMID: 38517770 DOI: 10.3233/bmr-230255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND Ultrasound-guided galvanic electrolysis technique (USGET) is an innovative mini-invasive intervention with the potential to optimise outcomes in the treatment of Achille's tendinopathy (AT). OBJECTIVE The aim of this pilot study is to evaluate the efficacy of adding USGET to conventional eccentric exercise treatment in patients with chronic AT. METHODS Inclusion criteria were patients with unilateral non-insertional AT, pain lasting > 3 months, aged 25-60 years. Patients were randomised in two groups receiving the same physiotherapy treatment (2 sessions per week for 8 weeks). In addition, the experimental group received three USGET stimulations, one every 15 days. Outcome measures were assessment of Achilles tendinopathy severity using the Victorian Institute of Sport Assessment-Achilles (VISA-A) and pain intensity using the Visual Analogue Scale (VAS). Assessment points occurred at the onset of treatment (T0), its conclusion (T1), and subsequent follow-ups at one (T2) and two months (T3). RESULTS Out of the 52 patients who met the study inclusion criteria, two participants withdrew from the study, resulting in a total of 50 subjects who completed the research. None of the parameters showed a different distribution at T1 (p> 0.337). At T2, there was a statistical difference in VISA-A (p= 0.010) and its subscales and VAS (p= 0.002) in the USGET group. At T3, both groups improved with a statistical difference observed in VISA-A (p< 0.001) and its subscales Pain (p= 0.004), Function (p= 0.003) and Sport (p= 0.002), but the EG patients showed a greater improvement. No adverse events were reported. CONCLUSION The effect of USGET combined with eccentric exercise appears to be a safe and effective technique for achieving pain relief and functional recovery in the medium term, supporting the integrated use of USGET as a rehabilitative treatment option for patients with chronic AT.
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Affiliation(s)
| | - Angelo Alito
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Daniele Borzelli
- Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Domenico Romeo
- Physiocare: Physiotherapy Rehabilitation Center, Augusta, Italy
| | | | - Dario Calafiore
- Department of Neurosciences, Physical Medicine and Rehabilitation Unit, ASST Carlo Poma, Mantova, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Physical and Rehabilitative Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Li W, Hadizadeh M, Yusof A, Naharudin MN. Effects of isometric training and R.I.C.E. treatment on the arm muscle performance of swimmers with elbow pain. Sci Rep 2024; 14:4736. [PMID: 38413632 PMCID: PMC10899567 DOI: 10.1038/s41598-024-54789-0] [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: 08/29/2023] [Accepted: 02/16/2024] [Indexed: 02/29/2024] Open
Abstract
The effects of IT and R.I.C.E. treatment on arm muscle performance in overhead athletes with elbow pain (EP) have been partially validated. However, there is a lack of research evidence regarding the efficacy of these two methods on arm muscle performance among swimmers with EP. The aim of this study was to investigate the trends and differences in the effects of IT and R.I.C.E. treatment on arm muscle performance among swimmers with EP. The main outcomes were the time effects and group effects of interventions on muscle voluntary contraction (MVC). Sixty elite freestyle swimmers from Tianjin, China, voluntarily participated in the study and completed a 10-week intervention program. Swimmers with EP in the IT group showed a positive trend in MVC, with an approximately 2% increase, whereas the MVC of subjects in the R.I.C.E. treatment group and control group decreased by approximately 4% and 5%, respectively. In comparison, the effects of the IT intervention on the MVC of the triceps and brachioradialis muscles in swimmers with EP were significant (p = 0.042 < 0.05, p = 0.027 < 0.05). The mean MVC value of the IT group (0.60) was greater than that of the other two groups (0.51, 0.50). IT has a beneficial impact on the MVC performance of the triceps and brachioradialis muscles in swimmers with EP. It is recommended that professionals consider incorporating IT into regular training routines to mitigate the risk of EP issues. Future research should examine the effectiveness of both interventions on hand-grip strength and completion time in 50-m freestyle swim drills in order for swimmers with EP to return to this sport.
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Affiliation(s)
- Weihan Li
- Faculty of Sports and Exercise Science, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Maryam Hadizadeh
- Faculty of Sports and Exercise Science, Universiti Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Ashril Yusof
- Faculty of Sports and Exercise Science, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Kazantayev KE, Mukhamedkerim KB, Muradov MI, Nabiyev Y, Turdalieva BS. Restoring Function of the Flexor Tendons of the Hand: State of the Science in Kazakhstan. PLASTIC AND AESTHETIC NURSING 2023; 43:219-224. [PMID: 37774170 DOI: 10.1097/psn.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
We conducted a literature review to highlight the diagnosis and treatment of hand flexor tendon injuries and discuss the current state of the science of hand surgery in the Republic of Kazakhstan. We reviewed the Google Scholar, PubMed, Web of Science, Elsevier, and National Center for Biotechnology Information databases and other printed sources for open access articles in three languages. We accepted relevant scientific articles that reflected the peculiarities of restoring function of the tendon flexors of the hand. We reviewed articles from the present to the previous 20 years and included 31 of these sources in our literature review. The medical examination of a patient who has sustained a flexor tendon injury should be thorough and gradual, supported by ultrasound and X-ray examination. For effective restoration of hand function following a hand injury, it is important for the surgeon to conduct a step-by-step assessment of the damage that has occurred to soft tissues, superficial and deep tendons, bones, nerves, and blood vessels. The main goal of tendon repair is to preserve tendon function. It is also known that early postoperative tendon movement leads to faster healing. The most frequent complications associated with flexor tendon repair include the development of adhesions, wound infection, tendon rupture, impaired hand function, and scar formation. Relative to the state of the science in the Republic of Kazakhstan, we conclude that hand surgery should be performed by highly skilled specialists in the field of microsurgery in a specialized department with microsurgical equipment.
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Affiliation(s)
- Kymbat E Kazantayev
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Kanat B Mukhamedkerim
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Mismil I Muradov
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Yergali Nabiyev
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Botagoz S Turdalieva
- Kymbat E. Kazantayev, MD, is a Resident Surgeon, Researcher, and Practitioner at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Kanat B. Mukhamedkerim, MD, is a Resident Physician and Public Health and Social Sciences Expert at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
- Mismil I. Muradov, MD, PhD, is a Reconstructive and Plastic Microsurgeon at the Department of Reconstructive and Plastic Microsurgery, Syzganov National Scientific Center of Surgery, Almaty, Republic of Kazakhstan
- Yergali Nabiyev, MD, is a Resident Surgeon at the Department of Traumatology and Orthopaedics, Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
- Botagoz S. Turdalieva, MD, is a Resident Physician and Researcher at the Department of Public Health and Social Sciences, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
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Tarantino D, Mottola R, Resta G, Gnasso R, Palermi S, Corrado B, Sirico F, Ruosi C, Aicale R. Achilles Tendinopathy Pathogenesis and Management: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6681. [PMID: 37681821 PMCID: PMC10487940 DOI: 10.3390/ijerph20176681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/09/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
The Achilles tendon is the thickest and strongest tendon of the human body, and it is frequently injured during sports activity. The incidence of Achilles tendon pathologies has increased over recent decades, especially in the last few years, because of increased sports participation among the general population and due to the diffusion of competitive sports at a high level. Tendinopathies are common in athletes and in middle-aged overweight patients. The term "tendinopathy" refers to a condition characterised clinically by pain and swelling, with functional limitations of tendon and nearby structures, and consequently to chronic failure of healing response process. Tendinopathies can produce marked morbidity, and at present, scientifically validated management modalities are limited. Despite the constantly increasing interest and number of studies about Achilles tendinopathy (AT), there is still not a consensual point of view on which is the best treatment, and its management is still controversial. AT can be treated conservatively primarily, with acceptable results and clinical outcomes. When this approach fails, surgery should be considered. Several surgical procedures have been described for both conditions with a relatively high rate of success with few complications and the decision for treatment in patients with AT should be tailored on patient's needs and level of activity. The aim of this article is to give insights about the pathogenesis and most used and recent treatment options for AT.
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Affiliation(s)
- Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Rosita Mottola
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Giuseppina Resta
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, 74121 Taranto, Italy;
| | - Rossana Gnasso
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Stefano Palermi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Bruno Corrado
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Felice Sirico
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Carlo Ruosi
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (R.M.); (R.G.); (S.P.); (B.C.); (F.S.); (C.R.)
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy;
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Radovanović G, Bohm S, Arampatzis A, Legerlotz K. In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries-An Ancillary Analysis of Data from a Controlled Clinical Trial. J Clin Med 2023; 12:jcm12031102. [PMID: 36769750 PMCID: PMC9918090 DOI: 10.3390/jcm12031102] [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: 12/17/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As inter-limb asymmetries can be associated with higher injury risk, we aimed to investigate their role in Achilles tendinopathy patients. METHODS In Achilles tendinopathy patients (n = 41), we assessed inter-limb asymmetries of mechanical, material, and morphological musculoskeletal properties and function and how those were affected by 12 weeks of exercise intervention (high-load protocol, n = 13; Alfredson protocol, n = 11). Moreover, we assessed whether asymmetry reductions correlated with improved Patient-Reported Outcomes (VISA-A score). RESULTS At baseline, tendinopathic tendons demonstrated lower tendon force (p = 0.017), lower tendon stress (p < 0.0001), larger tendon cross-sectional area (CSA) (p < 0.001), and increased intratendinous (p = 0.042) and tendon overall (p = 0.021) vascularization. For the high-load group, PRE-to-POST asymmetry comparisons revealed an asymmetry increase for the counter-movement jump (CMJ) (p = 0.034) and PRE-to-POST VISA-A score improvements correlated with CSA asymmetry reductions (p = 0.024). Within the Alfredson group, PRE-to-POST VISA-A score improvements correlated with CMJ asymmetry reductions (p = 0.044) and tendon stiffness asymmetry increases (p = 0.037). POST-to-POST in-between group comparisons revealed lower asymmetry in the high-load group for tendon elongation (p = 0.021) and tendon strain (p = 0.026). CONCLUSIONS The tendinopathic limb differs from the asymptomatic limb while therapeutic exercise interventions have little effect on asymmetries. Asymmetry reductions are not necessarily associated with tendon health improvements.
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Affiliation(s)
- Goran Radovanović
- Movement Biomechanics, Institute of Sports Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
- Department Performance, Neuroscience, Therapy and Health, Faculty of Health Sciences, Medical School Hamburg—University of Applied Sciences and Medical University, 20457 Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, Faculty of Health Sciences, Medical School Hamburg—University of Applied Sciences and Medical University, 20457 Hamburg, Germany
- Correspondence: ; Tel.: +49-030-2093-46052
| | - Sebastian Bohm
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sports Sciences, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
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