1
|
Pooryamanesh L, Daneshmandi H, Hadžić V, Sekulić D, Kondrič M. Eight-week exercise intervention improves shoulder pain and body posture of wheelchair athletes with spinal cord injury. J Sports Med Phys Fitness 2024; 64:483-489. [PMID: 38305007 DOI: 10.23736/s0022-4707.23.15414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Wheelchair athletes, as a group of elite athletes who participate in high-level sports activities, are constantly exposed to musculoskeletal injuries and disorders due to their frequent use of wheelchairs and overworked upper limbs. In this study, we investigated the effect of elastic band exercises on the extent of athletes' forward head angle, kyphosis, rounded shoulder, and pain scores. METHODS Twenty-six male and female wheelchair athletes with spinal cord injuries (age: 27.11±6.67), active in table tennis, basketball and pétanque, were selected and randomly divided into either a control or training group. The Wheelchair User's Shoulder Pain Index (WUSPI) questionnaire was used to investigate the level of shoulder pain. A sagittal view photogrammetry method was used to measure the forward head angle and round shoulder angle, and a flexible ruler was used to measure the thoracic kyphosis angle. For our statistical analysis, a covariance test (ANCOVA) and independent and dependent T tests were used. RESULTS After eight weeks of training, there was a significant decrease in the angle of the forward head tilt, kyphosis, round shoulder, and pain questionnaire scores in the training group (P<0.05). CONCLUSIONS Changes in the forward head angle, rounded shoulder and kyphosis angle, and pain scores show the desirable effect of resistance training with an elastic band. Therefore, this exercise program is recommended for wheelchair athletes with spinal cord injuries.
Collapse
Affiliation(s)
- Lale Pooryamanesh
- Faculty of Physical Education and Sports Sciences, University of Guilan, Rasht, Iran -
| | - Hassan Daneshmandi
- Faculty of Physical Education and Sports Sciences, University of Guilan, Rasht, Iran
| | - Vedran Hadžić
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Damir Sekulić
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Miran Kondrič
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
2
|
Hadis MA, Shortall AC, Palin WM. The power of light - From dental materials processing to diagnostics and therapeutics. Biomater Investig Dent 2024; 11:40308. [PMID: 38645925 PMCID: PMC11022655 DOI: 10.2340/biid.v11.40308] [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: 11/29/2023] [Accepted: 02/12/2024] [Indexed: 04/23/2024] Open
Abstract
Harnessing the power of light and its photonic energy is a powerful tool in biomedical applications. Its use ranges from biomaterials processing and fabrication of polymers to diagnostics and therapeutics. Dental light curable materials have evolved over several decades and now offer very fast (≤ 10 s) and reliable polymerization through depth (4-6 mm thick). This has been achieved by developments on two fronts: (1) chemistries with more efficient light absorption characteristics (camphorquinone [CQ], ~30 L mol-1 cm1 [ʎmax 470 nm]; monoacylphosphine oxides [MAPO], ~800 L mol-1 cm-1 [ʎmax 385 nm]; bisacylphosphine oxide [BAPO], ~1,000 L mol-1 cm-1 [ʎmax 385 nm]) as well mechanistically efficient and prolonged radical generation processes during and after light irradiation, and; (2) introducing light curing technologies (light emitting diodes [LEDs] and less common lasers) with higher powers (≤ 2 W), better spectral range using multiple diodes (short: 390-405 nm; intermediate: 410-450 nm; and long: 450-480 nm), and better spatial power distribution (i.e. homogenous irradiance). However, adequate cure of materials falls short for several reasons, including improper selection of materials and lights, limitations in the chemistry of the materials, and limitations in delivering light through depth. Photonic energy has further applications in dentistry which include transillumination for diagnostics, and therapeutic applications that include photodynamic therapy, photobiomodulation, and photodisinfection. Light interactions with materials and biological tissues are complex and it is important to understand the advantages and limitations of these interactions for successful treatment outcomes. This article highlights the advent of photonic technologies in dentistry, its applications, the advantages and limitations, and possible future developments.
Collapse
Affiliation(s)
- Mohammed A Hadis
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Adrian C Shortall
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - William M Palin
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
3
|
Whale R, Hasani F, Haines T, Munteanu SE, Ellis K, Patel S, Buchholtz K, Warne J, Vallance P, Malliaras P. Assessing calf exercise fidelity among people with Achilles tendinopathy using videos recorded via Zoom®: an observational study. Disabil Rehabil 2024; 46:697-704. [PMID: 36755434 DOI: 10.1080/09638288.2023.2174604] [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: 07/04/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Exercise fidelity is a fundamental aspect of exercise prescription by physiotherapists. Assessing exercise fidelity via telehealth (videoconference) is potentially useful but its reproducibility has not been assessed. The objective was to evaluate agreement (reproducibility) of video rating of calf exercise fidelity within (over four weeks) and between telehealth raters and compared with live rating. METHODS Nineteen videos of participants with AT undertaking calf exercises were rated by physiotherapists in person (live) and by watching pre-recorded videos (replicating telehealth). Three forms of agreement were assessed: (i) between live assessment and recorded video (telehealth) assessment; (ii) between telehealth raters (inter-rater); (iii) agreement within telehealth raters over four weeks (intra-rater). RESULTS There was weak to almost perfect agreement (Kappa = 0.65 to 1.00, rater 1, Kappa = 0.57 to 1.00, rater 2) between the telehealth and live raters. There was moderate to almost perfect agreement (Kappa = 0.65 to 1.00) when assessing intra-rater reliability, aside from one of the six criteria (quality of movement). CONCLUSION Assessing calf exercise fidelity via videos recorded on Zoom® appears to demonstrate weak or greater agreement versus live rating and over time. Inter-rater agreement was lower, suggesting that the criteria developed may be better suited to use by individual raters over time.Implications for rehabilitationTelehealth assessment (when compared with live, in person assessment) shows a moderate or greater agreement for the majority of assessment criteria when assessing calf exercise fidelity.The calf exercise fidelity criteria developed can be used as an adjunct to assessment and management of people with Achilles Tendinopathy.Intra-rater assessment was shown to be moderately or more consistent over a four-week period when assessing calf exercise fidelity.
Collapse
Affiliation(s)
- Rhiannon Whale
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia
| | - Fatmah Hasani
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia
- Physiotherapy Department, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Terry Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Science, Building G, Peninsula Campus, Monash University, Frankston, Victoria, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kirsten Ellis
- Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia
| | - Shalin Patel
- Back in Motion Physiotherapy, Melbourne, Victoria, Australia
| | - Kim Buchholtz
- Department of Physiotherapy, LUNEX University, Differdange, Luxembourg
| | - Jonathan Warne
- Physiotherapy department, Brunel University London, London, UK
| | - Patrick Vallance
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Murakami Y, Konrad A, Kasahara K, Yoshida R, Warneke K, Behm DG, Nakamura M. Acute effects of resistance training at different range of motions on plantar flexion mechanical properties and force. J Sports Sci 2024; 42:38-45. [PMID: 38394030 DOI: 10.1080/02640414.2024.2320522] [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: 10/20/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
The effects obtained from resistance training depend on the exercise range of motion (ROM) performed. We aimed to examine the acute effects of different exercise ROM resistance training on the plantar flexor muscles. Eighteen healthy untrained male adults participated in three conditions: calf raises in 1) partial condition [final (short muscle length) partial ROM], 2) full condition (full ROM), and 3) control condition. The ankle dorsiflexion (DF) ROM, passive torque at DF ROM, passive stiffness of muscle-tendon unit, and maximal voluntary isometric contraction (MVC-ISO) torque were measured before and immediately after the interventions. There were significant increases in DF ROM, passive torque at DF ROM, and a decrease in MVC-ISO, but no significant interaction in passive stiffness. Post hoc test, DF ROM demonstrated moderate magnitude increases in the full condition compared to the partial (p = 0.023, d = 0.74) and control (p = 0.003, d = 0.71) conditions. Passive torque at DF ROM also showed moderate magnitude increases in the full condition compared to the control condition (p = 0.016, d = 0.69). MVC-ISO had a moderate magnitude decrease in the full condition compared to the control condition (p = 0.018, d=-0.53). Resistance training in the full ROM acutely increases joint ROM to a greater extent than final partial ROM, most likely due to stretch tolerance.
Collapse
Affiliation(s)
- Yuta Murakami
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, University of Graz, Graz, Austria
| | - Kazuki Kasahara
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Riku Yoshida
- Department of Rehabilitation, Maniwa orthopedic clinic, Niigata, Japan
| | - Konstantin Warneke
- Department for Exercise, Sport and Health, Leuphana University, Lüneburg, Germany
| | - David G Behm
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, Newfoundland and Labrador, Canada
| | - Masatoshi Nakamura
- Faculty of Rehabilitation Sciences, Nishi Kyushu University, Kanzaki, Saga, Japan
| |
Collapse
|
5
|
Tharwat S, Saleh M, Elrefaey R, Nassar MK, Nassar MK. Clinical and Ultrasonographic Characteristics of the Achilles Tendon in Hemodialysis Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2181. [PMID: 38138284 PMCID: PMC10744597 DOI: 10.3390/medicina59122181] [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: 11/02/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The early recognition of tendon alterations in chronic hemodialysis (HD) patients, an awareness of the factors that influence the condition, and active intervention have considerable clinical relevance. The aim of this study was to investigate the musculoskeletal ultrasound (MSUS) features of the Achilles tendon in chronic HD patients and determine the factors associated with tendon abnormalities. Materials and Methods: This study was conducted on 46 HD patients and 24 sex- and age-matched controls. All participants were evaluated clinically for any signs of Achilles tendon abnormalities. Then, the Achilles tendon was scanned bilaterally using MSUS. Results: Among the 92 Achilles tendons in the HD patients, there was tenderness and swelling of only two (2.2%). Regarding MSUS features, there were statistically significant higher thicknesses in the proximal end (p < 0.001), midpoint (p < 0.001), and distal end (p < 0.001) of the Achilles tendons in the HD patients when compared with the healthy controls. Tendinosis was found in 12 (13%) of the HD patients' Achilles tendons, which was statistically significant in comparison to the healthy controls (p = 0.008). There were statistically significant higher scores of structural abnormalities (p = 0.005), bone erosions (p = 0.017), and calcifications (p = 0.015) in the HD patients when compared to the healthy controls. According to the results of a univariate regression analysis, age and male gender were predictive for US abnormalities in HD patients (p = 0.002 and 0.025, respectively). Conclusions: The Achilles tendon in subjects on chronic HD showed frequent US abnormalities. These abnormalities in HD patients appear to be more related to age and gender and may be asymptomatic.
Collapse
Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
| | - Marwa Saleh
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Rabab Elrefaey
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| | - Mona Kamal Nassar
- Department of Radiology, Student Hospital, Mansoura University, Mansoura 35516, Egypt;
| | - Mohammed Kamal Nassar
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt;
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt; (M.S.); (R.E.)
| |
Collapse
|
6
|
Pohlman C, Pardee A, Friedman M, Rutherford D, Vannatta CN, Kernozek TW. Effects of Body Weight Support in Running on Achilles Tendon Loading. Int J Sports Med 2023; 44:913-918. [PMID: 37336504 DOI: 10.1055/a-2113-1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Achilles tendon (AT) tendinopathy is common in runners. Repetitive AT loading may play a role in etiology. Interventions such as body weight support (BWS) may reduce loading on the AT in running. Examine how ground reaction force, AT loading, foot strike, and cadence variables change in running with BWS. Twenty-four healthy female runners free from injury were examined. Participants ran on an instrumented treadmill with and without BWS using a harness-based system at a standardized speed. The system has 4 elastic cords affixed to a harness that is attached to a frame-like structure. Kinematic data and kinetic data were used in a musculoskeletal model (18 segments and 16 degrees of freedom) to determine AT loading variables, foot strike angle, and cadence. Paired t-tests were used to compare each variable between conditions. Ground reaction force was 9.0% lower with BWS (p<.05). Peak AT stress, force, and impulse were 9.4, 11.7%, and 14.8% lower when using BWS in running compared to no support (p<.05). Foot strike angle was similar (p<.05) despite cadence being reduced (p<.05). BWS may reduce AT loading and impulse variables during running. This may be important in rehabilitation efforts.
Collapse
Affiliation(s)
- Callie Pohlman
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Andrew Pardee
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Mikey Friedman
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Drew Rutherford
- Health Professions, Physical Therapy Program, University of Wisconsin-La Crosse, La Crosse, United States
- Sports Physical Therapy, Gundersen Health System, La Crosse, United States
| | - Charles Nathan Vannatta
- La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, United States
| | - Thomas W Kernozek
- Health Professions, La Crosse Institute for Movement Science (LIMS), La Crosse, United States
| |
Collapse
|
7
|
Fitzmaurice BC, Heneghan NR, Rayen ATA, Grenfell RL, Soundy AA. Whole-Body Photobiomodulation Therapy for Fibromyalgia: A Feasibility Trial. Behav Sci (Basel) 2023; 13:717. [PMID: 37753995 PMCID: PMC10525895 DOI: 10.3390/bs13090717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/28/2023] [Accepted: 08/18/2023] [Indexed: 09/28/2023] Open
Abstract
Effective treatment for fibromyalgia (FM) is lacking and further treatment options are needed. Photobiomodulation therapy (PBMT) represents one potential treatment option. Whilst favourable findings have been reported using localised PBMT, no investigations have established the value of whole-body PBMT for the complete set of symptom domains in FM. A single-arm feasibility study was conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. A non-probability sampling method was used to access individuals with FM. The primary outcome measure was identified as the Revised Fibromyalgia Impact Questionnaire (FIQR). Forty-nine participants were screened and twenty-one trial participants entered the trial. Nineteen participants completed the intervention (18 whole-body PBMT sessions over approximately six weeks). Descriptive statistics and qualitative analysis was undertaken to represent feasibility outcomes. Acceptability of the trial device and processes were established. Outcome measures towards efficacy data were guided by core and peripheral OMERACT (outcomes measures in rheumatological clinical trials) domains, utilising a combination of participant-reported and performance-based outcome measures. Data for the embedded qualitative component of the trial were captured by participant-reported experience measures and audio-recorded semi-structured interviews. Positive changes were observed for FM-specific quality of life, pain, tenderness, stiffness, fatigue, sleep disturbance, anxiety, depression and cognitive impairment. Patient global assessment revealed improvements at 6 weeks, with continued effect at 24 weeks. FM-specific quality of life at 24 weeks remained improved compared with baseline scores. The findings provided evidence to support a full-scale trial and showed promise regarding potential efficacy of this novel non-invasive treatment in an FM population.
Collapse
Affiliation(s)
- Bethany C. Fitzmaurice
- Department of Pain Management, Sandwell and West Birmingham NHS Trust, Birmingham B71 4HJ, UK;
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (N.R.H.); (A.A.S.)
| | - Nicola R. Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (N.R.H.); (A.A.S.)
| | - Asius T. A. Rayen
- Department of Pain Management, Sandwell and West Birmingham NHS Trust, Birmingham B71 4HJ, UK;
| | - Rebecca L. Grenfell
- Clinical Research Facility, Sandwell and West Birmingham NHS Trust, Birmingham B71 4HJ, UK;
| | - Andrew A. Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; (N.R.H.); (A.A.S.)
| |
Collapse
|
8
|
Prudêncio DA, Maffulli N, Migliorini F, Serafim TT, Nunes LF, Sanada LS, Okubo R. Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2023; 15:9. [PMID: 36698184 PMCID: PMC9878810 DOI: 10.1186/s13102-023-00618-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented "some concerns", and 37.5% (five and three articles, respectively) presenting "high risk" of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was - 1.21 (- 2.72 to - 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.
Collapse
Affiliation(s)
- Diego Ailton Prudêncio
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Orthopaedics, School of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy ,grid.9757.c0000 0004 0415 6205School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, UK ,grid.4464.20000 0001 2161 2573Centre for Sports and Exercise Medicine at Queen, Mary University of London, London, UK
| | - Filippo Migliorini
- grid.412301.50000 0000 8653 1507Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Thiago Teixeira Serafim
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Luis Felipe Nunes
- grid.411237.20000 0001 2188 7235Department of Pharmacy, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Luciana Sayuri Sanada
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| | - Rodrigo Okubo
- grid.412287.a0000 0001 2150 7271Department of Physiotherapy, Physiotherapy Postgraduation Program (PPGF), Santa Catarina State University, Florianópolis, Brazil
| |
Collapse
|
9
|
Quarmby A, Mönnig J, Mugele H, Henschke J, Kim M, Cassel M, Engel T. Biomechanics and lower limb function are altered in athletes and runners with achilles tendinopathy compared with healthy controls: A systematic review. Front Sports Act Living 2023; 4:1012471. [PMID: 36685067 PMCID: PMC9845578 DOI: 10.3389/fspor.2022.1012471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Achilles tendinopathy (AT) is a debilitating injury in athletes, especially for those engaged in repetitive stretch-shortening cycle activities. Clinical risk factors are numerous, but it has been suggested that altered biomechanics might be associated with AT. No systematic review has been conducted investigating these biomechanical alterations in specifically athletic populations. Therefore, the aim of this systematic review was to compare the lower-limb biomechanics of athletes with AT to athletically matched asymptomatic controls. Databases were searched for relevant studies investigating biomechanics during gait activities and other motor tasks such as hopping, isolated strength tasks, and reflex responses. Inclusion criteria for studies were an AT diagnosis in at least one group, cross-sectional or prospective data, at least one outcome comparing biomechanical data between an AT and healthy group, and athletic populations. Studies were excluded if patients had Achilles tendon rupture/surgery, participants reported injuries other than AT, and when only within-subject data was available.. Effect sizes (Cohen's d) with 95% confidence intervals were calculated for relevant outcomes. The initial search yielded 4,442 studies. After screening, twenty studies (775 total participants) were synthesised, reporting on a wide range of biomechanical outcomes. Females were under-represented and patients in the AT group were three years older on average. Biomechanical alterations were identified in some studies during running, hopping, jumping, strength tasks and reflex activity. Equally, several biomechanical variables studied were not associated with AT in included studies, indicating a conflicting picture. Kinematics in AT patients appeared to be altered in the lower limb, potentially indicating a pattern of "medial collapse". Muscular activity of the calf and hips was different between groups, whereby AT patients exhibited greater calf electromyographic amplitudes despite lower plantar flexor strength. Overall, dynamic maximal strength of the plantar flexors, and isometric strength of the hips might be reduced in the AT group. This systematic review reports on several biomechanical alterations in athletes with AT. With further research, these factors could potentially form treatment targets for clinicians, although clinical approaches should take other contributing health factors into account. The studies included were of low quality, and currently no solid conclusions can be drawn.
Collapse
Affiliation(s)
- Andrew Quarmby
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany,Correspondence: Andrew Quarmby
| | - Jamal Mönnig
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Hendrik Mugele
- Department of Sport Science, Laboratory for Environmental and Exercise Science, University of Innsbruck, Innsbruck, Austria
| | - Jakob Henschke
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - MyoungHwee Kim
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Michael Cassel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| | - Tilman Engel
- University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany
| |
Collapse
|
10
|
Corrigan P, Hornsby S, Pohlig RT, Willy RW, Cortes DH, Silbernagel KG. Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return-to-sport. Scand J Med Sci Sports 2022; 32:1201-1212. [PMID: 35488734 PMCID: PMC9972464 DOI: 10.1111/sms.14178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
We aimed to (1) compare pain, tendon structure, lower limb function, and Achilles tendon loads while running between limbs in runners with Achilles tendinopathy, and (2) explore the relations of pain, tendon structure, and lower limb function to Achilles tendon loads while running. Twenty runners with Achilles tendinopathy participated in this pilot study. Pain was assessed with questionnaires, quantitative sensory testing, and functional testing. Tendon morphology and mechanical properties were evaluated with ultrasound imaging, continuous shear wave elastography, and ultrasound imaging combined with dynamometry. Lower limb function was assessed with an established test battery. Achilles tendon loads were estimated from biomechanical data acquired during running. Compared to the least symptomatic limb, the most symptomatic limb had lower scores on the Victorian Institute of Sports Assessment - Achilles questionnaire and worse pain during drop countermovement jumping, hopping, and running. Tendon thickness and cross-sectional area were greater, and Young's modulus, drop countermovement jump height, and plyometric quotient during hopping were lower on the most symptomatic limb. Side-to-side differences in drop countermovement jump height were significantly associated with side-to-side differences in Achilles tendon peak forces and average loading rates during running. Various measures of pain, structure, and function differ between limbs in runners with Achilles tendinopathy during return-to-sport. Tendon forces, however, do not differ between limbs during comfortable running. In addition to measures that differ between limbs, measures of performance during drop countermovement jumping may aid in clinical decision-making during return-to-sport because they are associated with tendon forces while running.
Collapse
Affiliation(s)
- Patrick Corrigan
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, Missouri, USA,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Samantha Hornsby
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Ryan T. Pohlig
- College of Health Sciences Biostatistics Core Facility, University of Delaware, Burlington, Vermont, USA
| | - Richard W. Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
| | - Daniel H. Cortes
- Department of Mechanical Engineering, Penn State University, State College, Pennsylvania, USA
| | | |
Collapse
|
11
|
Fitzmaurice B, Heneghan NR, Rayen A, Soundy A. Whole-body photobiomodulation therapy for chronic pain: a protocol for a feasibility trial. BMJ Open 2022; 12:e060058. [PMID: 35768101 PMCID: PMC9244683 DOI: 10.1136/bmjopen-2021-060058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic pain conditions are a leading cause of disease and disability. They are associated with symptoms such as fatigue, sleep and mood disturbances. Minimal evidence is available to support effective treatments and alternatives treatment approaches are called for. Photobiomodulation therapy has been highlighted as one promising option. A whole-body therapy device (NovoTHOR) has recently been developed with a number of potential advantages for people with chronic pain. Research is needed to consider the feasibility of this device. METHODS AND ANALYSIS A single-centre single-armed (no placebo group) feasibility study with an embedded qualitative component will be conducted. The intervention will comprise 18 treatments over 6 weeks, with 6-month follow-up, in the whole-body photobiomodulation device. A non-probability sample of 20 adult participants with a clinician diagnosis of chronic axial pain, polyarthralgia, myofascial pain or widespread pain will be recruited (self-referral and clinician referral). Outcome measures will focus on acceptability of trial processes with a view to guiding a definitive randomised controlled trial. Analyses will use descriptive statistics for quantitative aspects. The qualitative element will be assessed by means of a participant-reported experience questionnaire postintervention and semistructured audio-recorded interviews at three stages; preintervention, midintervention and postintervention. The latter will be transcribed verbatim and a reflexive thematic analysis will be used to identify emerging themes. Exploratory outcomes (participant-reported and performance-based measures) will be analysed according to data distribution. ETHICS AND DISSEMINATION The study has received ethical approval from the Leicester Central Research and Ethics Committee. Findings will be disseminated via local chronic pain groups, public register update, submission for presentation at scientific meetings and open-access peer-reviewed journals, and via academic social networks. TRIAL REGISTRATION NUMBER NCT05069363.
Collapse
Affiliation(s)
- Bethany Fitzmaurice
- School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Department of Pain Management, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Nicola R Heneghan
- School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Asius Rayen
- Department of Pain Management, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Andrew Soundy
- School of Sport Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
12
|
Scattone Silva R, Smitheman HP, Smith AK, Silbernagel KG. Are static foot posture and ankle dorsiflexion range of motion associated with Achilles tendinopathy? A cross-sectional study. Braz J Phys Ther 2022; 26:100466. [PMID: 36470091 PMCID: PMC9720357 DOI: 10.1016/j.bjpt.2022.100466] [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: 02/17/2022] [Revised: 10/03/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Subtalar hyperpronation and ankle dorsiflexion restriction have been theoretically associated with Achilles tendinopathy (AT). However, evidence to support these associations is lacking. OBJECTIVES To compare foot alignment and ankle dorsiflexion range of motion (ROM) between the symptomatic and non-symptomatic limbs of individuals with unilateral AT. And to verify whether differences exist between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain, structure, and symptom severity. METHODS Sixty-three participants with unilateral AT underwent a bilateral evaluation of pain during tendon palpation, symptom severity, tendon thickening, tendon neovascularization, ankle dorsiflexion ROM, and foot posture alignment [foot posture index (FPI), navicular drop, navicular drift, and longitudinal arch angle (LAA)]. Side and group comparisons were made using t-tests and correlations were evaluated using the Pearson test. RESULTS There were no differences between the symptomatic and non-symptomatic limbs regarding foot posture alignment. Specifically, non-significant negligible differences were observed between limbs regarding FPI [mean difference (MD)=-0.23; 95% confidence interval (CI)=-0.70, 0.25), navicular drop (MD=0.58 mm; 95%CI=-0.25, 1.43), navicular drift (MD=0.16 mm; 95%CI=-0.77, 1.09), and LAA (MD=0.30º; 95%CI=-1.74, 2.34). There was no difference between limbs regarding ankle dorsiflexion ROM. However, lower ankle dorsiflexion was associated with worse symptom severity (r = 0.223). Finally, no difference was observed between individuals with symptomatic pronated feet and individuals with symptomatic neutral/supinated feet in terms of tendon pain or structure. CONCLUSIONS Static foot alignment measures do not seem to be clinically relevant in patients with AT. Smaller ankle dorsiflexion ROM, however, was associated with greater symptom severity in this population.
Collapse
Affiliation(s)
- Rodrigo Scattone Silva
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States,Postgraduate Program in Rehabilitation Sciences and Postgraduate Program in Physical Therapy, Universidade Federal do Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Hayley Powell Smitheman
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Andy K. Smith
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Karin Grävare Silbernagel
- Delaware Tendon and Ligament Research Team, Department of Physical Therapy, University of Delaware, Newark, DE, United States,Corresponding author at: University of Delaware, Department of Physical Therapy, 540 South College Avenue, Newark, DE 19713, United States.
| |
Collapse
|
13
|
Matthews W, Ellis R, Furness J, Hing WA. The clinical diagnosis of Achilles tendinopathy: a scoping review. PeerJ 2021; 9:e12166. [PMID: 34692248 PMCID: PMC8485842 DOI: 10.7717/peerj.12166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Achilles tendinopathy describes the clinical presentation of pain localised to the Achilles tendon and associated loss of function with tendon loading activities. However, clinicians display differing approaches to the diagnosis of Achilles tendinopathy due to inconsistency in the clinical terminology, an evolving understanding of the pathophysiology, and the lack of consensus on clinical tests which could be considered the gold standard for diagnosing Achilles tendinopathy. The primary aim of this scoping review is to provide a method for clinically diagnosing Achilles tendinopathy that aligns with the nine core health domains. Methodology A scoping review was conducted to synthesise available evidence on the clinical diagnosis and clinical outcome measures of Achilles tendinopathy. Extracted data included author, year of publication, participant characteristics, methods for diagnosing Achilles tendinopathy and outcome measures. Results A total of 159 articles were included in this scoping review. The most commonly used subjective measure was self-reported location of pain, while additional measures included pain with tendon loading activity, duration of symptoms and tendon stiffness. The most commonly identified objective clinical test for Achilles tendinopathy was tendon palpation (including pain on palpation, localised tendon thickening or localised swelling). Further objective tests used to assess Achilles tendinopathy included tendon pain during loading activities (single-leg heel raises and hopping) and the Royal London Hospital Test and the Painful Arc Sign. The VISA-A questionnaire as the most commonly used outcome measure to monitor Achilles tendinopathy. However, psychological factors (PES, TKS and PCS) and overall quality of life (SF-12, SF-36 and EQ-5D-5L) were less frequently measured. Conclusions There is significant variation in the methodology and outcome measures used to diagnose Achilles tendinopathy. A method for diagnosing Achilles tendinopathy is proposed, that includes both results from the scoping review and recent recommendations for reporting results in tendinopathy.
Collapse
Affiliation(s)
- Wesley Matthews
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Richard Ellis
- Active Living and Rehabilitation: Aotearoa New Zealand, Health and Rehabilitation Research Institute, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.,Department of Physiotherapy, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - James Furness
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Wayne A Hing
- Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| |
Collapse
|
14
|
Fares MY, Salhab HA, Khachfe HH, Fares J, Haidar R, Musharrafieh U. Sever's Disease of the Pediatric Population: Clinical, Pathologic, and Therapeutic Considerations. Clin Med Res 2021; 19:132-137. [PMID: 34531270 PMCID: PMC8445662 DOI: 10.3121/cmr.2021.1639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
Sever's disease is an underreported prevalent pediatric condition that causes heel pain in children worldwide. It is often described as an overuse injury that can present with either unilateral or bilateral heel pain. Even though the exact mechanism of injury is unknown, it is often thought it involves repetitive stress and pressure on the calcaneal growth plate. Diagnosing Sever's disease mainly relies on a thorough clinical investigation and physical examination, with a positive squeeze test usually sufficient to establish diagnosis. Nevertheless, radiographic imaging can help exclude other differential diagnoses. Therapeutic options of Sever's disease are mostly conservative, and these include rest, physical therapy, kinesiotherapy, and orthoses. Educating parents and coaches on the symptomatology and presentation of Sever's disease is pivotal for the establishment of efficient preventive interventions and earlier diagnoses. This study presents a case of a pediatric patient with Sever's disease and offers medical insight into the diagnostic, clinical, pathologic, and therapeutic characteristics of this condition, in light of the current existing literature.
Collapse
Affiliation(s)
- Mohamad Y Fares
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Hamza A Salhab
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hussein H Khachfe
- Neuroscience Research Center, Faculty of Medicine, Lebanese University, Beirut, Lebanon
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jawad Fares
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Rachid Haidar
- Department of Orthopedics, American University of Beirut Medical Center, Beirut, Lebanon
| | | |
Collapse
|
15
|
Osborn ML, Cornille JL, Blas‐Machado U, Uhl EW. The equine navicular apparatus as a premier enthesis organ: Functional implications. Vet Surg 2021; 50:713-728. [PMID: 33710628 PMCID: PMC8251969 DOI: 10.1111/vsu.13620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/26/2021] [Accepted: 02/21/2021] [Indexed: 12/23/2022]
Abstract
Navicular syndrome has been traditionally characterized by progressive lameness with chronic degeneration of the navicular bone. Advances in imaging techniques have revealed that its associated soft tissue structures are also affected. This distribution of lesions is explained by conceptualizing the equine navicular apparatus as an enthesis organ that facilitates the dissemination of mechanical stress throughout the tissues of the foot. The navicular apparatus has the same structural adaptations to mechanical stress as the human Achilles tendon complex. These adaptations efficiently dissipate mechanical force away from the tendon's bony attachment site, thereby protecting it from failure. The comparison of these two anatomically distinct structural systems demonstrates their similar adaptations to mechanical forces, and illustrates that important functional insights can be gained from studying anatomic convergences and cross-species comparisons of function. Such a functional conceptualization of the equine navicular apparatus resolves confusion about the diagnosis of navicular syndrome and offers insights for the development of mechanically based therapies. Through comparison with the human Achilles complex, this review (1) re-conceptualizes the equine navicular apparatus as an enthesis organ in which mechanical forces are distributed throughout the structures of the organ; (2) describes the relationship between failure of the navicular enthesis organ and lesions of navicular syndrome; (3) considers the therapeutic implications of navicular enthesis organ degeneration as a form of chronic osteoarthritis; and based upon these implications (4) proposes a focus on whole body posture/motion for the development of prehabilitative and rehabilitative therapies similar to those that have already proven effective in humans.
Collapse
Affiliation(s)
- Michelle L. Osborn
- Department of Comparative Biomedical SciencesSchool of Veterinary Medicine, Louisiana State UniversityBaton RougeLouisianaUSA
| | | | - Uriel Blas‐Machado
- Department of PathologyCollege of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
| | - Elizabeth W. Uhl
- Department of PathologyCollege of Veterinary Medicine, University of GeorgiaAthensGeorgiaUSA
| |
Collapse
|
16
|
Are Plantarflexor Muscle Impairments Present Among Individuals with Achilles Tendinopathy and Do They Change with Exercise? A Systematic Review with Meta-analysis. SPORTS MEDICINE-OPEN 2021; 7:18. [PMID: 33689050 PMCID: PMC7947084 DOI: 10.1186/s40798-021-00308-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/14/2021] [Indexed: 01/22/2023]
Abstract
Background Understanding plantarflexor muscle impairments among individuals with Achilles tendinopathy (AT) may help to guide future research and inform clinical management of AT. Therefore, the aim of this review is to evaluate plantarflexor muscle impairments among individuals with AT and whether plantarflexor muscle function changes following resistance training interventions. Methods We searched relevant databases including Cochrane Central Register of Controlled Trials, Ovid (MEDLINE, EMBASE, AMED) and EBSCO (CINAHL Plus and SPORTDiscus) up to September 2020. Studies investigating plantarflexor muscle function were included if they met the following criteria: (1) any study design enabled comparison of plantarflexor muscle function between individuals with and without AT, or the affected and unaffected side of individuals with unilateral AT, and (2) any studies enabled investigation of change in plantarflexion muscle function over time with use of resistance training intervention. We included studies that recruited adults with either insertional or mid-portion AT of any duration. Study selection, quality assessment and data extraction were undertaken independently by two reviewers. Discrepancies were resolved via discussion, or by consulting a third reviewer where necessary. The Joanna Briggs Institute (JBI) critical appraisal tools specific to each study design were used to assess the methodological quality of included studies. Grading the strength of evidence for each outcome was determined according to the quality and number of studies. Results A total of 25 studies (545 participants) met inclusion. Participants’ mean age was 40 ± 7 years old. Six studies were high quality for all domains, while the remaining were susceptible to the risk of bias (e.g. selection criteria, reporting findings). This review identified moderate evidence that individuals with AT have impairment in maximal plantarflexor torque (seven studies including one with a mixed population) on their affected side, compared with the unaffected side. Impairments were modest (9% and 13% [pooled effect divided by mean of the unaffected side scores]) and of uncertain clinical importance. The remaining evidence, primarily among individuals with mid-portion AT, showed conflicting impairments for plantarflexor function (i.e. explosive strength and endurance) between sides. There was limited to very limited evidence for improvement in plantarflexor endurance (7% and 23%) but not power or strength (five studies including one with a mixed population for strength) over time, despite individuals undertaking several weeks of resistance training. Conclusions Plantarflexor impairments appear more common between sides than compared with control groups but given limitations in the literature further exploration of these relationships is needed. Registration PROSPERO Database; number CRD42019100747. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00308-8.
Collapse
|
17
|
Andere NFB, Godoy-Santos AL, Mochizuki L, Rodrigues MB, Fernandes TD, Soares-Júnior JM, Alonso AC, Luna NMS, Brech GC, Greve JMD. Biomechanical evaluation in runners with Achilles tendinopathy. Clinics (Sao Paulo) 2021; 76:e2803. [PMID: 34133661 PMCID: PMC8158676 DOI: 10.6061/clinics/2021/e2803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the clinical characteristics, ground reaction force (GRF), and function of the plantar muscles and dorsiflexors of the ankle in runners with and without Achilles tendinopathy (AT) and in non-runners. METHODS Seventy-two participants (42 men, 30 women; mean age: 37.3±9.9 years) were enrolled in this cross-sectional study and divided into three groups: AT group (ATG, n=24), healthy runners' group (HRG, n=24), and non-runners' group (NRG, n=24). Both ankles were evaluated in each group. The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale was used for clinical and functional evaluation. GRF was evaluated using force plates and muscle strength was evaluated using an isokinetic dynamometer. RESULTS The AOFAS scores were lower in the ATG. The strike impulse was higher in the ATG than in the HRG and NRG. However, GRF was similar among the groups. The ATG exhibited lower total work at 120°/s speed than the HRG. The peak torque in concentric dorsiflexion was lower in the NRG than in the ATG and HRG. The peak torque and total work in concentric plantar flexion were lower in the NRG than in the ATG. The peak torque and total work in eccentric plantar flexion were lower in the NRG than in the ATG and HRG. CONCLUSION Runners with AT showed higher strike impulse, lower muscle strength of the plantar flexors, and higher clinical and functional damage.
Collapse
Affiliation(s)
- Nathalie Ferrari Bechara Andere
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Alexandre Leme Godoy-Santos
- Departamento de Cirurgia Ortopedica, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luis Mochizuki
- Laboratorio de Biomecanica, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Bordalo Rodrigues
- Departamento de Cirurgia Ortopedica, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Túlio Diniz Fernandes
- Departamento de Cirurgia Ortopedica, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Maria Soares-Júnior
- Disciplina de Ginecologia, Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, BR
| | - Angélica Castilho Alonso
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Programa de Ciencias do Envelhecimento, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Natália Mariana Silva Luna
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Guilherme Carlos Brech
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Programa de Ciencias do Envelhecimento, Universidade Sao Judas Tadeu (USJT), Sao Paulo, SP, BR
| | - Júlia Maria D’Andréa Greve
- Laboratorio de Estudos do Movimento, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
18
|
Girgis B, Duarte JA. Physical therapy for tendinopathy: An umbrella review of systematic reviews and meta-analyses. Phys Ther Sport 2020; 46:30-46. [PMID: 32877858 DOI: 10.1016/j.ptsp.2020.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To summarize evidence in the last decade regarding the efficacy of physical therapy interventions to treat tendinopathy, as a single disease entity, as determined in systematic reviews (SRs) and/or meta-analyses (MAs). METHODS Electronic search of PubMed, PEDro, and Scopus database was performed from year 2010 to January 2020. The methodological quality of the identified studies was assessed using the AMSTAR 2 tool. Studies scoring 9 points or higher were further analyzed using GRADE principles. RESULTS 40 SRs and/or MAs were included in qualitative synthesis, whereas only 5 MAs were included in quantitative synthesis. Low-level laser therapy (LLLT) intervention showed a pooled improvement in pain reduction of 1.53 cm; 95% CI, [1.14, 1.91] (I2 = 1.9%, p = 0.361) on visual analogue scale, and grip strength of 9.59 kg; 95% CI, [5.90, 13.27]. CONCLUSIONS Moderate-quality evidence may support these following interventions: LLLT revealed a statistically and potentially clinically significant improvement in pain and function on the short-term. Extracorporeal shockwave therapy showed a statistically significant enhancement in pain and function at all follow-up durations; however, its clinical significance was undetermined. Eccentric exercise was supported by qualitative evidence only. Caution is advised when interpreting results due to possible pathological differences in tendinopathy at each region.
Collapse
Affiliation(s)
- Beshoy Girgis
- CIAFEL, Faculty of Sport, University of Porto, R. Dr. Plácido Costa, 91, 4200-450, Porto, Portugal.
| | - José Alberto Duarte
- CIAFEL, Faculty of Sport, University of Porto, R. Dr. Plácido Costa, 91, 4200-450, Porto, Portugal.
| |
Collapse
|
19
|
Koszalinski A, Flynn T, Hellman M, Cleland JA. Trigger point dry needling, manual therapy and exercise versus manual therapy and exercise for the management of Achilles tendinopathy: a feasibility study. J Man Manip Ther 2020; 28:212-221. [PMID: 32048918 PMCID: PMC8550527 DOI: 10.1080/10669817.2020.1719299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 12/18/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES The effects of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy (AT) are unknown. We conducted a study to test the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to MT and exercise in a patient population with AT. METHODS Twenty-two subjects were randomly assigned to a control (MT+Ex) or experimental group (TDN+MT+Ex) and completed eight treatment sessions over 4 weeks with follow up at 3 months. TDN was performed to MTPs in the gastrocnemius, soleus or tibialis posterior each session. The same MT and exercise program was conducted in both groups. RESULTS Two of three criteria for feasibility were met. The attrition rate at 4-week and 3-month follow-up was 18.1% and 68%, respectively. Significant differences (p < .05) reported for within group analysis for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 3 months. The GROC was significant for MT + Ex at 3 months. No between group differences were found. The MCID for the FAAM, GROC was surpassed in both groups at 4 weeks and 3 months and NPRS for the MT + Ex group at 4 weeks. DISCUSSION A large RCT to investigate the effects of TDN on MTP in AT is not feasible without modifications due to low recruitment and high attrition rate. Modifications to study design should give consideration for closed or national health-care system for access to large patient populations and reduced financial burden to subjects. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03261504F.
Collapse
Affiliation(s)
- A. Koszalinski
- Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - T. Flynn
- Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - M. Hellman
- Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - J. A. Cleland
- Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, FL, USA
| |
Collapse
|
20
|
Extracorporeal Shockwave Therapy for Patients with Chronic Achilles Tendinopathy in Long or Short Course. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7525096. [PMID: 32851086 PMCID: PMC7441454 DOI: 10.1155/2020/7525096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
Methods The data of 66 patients with CAT received ESWT was reviewed. According to the disease courses, those cases were allocated to short-term group (ST group, symptom duration 3-6 months) and long-term group (LT group, symptom duration >6 months). Propensity scores match (PSM) method was conducted to eliminate the confound factors in baseline features including gender, sport history, sides, type of CAT, BMI (body mass index), age, and scores evaluated by AOFAS (American Orthopedic Foot and Ankle Society) and VAS (Visual Analogue Scale) before ESWT. After balancing the features between ST and LT group, postinterventional VAS, AOFAS, and rate of Likert satisfaction scale at the 3rd month after first ESWT was statistically analyzed. Results Among the baseline features in ST and LT group, gender (female ratio, 44.4% vs 71.4%, p = 0.041) and BMI (23.26 ± 2.15 vs 24.63 ± 2.41, p = 0.024) were identified as confound factors. After elimination of biased features with PSM, 3 months after first ESWT, AOFAS and VAS in both groups are significantly improved, when compared with their scores at baseline (p < 0.01). Moreover, at postintervention month 3 (PIM3), AOFAS in ST group is significantly higher than LT group (85.08 ± 9.83 vs 76.76 ± 9.85, t = 76.76 ± 9.85, p = 0.019), and the rate of Likert satisfaction in ST group is better than LT group; although, it did not reach but close to significant level (70.6% vs 47.1%, χ 2 = 1.943, p = 0.163). However, there is no statistical difference of VAS scores between two groups after ESWT (1.96 ± 0.98 vs 2.24 ± 1.29, t = 0.703, p = 0.487). Conclusions ESWT could effectively relieve pain and improve function of hind foot in patients with chronic Achilles tendinopathy, and especially, it could offer better benefit on functional improvement in patients with short duration of CAT symptom.
Collapse
|
21
|
DiLiberto FE, Nawoczenski DA, Tome J, Tan RK, DiGiovanni BF. Changes in Muscle Morphology Following Gastrocnemius Recession for Achilles Tendinopathy: A Prospective Cohort Imaging Study. Foot Ankle Spec 2020; 13:297-305. [PMID: 31230471 DOI: 10.1177/1938640019857805] [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: 11/16/2022]
Abstract
Background. The purpose of this study was to evaluate changes in posterior compartment muscle volume and intramuscular fat content following gastrocnemius recession in people with Achilles tendinopathy (AT). Methods. Eight patients diagnosed with unilateral recalcitrant AT and an isolated gastrocnemius contracture participated in this prospective cohort study. Magnetic resonance imaging was performed on both limbs of each participant before and 6 months following an isolated gastrocnemius recession. Involved limb muscle volumes and fat fractions (FFs) of the medial gastrocnemius, lateral gastrocnemius, and soleus muscle were normalized to the uninvolved limb. Preoperative to postoperative comparisons were made with Wilcoxon signed-rank tests. Results. Soleus or lateral gastrocnemius muscle volumes or FFs were not significantly different between study time points. A significant difference was found in medial gastrocnemius muscle volume (decrease; P = .012) and FF (increase; P = .017). Conclusion. A major goal of the Strayer gastrocnemius recession, selective lengthening of the posterior compartment while preserving soleus muscle morphology, was supported. The observed changes isolated to the medial gastrocnemius muscle may reduce ankle plantarflexion torque capacity. Study findings may help inform selection of surgical candidates, refine anticipated outcomes, and better direct postoperative rehabilitation following gastrocnemius recession for AT.Levels of Evidence: Level IV: Prospective cohort study.
Collapse
Affiliation(s)
- Frank E DiLiberto
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Deborah A Nawoczenski
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Josh Tome
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Raymond K Tan
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| | - Benedict F DiGiovanni
- Department of Physical Therapy, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois (FED).,Department of Orthopaedics, School of Medicine and Dentistry, University of Rochester, University of Rochester Medical Center, Rochester, New York (DAN, BFD).,School of Health Science and Human Performance, Movement Analysis Laboratory, Ithaca College, Ithaca, New York (JT).,Department of Imaging Sciences, University of Rochester Medical Center, Highland Hospital, Rochester, New York (RKT)
| |
Collapse
|
22
|
Pinitkwamdee S, Laohajaroensombat S, Orapin J, Woratanarat P. Effectiveness of Extracorporeal Shockwave Therapy in the Treatment of Chronic Insertional Achilles Tendinopathy. Foot Ankle Int 2020; 41:403-410. [PMID: 31924120 DOI: 10.1177/1071100719898461] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Extracorporeal shockwave therapy (ESWT) has been proposed as a conservative treatment for insertional Achilles tendinopathy from limited evidence without placebo controls. Our objective was to assess the effectiveness of ESWT compared with sham controls in chronic insertional Achilles tendinopathy. METHODS A double-blind, randomized sham-controlled trial was conducted between 2016 and 2018. The inclusion criteria were patients aged 18 to 70 years diagnosed with chronic insertional Achilles tendinopathy who failed standard conservative treatment. After computerized randomization, patients were allocated into either low-energy ESWT or sham control. Pain, function, and other complaints were assessed using visual analog scale (VAS) and VAS foot and ankle (VAS-FA) at preintervention and weeks 2, 3, 4, 6, 12, and 24. Intention-to-treat analysis and repeated measurement were performed using STATA 15.0. RESULTS Sixteen patients in ESWT and 15 patients in sham control groups had nonsignificant different baseline characteristics with preintervention VAS (6.0 ± 2.6 vs 5.2 ± 2.2) and VAS-FA (64.8 ± 16.6 vs 65.3 ± 12.7). There was no significant difference in VAS, VAS-FA, and its domains in the long term between the 2 groups. In addition, the ESWT group had significant improvement in VAS (2.9 ± 2.2) at weeks 4 to 12, and sham controls group had significantly improved VAS (2.3 ± 2.6) at weeks 12 to 24. Complications were found only after ESWT treatment. CONCLUSION There was no difference at 24 weeks with the use of low-energy ESWT for chronic insertional Achilles tendinopathy, especially in elderly patients. However, it may provide a short period of therapeutic effects as early as weeks 4 to 12. LEVEL OF EVIDENCE Level I, randomized controlled study.
Collapse
Affiliation(s)
- Siwadol Pinitkwamdee
- Department of Orthopedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sukij Laohajaroensombat
- Department of Orthopedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jakrapong Orapin
- Department of Orthopedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Patarawan Woratanarat
- Department of Orthopedic Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
23
|
Abstract
BACKGROUND Runners experience a high proportion of overuse injuries, with extended recovery periods involving a gradual, progressive return to preinjury status. A running-specific patient-reported outcome (PRO) measure does not exist, and a questionnaire assessing critical elements of runners' recovery processes may have excellent psychometric properties. OBJECTIVES To develop a valid, reliable, and responsive evaluative PRO measure to assess longitudinal change in running ability after running-related injury (RRI) for clinical practice and research applications. METHODS Self-identified runners and selected experts participated in an iterative, 6-step development process of the University of Wisconsin Running Injury and Recovery Index (UWRI) in this longitudinal clinical measurement study. Content-related validity was assessed using open comments. Reproducibility was assessed using Cronbach's alpha, the intraclass correlation coefficient (ICC), and standard error of measurement (SEM). An anchor-based construct validity assessment measured the association between the change in UWRI score and global rating of change (GROC). Responsiveness assessments included floor and ceiling effects. RESULTS The 9-item UWRI assesses running ability following an RRI, with the maximum score of 36 indicating a return to preinjury running ability. The UWRI demonstrated acceptable internal consistency (α = .82), test-retest reliability (ICC = 0.93), and SEM (1.47 points). Change in UWRI score was moderately correlated with the GROC (r = 0.61; 95% confidence interval: 0.4, 0.76). Floor and ceiling effects were absent. Completion required 3 minutes 15 seconds. CONCLUSION The UWRI is a reliable PRO measure and is responsive to changes in running function following an RRI, with minimal administrative burden. LEVEL OF EVIDENCE Therapy, level 2c. J Orthop Sports Phys Ther 2019;49(10):751-760. Epub 3 Aug 2019. doi:10.2519/jospt.2019.8868.
Collapse
|
24
|
Sancho I, Malliaras P, Barton C, Willy RW, Morrissey D. Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis. Gait Posture 2019; 73:189-201. [PMID: 31351358 DOI: 10.1016/j.gaitpost.2019.07.121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 06/19/2019] [Accepted: 07/01/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Biomechanical alterations during running and hopping in people with Achilles tendinopathy (AT) may provide treatment and prevention targets. This review identifies and synthesises research evaluating biomechanical alterations among people with AT during running, jumping and hopping. METHOD MEDLINE, EMBASE, CiNAHL and SPORTDiscus were searched in July 2018 for case control, cross-sectional and prospective studies investigating kinematics, kinetics, plantar pressures and neuromuscular activity in AT participants during running or hopping. Study quality was assessed with a modified version of the Downs and Black quality checklist, and evidence grading applied. RESULTS 16 studies reported 249 outcomes, of which 17% differed between groups. Reduced peroneus longus (standardized mean difference [95%CI]; -0.53 [-0.98, -0.09]) and medial gastrocnemius (-0.60 [-1.05, -0.15]) amplitude in AT runners versus control was found (limited evidence). Increased hip adduction impulse 1.62 [0.69, 2.54], hip peak external rotation moment (1.55 [0.63, 2.46] and hip external rotation impulse (1.45 [0.55, 2.35]) was found in AT runners versus control (limited evidence). Reduced anterior (-0.94 [-1.64, -0.24] and greater lateral (-0.92 [-1.61, -0.22]) displacement of plantar pressure preceded AT in runners (limited evidence). Delayed onsets of gluteus medius (1.95 [1.07, 2.83] and gluteus maximus (1.26 [0.48, 2.05] and shorter duration of gluteus maximus activation (-1.41 [-2.22, -0.61] was found during shod running in the AT group versus control (limited evidence). Earlier offset time of gluteus maximus (-1.03 [-1.79, -0.27] and shorter duration of activation of gluteus medius (-0.18 [-0.24, -0.12] during running in AT runners versus control was found (limited evidence). Reduced leg stiffness was found in the affected side during submaximal hopping (-0.39 [-0.79, -0.00]) (limited evidence). CONCLUSION This review identified potential biomechanical treatment targets in people with AT. The efficacy of treatments targeting these biomechanics should be assessed. SYSTEMATIC REVIEW REGISTRY PROSPERO registration number: CRD42016048636.
Collapse
Affiliation(s)
- Igor Sancho
- Sports and Exercise Medicine. Queen Mary University of London, United Kingdom.
| | | | - Christian Barton
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia.
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, Montana, United States.
| | - Dylan Morrissey
- Sports and Exercise Medicine. Queen Mary University of London, United Kingdom; Physiotherapy Department, Barts Health NHS Trust, London, United Kingdom.
| |
Collapse
|
25
|
Nunes GS, Tessarin BM, Scattone Silva R, Serrão FV. Relationship between the architecture and function of ankle plantar flexors with Achilles tendon morphology in ballet dancers. Hum Mov Sci 2019; 67:102494. [PMID: 31326740 DOI: 10.1016/j.humov.2019.102494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 11/16/2022]
Abstract
Achilles tendinopathy is the most frequent foot overuse injury in ballet dancers and knowledge of clinically modifiable factors related to tendon structure in a population at risk, such as ballet dancers, would be important for the development of preventive programs. Therefore, the present study aimed to assess relationships of gastrocnemius muscle architecture and ankle plantar flexors function with Achilles tendon morphology in ballet dancers. Fifty-four measures from 27 ballet dancers were collected. Tendon morphology (thickness, echogenicity, hypoechoic areas and neovascularisation) and muscle architecture (thickness, pennation angle and fascicle length) were evaluated using ultrasonography; ankle plantar flexors torque was evaluated using hand-held dynamometry, flexibility was evaluated in maximal weight-bearing ankle dorsiflexion position using inclinometer, and endurance was evaluated using the heel rise test. Ankle plantar flexors torque and medial gastrocnemius muscle architecture (thickness, pennation angle and fascicle length) are associated with Achilles tendon thickness in ballet dancers (r2 = 0.24, p = 0.008). Ankle plantar flexors torque and medial gastrocnemius muscle fascicle length are also associated with the echogenicity of the Achilles tendon (r2 = 0.13, p = 0.03). These findings call attention to the potential importance of ankle plantar flexors muscle force in healthy ballet dancers for the prevention of alterations in Achilles tendon structure.
Collapse
Affiliation(s)
- Guilherme S Nunes
- Department of Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | | | - Rodrigo Scattone Silva
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | | |
Collapse
|
26
|
The Effects of Needling Therapies on Muscle Force Production: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2019; 49:154-170. [PMID: 30501386 DOI: 10.2519/jospt.2019.8270] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Needling has been shown to decrease pain in the short term; however, its effects on muscle force production are unclear. OBJECTIVE To evaluate the evidence regarding the comparative effects of needling on muscle force production. METHODS In this systematic review, an electronic search was performed using key words related to needling. Methodological quality of articles was appraised and effect sizes were calculated. The strength of evidence was determined, and meta-analysis was performed when similar methods were used in studies for similar conditions. RESULTS Twenty-one studies were included in this review, of which 9 were deemed to be of high quality (greater than 6/10 on the Physiotherapy Evidence Database [PEDro] scale), 11 of fair quality (5 to 6/10), and 1 of poor quality (less than 5/10). Three meta-analyses were performed. There was moderate strength of evidence and medium effect sizes for needling therapy to enhance force production in those with neck pain, and very low strength of evidence of no effect for individuals with nonspecific and postoperative shoulder pain and those with lateral epicondylalgia. Other studies not included in the 3 meta-analyses demonstrated no significant effect of needling on force production. These studies included individuals with carpal tunnel syndrome, knee osteoarthritis, ankle sprains, knee arthroscopy, or delayed-onset muscle soreness. CONCLUSION The majority of studies suggest no effect of dry needling on force production. High-quality studies with adequate power that control for the placebo effect and follow accepted reporting standards could make valuable contributions to the literature. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42017080318). LEVEL OF EVIDENCE Therapy, level 1a. J Orthop Sports Phys Ther 2019;49(3):154-170. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8270.
Collapse
|
27
|
Edama M, Takabayashi T, Inai T, Kikumoto T, Ito W, Nakamura E, Hirabayashi R, Ikezu M, Kaneko F, Kageyama I. Differences in the strain applied to Achilles tendon fibers when the subtalar joint is overpronated: a simulation study. Surg Radiol Anat 2019; 41:595-599. [PMID: 30617509 DOI: 10.1007/s00276-019-02181-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to investigate the strain applied to each of the tendon fiber bundles of the medial head of the gastrocnemius (MG), the lateral head of the gastrocnemius (LG), and the soleus muscle (Sol) that compose the Achilles tendon (AT) when the subtalar joint is pronated and supinated. METHODS Three AT twist types (least, moderate, extreme) were investigated. Using the MicroScribe system, the AT and the talocrural and subtalar joints were digitized to reconstruct three-dimensional models. Using this system, subtalar joint rotations in the pronation (20°) and supination (20°) directions were simulated, and the degrees of strain (%) on each tendon were calculated. RESULTS For all twist types, when the subtalar joint was pronated, MG, LG, and Sol stretched, and when supinated, MG, LG, and Sol shortened. In particular, the least and severe twist types had large degrees of strain of Sol when the subtalar joint was pronated, and furthermore, each tendon fiber composing Sol had different degrees of strain. CONCLUSIONS The study results suggest that the degree of strain applied within the AT with subtalar joint pronation is not constant, and that, especially in least and extreme twist types, the risk of developing AT disorders may increase.
Collapse
Affiliation(s)
- Mutsuaki Edama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan. .,Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan.
| | - Tomoya Takabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Takuma Inai
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Takanori Kikumoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Wataru Ito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Emi Nakamura
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Ryo Hirabayashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Masahiro Ikezu
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Fumiya Kaneko
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, Kita-ku, Niigata City, 950-3198, Japan
| | - Ikuo Kageyama
- Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan
| |
Collapse
|
28
|
Shepherd M, Louw A, Podolak J. The clinical application of pain neuroscience, graded motor imagery, and graded activity with complex regional pain syndrome-A case report. Physiother Theory Pract 2018; 36:1043-1055. [PMID: 30499359 DOI: 10.1080/09593985.2018.1548047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic Regional Pain Syndrome (CRPS) is a condition that physical therapists may encounter in an outpatient orthopedic setting. In physical therapy (PT) treatment of CRPS addresses pain and the changes observed in the brain through the use of graded motor imagery (GMI). CASE DESCRIPTION A 57-year-old female presented to an outpatient PT clinic with CRPS type 1. Complicating psychosocial factors such as kinesiophobia and catastrophization were present. The patient engaged in a treatment plan including GMI: pain neuroscience education (PNE), laterality training, motor imagery, and mirror training. As symptoms improved, graded functional exposure and functional restoration occurred. OUTCOMES The patient was seen for a total of 26 visits over a 9-month period. FAAM measures exceeded reported clinically important change that was sustained at two-year follow-up. Long term outcomes showed no functional deficits related to her foot or ankle and minimal to no catastrophizing and fear avoidance behaviors. DISCUSSION This case report showcases the use of GMI with a patient with CRPS type 1 in an outpatient orthopedic clinic. Clinicians may consider the use of GMI to progress a patient toward maximal functional gains.
Collapse
Affiliation(s)
- Mark Shepherd
- Department of Physical Therapy, South College , Knoxville, TN, USA.,Evidence in Motion Institute of Health Professions , Louisville, KY, USA
| | - Adriaan Louw
- International Spine and Pain Institute , Louisville, KY, USA
| | | |
Collapse
|
29
|
Krill MK, Hoffman J, Yang J, Hodax JD, Owens BD, Hewett TE. Previous foot injuries associated with a greater likelihood of Achilles tendon ruptures in professional American football players. PHYSICIAN SPORTSMED 2018; 46:342-348. [PMID: 29860909 DOI: 10.1080/00913847.2018.1482188] [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] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The purpose of this study was to build on current understanding of Achilles tendon (AT) ruptures in football through the examination of lower extremity injury rates (IR) in the season prior to AT rupture. METHODS An online review was conducted to document AT ruptures in the National Football League (NFL) from the 2010-11 through 2016-17 seasons. Player-specific information was gathered through the online search, injury reports, or video analysis. Injury incidence was recorded for each season. Descriptive statistics were calculated for all variables. IRs per 1000 athlete-exposures with 95% confidence intervals (CI) were established. Injury rate ratios (IRR) with 95% CI were calculated to evaluate differences in IR with statistical significance established at p < 0.05. RESULTS From the 2010-11 to 2016-17 NFL seasons, 109 AT ruptures were identified. 36 athletes participated in the NFL the season prior and sustained a total of 40 injuries. Thirty-two (32/40, 80%) of the injuries involved the lower extremity. The most frequent body parts injured in the NFL season prior to AT rupture were the knee (n = 8, 22.5%), upper leg and thigh (n = 7, 17.5%), lower leg and shin (n = 5, 12.5%), and ankle (n = 5, 12.5%). The overall IR for the AT rupture group was not significantly different than the NFL group (IRR: 0.94, 0.68-1.31 95% CI, p = 0.73). The AT rupture group demonstrated a significantly increased rate of foot injuries compared to the NFL cohort (IRR: 2.58, 1.16-5.77 95% CI, p = 0.02). CONCLUSION There was an increased identified incidence of AT ruptures in the NFL from 2010 to 2017 compared to AT ruptures reported from 1997 to 2002. There was no significant difference in lower extremity IR the season prior to AT rupture. Only foot injuries demonstrated an increased IR the season prior to AT rupture compared to an NFL cohort. Eleven athletes sustained 2 AT ruptures and all 11 players sustained the subsequent AT rupture to the contralateral limb.
Collapse
Affiliation(s)
- Michael K Krill
- a James Crane Sports Medicine Institute, Motion Analysis and Performance Laboratory , The Ohio State University Wexner Medical Center , Columbus , OH , USA.,b Charles E. Schmidt College of Medicine , Florida Atlantic University , Boca Raton , FL , USA.,c Physical Medicine and Rehabilitation, Department of Neurology, Division of Neurorehabilitation , Washington University in St. Louis , St. Louis , MO , USA
| | - Joshua Hoffman
- a James Crane Sports Medicine Institute, Motion Analysis and Performance Laboratory , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - JaeWon Yang
- d Warren Alpert Medical School of Brown University , Providence , RI
| | - Johnathan D Hodax
- e Department of Orthopaedic Surgery , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Brett D Owens
- e Department of Orthopaedic Surgery , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Timothy E Hewett
- f Sports Medicine Center , Mayo Clinic , Rochester , MN , USA.,g Department of Orthopedic Surgery , Mayo Clinic , Rochester , MN , USA.,h Department of Physiology and Biomedical Engineering , Mayo Clinic , Rochester , MN , USA.,i Department of Physical Medicine & Rehabilitation , Mayo Clinic , Rochester , MN , USA
| |
Collapse
|
30
|
Wilson F, Walshe M, O'Dwyer T, Bennett K, Mockler D, Bleakley C. Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis. Br J Sports Med 2018; 52:1564-1574. [PMID: 30170996 DOI: 10.1136/bjsports-2017-098913] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To assess the efficacy of exercise, orthoses and splinting on function, pain and quality of life (QoL) for the management of mid-portion and insertional Achilles tendinopathy, and to compare different types, applications and modes of delivery within each intervention category. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, CINAHL, Embase, AMED, WHO ICTRP, Web of Science, PEDro and Cochrane Library from inception to October 2017. Citation tracking of published studies and conference proceedings and contacting experts in the field. STUDY ELIGIBILITY CRITERIA Controlled clinical trials evaluating either exercise, orthoses or splinting for the management of Achilles tendinopathy. METHODS Independent reviewers undertook searches, screening and risk of bias appraisal. Primary outcomes of interest were function, pain and QoL. RESULTS Twenty-two studies were included (1137 participants). Moderate level evidence favoured eccentric exercise over control for improving pain and function in mid-portion tendinopathy. Moderate level evidence favoured eccentric exercise over concentric exercise for reducing pain. There was moderate level evidence of no significant difference in pain or function between eccentric exercise and heavy slow resistance exercise. There was low level evidence that eccentric exercise was not superior to stretching for pain or QoL. There was moderate level evidence that a combined exercise protocol was not superior to a lower dosage protocol for improving functional performance. There was moderate to low level evidence of a significant difference in pain (mean difference (MD) 6.3 mm, 95% CI -4.45 to 17.04, moderate) or function (MD 1.83 Victoria Institute of Sport Assessment points, 95% CI -7.47 to 11.12, low) between high-dose and low-dose eccentric training. There was high to moderate level evidence of no difference in pain (moderate) or function (high) between orthoses and control. There was low level evidence of no significant benefit in adding a night splint to an eccentric exercise programme for function, and moderate level evidence for no reduction in pain (MD -3.50, 95% CI -10.49 to 3.48). Eccentric exercise was not superior to splinting for pain (moderate evidence) or function (low level evidence). SUMMARY We conditionally recommend exercise for improving pain and function in mid-portion Achilles tendinopathy. The balance of evidence did not support recommendation of one type of exercise programme over another. We conditionally recommend against the addition of a splint to an eccentric exercise protocol and we do not recommend the use of orthoses to improve pain and function in Achilles tendinopathy.
Collapse
Affiliation(s)
- Fiona Wilson
- School of Medicine, Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Tom O'Dwyer
- School of Medicine, Discipline of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - Kathleen Bennett
- RCSI Population and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St. James Hospital, Dublin, Ireland
| | - Christopher Bleakley
- Department of Physical Therapy, Congdon School of Health Sciences, High Point University, High Point, North Carolina, USA
| |
Collapse
|
31
|
Gheidi N, Kernozek TW, Willson JD, Revak A, Diers K. Achilles tendon loading during weight bearing exercises. Phys Ther Sport 2018; 32:260-268. [DOI: 10.1016/j.ptsp.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 04/18/2018] [Accepted: 05/08/2018] [Indexed: 01/18/2023]
|
32
|
Gerdesmeyer L, Saxena A, Klueter T, Harrasser N, Fullem B, Krath A. Electromagnetic Transduction Therapy for Achilles Tendinopathy: A Preliminary Report on a New Technology. J Foot Ankle Surg 2018; 56:964-967. [PMID: 28842106 DOI: 10.1053/j.jfas.2017.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Indexed: 02/03/2023]
Abstract
A parallel prospective feasibility study was performed on 53 patients with chronic mid-portion Achilles tendinopathy (age 44.7 ± 9.1 years). Of the 53 patients, 28 (active group) were treated using a new electromagnetic (pulsed electromagnetic field) transduction therapy device (Cellactor® MT1) and heel cushions. The device produces an electromagnetic field of 80 milliTesla; a total of 8 treatments was performed within 4 weeks in an outpatient setting, without anesthesia, immobilization, or rest. A control group of 25 patients with a similar duration of symptoms was treated with heel cushions only. At the 12-week assessment point, the visual analog scale scores in both groups had significantly decreased, although the active group had significantly improved visual analog scale scores compared with those of the controls. The Role-Maudsley scores had also significantly improved in both the active and the control groups (p < .00001 and p = .0002, respectively). Electromagnetic transduction therapy could potentially be a useful modality for the treatment of Achilles tendinopathy. It should be compared with the current reference standard of extracorporeal shockwave therapy/radial soundwave therapy with similar level I, II, and III studies.
Collapse
Affiliation(s)
- Ludger Gerdesmeyer
- Professor and Orthopedist, Department of Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Kiel, Germany; Professor and Orthopedist, Department of Orthopaedic and Traumatology, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Amol Saxena
- Podiatrist, Department of Sports Medicine, Palo Alto Foundation Medical Group, Palo Alto, CA.
| | - Tim Klueter
- Orthopedist, Department of Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Norbert Harrasser
- Professor and Orthopedist, Department of Orthopaedic and Traumatology, Technical University Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Brian Fullem
- Podiatrist, Elite Sports Podiatry, Clearwater, FL
| | - Andre Krath
- Professor and Orthopedist, Department of Orthopaedic Surgery and Traumatology, University Schleswig Holstein, Campus Kiel, Kiel, Germany
| |
Collapse
|
33
|
Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018: Using the Evidence to Guide Physical Therapist Practice. J Orthop Sports Phys Ther 2018; 48:425-426. [PMID: 29712549 DOI: 10.2519/jospt.2018.0505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Midportion Achilles tendinopathy is a relatively common, overuse, lower extremity soft tissue injury for individuals who are active and participate in sports. The clinical practice guideline published in the May 2018 issue of JOSPT, titled "Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018," can help physical therapists engage in evidence-informed practice and reduce unnecessary clinical variation. J Orthop Sports Phys Ther 2018;48(5):425-426. doi:10.2519/jospt.2018.0505.
Collapse
|
34
|
Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018; 48:A1-A38. [PMID: 29712543 DOI: 10.2519/jospt.2018.0302] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to midportion Achilles tendinopathy. J Orthop Sports Phys Ther 2018;48(5):A1-A38. doi:10.2519/jospt.2018.0302.
Collapse
|
35
|
Young JL, Rhon DI, de Zoete RMJ, Cleland JA, Snodgrass SJ. The influence of dosing on effect size of exercise therapy for musculoskeletal foot and ankle disorders: a systematic review. Braz J Phys Ther 2018; 22:20-32. [PMID: 29157736 PMCID: PMC5816081 DOI: 10.1016/j.bjpt.2017.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The purpose of this review was to identify doses of exercise therapy associated with greater treatment effect sizes in individuals with common musculoskeletal disorders of the foot and ankle, namely, achilles tendinopathy, ankle sprains and plantar heel pain. METHODS AMED, EMBASE and MEDLINE were searched from 2005 to August 2017 for randomized controlled trials related to exercise for these three diagnoses. The Physiotherapy Evidence Database scale was used for methodological quality assessment. Exercise dosing variables and outcome measures related to pain and function were extracted from the studies, and standardized mean differences were calculated for the exercise groups. RESULTS Fourteen studies met the final inclusion. A majority of the studies showed large effects and two small trends were identified. Patients with plantar heel pain may benefit more from a daily home exercise program than two supervised visits per week (SMD=3.82), but this recommendation is based on weak evidence. In achilles tendinopathy, a relationship was also seen when sets and repetitions of eccentric exercise were performed as tolerated (SMD=1.08 for function, -1.29 for pain). CONCLUSIONS Session duration, frequency, total number of visits, and overall length of care may all be dosing variables with limited value for determining effective exercise prescription. However, the limited number of studies prevents any definitive conclusions. Further investigation is warranted to improve our understanding of the influence exercise dosing has on treatment effect sizes. Future randomized controlled trials comparing specific exercise dose variables should be conducted to clarify the impact of these variables.
Collapse
Affiliation(s)
- Jodi L Young
- Arizona School of Health Sciences, Department of Physical Therapy, AT Still University, Mesa, AZ, USA; The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia.
| | - Daniel I Rhon
- The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia; Center for the Intrepid, San Antonio, TX, USA; Physical Therapy, Baylor University, Joint Base San Antonio - Fort Sam Houston, TX, USA
| | - Rutger M J de Zoete
- The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia
| | - Joshua A Cleland
- Franklin Pierce University, Manchester, Department of Physical Therapy, NH, USA
| | - Suzanne J Snodgrass
- The University of Newcastle, School of Health Sciences, Discipline of Physiotherapy, Callaghan, Australia
| |
Collapse
|
36
|
Musculoskeletal Injuries and Regenerative Medicine in the Elderly Patient. Phys Med Rehabil Clin N Am 2017; 28:777-794. [DOI: 10.1016/j.pmr.2017.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
37
|
Schneebeli A, Del Grande F, Vincenzo G, Cescon C, Barbero M. Test-retest reliability of echo intensity parameters in healthy Achilles tendons using a semi-automatic tracing procedure. Skeletal Radiol 2017; 46:1553-1558. [PMID: 28828624 DOI: 10.1007/s00256-017-2748-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/07/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the test-retest reliability of the ultrasound echo intensity parameters on healthy Achilles tendon using a semi-automatic tracing procedure. MATERIALS AND METHODS Eighteen healthy volunteers participated. B-mode images were acquired in the transverse plane (mid-tendon; insertion) and used to analyze tendon echogenicity. Grayscale distribution of the pixels within the selected ROIs was represented as a histogram. Descriptive statistics of the grayscale distribution (mean, variance, skewness, kurtosis, and entropy) and parameters from the co-occurrence matrix (contrast, energy, and homogeneity) were calculated. RESULTS Reliability of echo intensity parameters of the mid-Achilles tendon ranged from high to very high with an ICC2.k of 0.94 for echogenicity, 0.87 for variance, 0.80 for skewness, 0.72 for kurtosis, 0.89 for entropy, 0.90 for contrast, 0.91 for energy, and 0.93 for homogeneity, while for tendon insertion they ranged from moderate to high with an ICC2.k of 0.74 for echogenicity, 0.88 for variance, 0.75 for skewness, 0.55 for kurtosis, 0.87 for entropy, 0.70 for contrast, 0.77 for energy, and 0.56 for homogeneity. CONCLUSION Ultrasound echo intensity is a reliable technique to characterize the internal structure of the Achilles tendon.
Collapse
Affiliation(s)
- Alessandro Schneebeli
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Stabile piazzetta, Via violino, 6928, Manno, Switzerland.
| | - Filippo Del Grande
- Servizio di Radiologia del Sottoceneri, sede Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Gabriele Vincenzo
- Servizio di Radiologia del Sottoceneri, sede Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Corrado Cescon
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Stabile piazzetta, Via violino, 6928, Manno, Switzerland
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Stabile piazzetta, Via violino, 6928, Manno, Switzerland
| |
Collapse
|
38
|
Fellas A, Hawke F, Santos D, Coda A. Prevalence, presentation and treatment of lower limb pathologies in juvenile idiopathic arthritis: A narrative review. J Paediatr Child Health 2017; 53:836-840. [PMID: 28767173 DOI: 10.1111/jpc.13646] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 01/17/2017] [Accepted: 05/23/2017] [Indexed: 12/26/2022]
Abstract
Juvenile idiopathic arthritis is a chronic, autoimmune, inflammatory joint disease. It is the most common arthritis in children and adolescents. This paper reviews the presentation and treatment of lower limb pathologies in juvenile idiopathic arthritis from an allied health perspective. Common lower limb pathologies include: synovitis causing swelling, tenderness and pain; persistent inflammation leading to flexion contractures; limb length discrepancies; muscle atrophy; enthesopathies such as plantar fasciitis and Achilles tendonitis; and tenosynovitis. Allied health professionals may use a range of non-invasive therapies, including hydrotherapy, strengthening and stretching exercises, massaging, taping and foot orthoses to manage lower limb pathologies in juvenile idiopathic arthritis. Early detection and treatment of these common and potentially disabling lower limb pathologies are fundamental to achieving gold standard care for children with juvenile idiopathic arthritis.
Collapse
Affiliation(s)
- Antoni Fellas
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Fiona Hawke
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Andrea Coda
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
39
|
Stanley LE, Lucero A, Mauntel TC, Kennedy M, Walker N, Marshall SW, Padua DA, Berkoff DJ. Achilles tendon adaptation in cross-country runners across a competitive season. Scand J Med Sci Sports 2017; 28:303-310. [DOI: 10.1111/sms.12903] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2017] [Indexed: 02/03/2023]
Affiliation(s)
- L. E. Stanley
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Human Movement Science Curriculum; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - A. Lucero
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - T. C. Mauntel
- Department of Orthopaedics; Walter Reed National Military Medical Center; Bethesda MD USA
| | - M. Kennedy
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - N. Walker
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - S. W. Marshall
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Epidemiology; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - D. A. Padua
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Human Movement Science Curriculum; University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Orthopaedics; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| | - D. J. Berkoff
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
- Department of Orthopaedics; University of North Carolina at Chapel Hill; Chapel Hill NC USA
| |
Collapse
|
40
|
George SZ, Beneciuk JM, Lentz TA, Wu SS. The Optimal Screening for Prediction of Referral and Outcome (OSPRO) in patients with musculoskeletal pain conditions: a longitudinal validation cohort from the USA. BMJ Open 2017; 7:e015188. [PMID: 28600371 PMCID: PMC5734477 DOI: 10.1136/bmjopen-2016-015188] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/05/2017] [Accepted: 04/27/2017] [Indexed: 11/04/2022] Open
Abstract
PURPOSE There is an increased need for determining which patients with musculoskeletal pain benefit from additional diagnostic testing or psychologically informed intervention. The Optimal Screening for Prediction of Referral and Outcome (OSPRO) cohort studies were designed to develop and validate standard assessment tools for review of systems and yellow flags. This cohort profile paper provides a description of and future plans for the validation cohort. PARTICIPANTS Patients (n=440) with primary complaint of spine, shoulder or knee pain were recruited into the OSPRO validation cohort via a national Orthopaedic Physical Therapy-Investigative Network. Patients were followed up at 4 weeks, 6 months and 12 months for pain, functional status and quality of life outcomes. Healthcare utilisation outcomes were also collected at 6 and 12 months. FINDINGS TO DATE There are no longitudinal findings reported to date from the ongoing OSPRO validation cohort. The previously completed cross-sectional OSPRO development cohort yielded two assessment tools that were investigated in the validation cohort. FUTURE PLANS Follow-up data collection was completed in January 2017. Primary analyses will investigate how accurately the OSPRO review of systems and yellow flag tools predict 12-month pain, functional status, quality of life and healthcare utilisation outcomes. Planned secondary analyses include prediction of pain interference and/or development of chronic pain, investigation of treatment expectation on patient outcomes and analysis of patient satisfaction following an episode of physical therapy. TRIAL REGISTRATION NUMBER The OSPRO validation cohort was not registered.
Collapse
Affiliation(s)
- Steven Z George
- Musculoskeletal Research, Duke Clinical Research Institute, Durham, North Carolina, USA
- Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Jason M Beneciuk
- Department of Physical Therapy, Brooks—PHHP Research Collaboration, University of Florida, Gainesville, Florida, USA
| | - Trevor A Lentz
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
41
|
Pincus D, Kuhn JE, Sheth U, Rizzone K, Colbenson K, Dwyer T, Karpinos A, Marks PH, Wasserstein D. A Systematic Review and Appraisal of Clinical Practice Guidelines for Musculoskeletal Soft Tissue Injuries and Conditions. Am J Sports Med 2017; 45:1458-1464. [PMID: 28298051 DOI: 10.1177/0363546516667903] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinical practice guidelines (CPGs) are published by several sports medicine institutions. A systematic evaluation can help identify the highest quality CPGs for clinical use and identify any deficiencies that remain. PURPOSE To identify and appraise CPGs relevant to clinical sports medicine professionals. STUDY DESIGN Systematic review. METHODS Predetermined selection criteria were utilized by 2 reviewers who independently identified published CPGs before January 1, 2014. CPGs were excluded if they focused on injured workers, radiological criteria, medical pathology, or the axial skeleton (back/neck). The remaining guidelines were scored by 6 reviewers with different clinical backgrounds using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). Scores lower than 50% indicated deficiency. Scores were also stratified by the publishing institution and anatomic location and compared using Kruskal-Wallis tests. The Spearman correlation coefficient was used to assess the range of interobserver agreement between the evaluators. RESULTS Seventeen CPGs met the inclusion criteria. The majority of guidelines pertained to the knee, ankle, or shoulder. Interobserver agreement was strong ( r = 0.548-0.740), and mean total scores between nonsurgical (107.8) and surgical evaluators (109.3) were not statistically different. Overall guideline quality was variable but not deficient for 16 of 17 guidelines (>50%), except regarding clinical "applicability" and "editorial independence." No difference was found between CPGs of the knee, shoulder, foot/ankle, or chronic conditions. However, CPG publishing institutions had significantly different scores; the American Academy of Orthopaedic Surgeons (AAOS) guidelines scored significantly higher (141.4) than the total mean score (108.0). CONCLUSION The overall quality of sports medicine CPGs was variable but generally not deficient, except regarding applicability and editorial independence. Bias through poor editorial independence is a concern. To improve future guideline quality, authors should pay particular attention to these areas and use existing highest quality guidelines, or the AGREE II instrument, as templates. CPGs dedicated to anatomic areas other than the knee, ankle, and shoulder are needed.
Collapse
Affiliation(s)
- Daniel Pincus
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John E Kuhn
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ujash Sheth
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Katie Rizzone
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristi Colbenson
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tim Dwyer
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ashley Karpinos
- Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Paul H Marks
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - David Wasserstein
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Vanderbilt Sports Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Zheng Y, Zhou Y, Zhang X, Chen Y, Zheng X, Cheng T, Wang C, Hu X, Hong J. Effects of hypoxia on differentiation of menstrual blood stromal stem cells towards tenogenic cells in a co-culture system with Achilles tendon cells. Exp Ther Med 2017; 13:3195-3202. [PMID: 28587393 PMCID: PMC5450725 DOI: 10.3892/etm.2017.4383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/09/2016] [Indexed: 01/08/2023] Open
Abstract
Achilles tendons have a very poor capacity for intrinsic regeneration. The cell-based treatment strategy for Achilles tendinitis includes the application of mesenchymal stem cells (MSCs), which have high proliferative and multipotent differentiation ability, and is a promising approach. The aim of the present study was to explore the tenogenic potential of human menstrual blood stromal stem cells (MenSCs) in a co-culture system and to compare the tenogenic capability under normoxic and hypoxic conditions. MenSCs were co-cultured indirectly with Achilles tendon cells in a Transwell co-culture system for 1, 2, or 3 weeks in two different concentrations of oxygen (20 and 2% O2), whereas the control contained only MenSCs. The extracellular matrix of MenSCs in each system was evaluated by Alcian blue staining assay, histological staining, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and western blot analysis. Alcian blue staining assay revealed a significant increase (P<0.05) in proteoglycan secretion by the differentiated MenSCs. Identical results were obtained by RT-qPCR for collagen I, which was validated by western blot analysis. Considerably increased collagen I and collagen III gene expression levels were exhibited by cells in the co-culture treatment group when compared with the control (P<0.05); however, no significant difference was detected between the normoxic (20% O2) and hypoxic treatment (2% O2) groups. RT-qPCR was utilized to determine the expression levels of thrombospondin 4, scleraxis and tenascin C in the differentiated MenSCs; a significant increase in the expression of these specific genes was indicated in the co-culture treatment group compared with the control (P<0.05). Although the expression levels were markedly higher in hypoxia than in normoxia conditions, this difference was not significant. To conclude, the present study indicated that MenSCs manifested a strong proliferative and multipotent capacity for differentiation and differentiated into Achilles tenogenic cells. Therefore, the use of MenSCs may be considered in Achilles tendinitis therapy.
Collapse
Affiliation(s)
- Yijing Zheng
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Yifei Zhou
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Xiaolei Zhang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Yuemiao Chen
- Department of Hematology, Wenzhou Central Hospital, Wenzhou, Zhejiang 325000, P.R. China
| | - Xuhao Zheng
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Tao Cheng
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Chaonan Wang
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Xuqi Hu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| | - Jianjun Hong
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, P.R. China
| |
Collapse
|
43
|
McClinton S, Luedke L, Clewley D. Nonsurgical Management of Midsubstance Achilles Tendinopathy. Clin Podiatr Med Surg 2017; 34:137-160. [PMID: 28257671 DOI: 10.1016/j.cpm.2016.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Midsubstance Achilles tendinopathy is one of the most common lower leg conditions. Most patients can recover with nonsurgical treatment that focuses on tendon loading exercises and, when necessary, symptom modulating treatments such as topical, oral, or injected medication, ice, shoe inserts, manual therapy, stretching, taping, or low-level laser. If unresponsive to initial management, a small percentage of patients may consider shockwave or sclerosing treatment and possibly surgery.
Collapse
Affiliation(s)
- Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA.
| | - Lace Luedke
- Kinesiology Department, University of Wisconsin-Oshkosh, 108B Albee Hall, 800 Algoma Boulevard, Oshkosh, WI 54901, USA
| | - Derek Clewley
- Division of Doctor of Physical Therapy, Duke University, 2200 West Main Street, B-230, Durham, NC 27705, USA
| |
Collapse
|
44
|
Noninsertional Achilles Tendinopathy Pathologic Background and Clinical Examination. Clin Podiatr Med Surg 2017; 34:129-136. [PMID: 28257670 DOI: 10.1016/j.cpm.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The term tendinopathy includes a series of pathologies, all of which have a combination of pain, swelling, and impaired performance. The terms tendinosis, tendinitis and peritendinitis are all within the main heading of tendinopathy; this terminology provides a more accurate understanding of the condition and highlights the uniformity of clinical findings while distinguishing the individual histopathological findings of each condition. Understanding the clinical features and the underlying histopathology leads to a more accurate clinical diagnosis and subsequent treatment selection. Misuse of the term tendinitis can lead to the underestimation of chronic degenerative nature of many tendinopathies, affecting the treatment selection.
Collapse
|
45
|
Ferreira D. Utilizing Behavior Change Techniques to Elicit Adherence to Clinical Practice Guidelines. Front Public Health 2017; 5:37. [PMID: 28321392 PMCID: PMC5337816 DOI: 10.3389/fpubh.2017.00037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 02/20/2017] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Two 2-day continuing education seminars were developed to address the orthopedic physical therapy deficits in Guyana. Material was presented in a way to address all stages of behavior change. METHODS Surveys evaluating preseminar and postseminar knowledge was conducted. Chart reviews to establish adherence to clinical practice guidelines were performed. RESULTS Preseminar surveys revealed minimal knowledge of clinical practice guidelines, which was consistent with preseminar chart review data. Postseminar data indicate improvements in both knowledge and adherence to guidelines. DISCUSSION A brief series of two 2-day seminars utilizing behavior change strategies to improve adherence to clinical practice guidelines shows promise for countries and regions that rely on international health volunteers to provide clinical instruction. Because this study is limited to one situation, further studies with longer follow-up in a variety of clinical settings are recommended to support generalizability of findings.
Collapse
Affiliation(s)
- Daniel Ferreira
- Center for Sports Medicine, Concord Hospital, Concord, NH, USA
| |
Collapse
|
46
|
Revak A, Diers K, Kernozek TW, Gheidi N, Olbrantz C. Achilles Tendon Loading During Heel-Raising and -Lowering Exercises. J Athl Train 2017; 52:89-96. [PMID: 28145739 DOI: 10.4085/1062-6050-52.1.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT Achilles tendinopathies are common injuries during sport participation, although men are more prone to Achilles tendon injuries than women. Heel-raising and -lowering exercises are typically suggested for Achilles tendon rehabilitation. OBJECTIVE To compare the estimated Achilles tendon loading variables and the ankle range of motion (ROM) using a musculoskeletal model during commonly performed heel-raising and -lowering exercises. DESIGN Controlled laboratory study. SETTING University biomechanics laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-one healthy men (age = 21.59 ± 1.92 years, height = 178.22 ± 8.02 cm, mass = 75.81 ± 11.24 kg). INTERVENTION(S) Each participant completed 4 exercises: seated heel raising and lowering, bilateral standing heel raising and lowering, bilateral heel raising and unilateral lowering, and unilateral heel raising and lowering. MAIN OUTCOME MEASURE(S) A repeated-measures multivariate analysis of variance (α = .05) was used to compare Achilles tendon stress, force, and strain and ankle ROM for each exercise. Kinematic data were recorded at 180 Hz with 15 motion-analysis cameras synchronized with kinetic data collected from a force platform sampled at 1800 Hz. These data were then entered in a musculoskeletal model to estimate force in the triceps surae. For each participant, we determined Achilles tendon stress by measuring cross-sectional images using ultrasound. RESULTS Peak Achilles tendon loading was lowest when performing the seated heel-raising and -lowering exercise and highest when performing the unilateral heel-raising and -lowering exercise. Loading was greater for the unilateral exercise or portions of the exercise that were performed unilaterally. CONCLUSIONS Bilateral and seated exercises with less weight-bearing force resulted in less Achilles tendon loading. These exercises may serve as progressions during the rehabilitation process before full-body weight-bearing, unilateral exercises are allowed. Ankle ROM did not follow the same order as loading and may need additional monitoring or instruction during rehabilitation.
Collapse
Affiliation(s)
- Andrew Revak
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse
| | - Keith Diers
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse
| | - Naghmeh Gheidi
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse
| | - Christina Olbrantz
- La Crosse Institute for Movement Science, Physical Therapy Program, Department of Health Professions, University of Wisconsin-La Crosse
| |
Collapse
|
47
|
Zwiers R, Wiegerinck JI, van Dijk CN. Treatment of midportion Achilles tendinopathy: an evidence-based overview. Knee Surg Sports Traumatol Arthrosc 2016; 24:2103-11. [PMID: 25366192 DOI: 10.1007/s00167-014-3407-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/22/2014] [Indexed: 12/14/2022]
Abstract
UNLABELLED In Achilles tendinopathy, differentiation should be made between paratendinopathy, insertional- and midportion Achilles tendinopathy. Midportion Achilles tendinopathy is clinically characterized by a combination of pain and swelling at the affected site, with impaired performance as an important consequence. The treatment of midportion Achilles tendinopathy contains both non-surgical and surgical options. Eccentric exercise has shown to be an effective treatment modality. Promising results are demonstrated for extracorporeal shockwave therapy. In terms of the surgical treatment of midportion Achilles tendinopathy, no definite recommendations can be made. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Ruben Zwiers
- Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Johannes I Wiegerinck
- Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Academical Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| |
Collapse
|
48
|
Borda J, Selhorst M. The use of compression tack and flossing along with lacrosse ball massage to treat chronic Achilles tendinopathy in an adolescent athlete: a case report. J Man Manip Ther 2016; 25:57-61. [PMID: 28855793 DOI: 10.1080/10669817.2016.1159403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Achilles tendinopathy is an overuse injury that often affects individuals engaged in recreational or competitive level activity. Although most patients experience satisfactory results with therapy, a substantial portion fail to respond to traditional treatment. The purpose of this case study is to describe the successful use of compression tack and flossing (CTF) with lacrosse ball massage (LBM) in the treatment of an adolescent athlete with Achilles tendinopathy who had failed to respond to traditional treatment. CASE DESCRIPTION The patient was a 14-year old female diagnosed with chronic Achilles tendinopathy. She presented with 8/10 left posterior ankle pain during activity and scored 66/80 on the Lower Extremity Functional Scale (LEFS). After six weeks of PT consisting of eccentric exercise, proprioceptive training, and iontophoresis, the patient continued to report pain during sport and no significant improvements on the LEFS. With traditional PT failing to resolve symptoms, the patient was treated with CTF and LBM. OUTCOMES The outcomes of interest were the LEFS and the ability to participate in sport without pain. After only two sessions focusing on CTF and LBM, she had 0/10 pain during sport and scored a 79/80 on the LEFS. Patient was discharged to continue with a home exercise program consisting of CTF and LBM, and eccentric exercise. DISCUSSION The patient's outcomes significantly improved after CTF and LBM was added to eccentric exercise. These results suggest that this intervention may be a viable adjunct treatment for Achilles tendinopathy; however further research, including controlled clinical trials and long-term outcome data, are warranted.
Collapse
Affiliation(s)
- Jennifer Borda
- Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mitchell Selhorst
- Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
49
|
Jayaseelan DJ, Kecman M, Alcorn D, Sault JD. Manual therapy and eccentric exercise in the management of Achilles tendinopathy. J Man Manip Ther 2016; 25:106-114. [PMID: 28559670 DOI: 10.1080/10669817.2016.1183289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Chronic Achilles tendinopathy (AT) is an overuse condition seen among runners. Eccentric exercise can decrease pain and improve function for those with chronic degenerative tendon changes; however, some individuals have continued pain requiring additional intervention. While joint mobilization and manipulation has not been studied in the management in Achilles tendinopathy, other chronic tendon dysfunction, such as lateral epicondylalgia, has responded well to manual therapy (MT). Three runners were seen in physical therapy (PT) for chronic AT. They were prescribed eccentric loading exercises and calf stretching. Joint mobilization and manipulation was implemented to improve foot and ankle mobility, decrease pain, and improve function. Immediate within-session changes in pain, heel raise repetitions, and pressure pain thresholds (PPT) were noted following joint-directed MT in each patient. Each patient improved in self-reported function on the Achilles tendon specific Victorian Institute for Sport Assessment questionnaire (VISA-A), pain levels, PPT, joint mobility, ankle motion, and single-leg heel raises at discharge and 9-month follow-up. The addition of MT directed at local and remote sites may enhance the rehabilitation of patients with AT. Further research is necessary to determine the efficacy of adding joint mobilization to standard care for AT. LEVEL OF EVIDENCE Case series. Therapy, Level 4.
Collapse
Affiliation(s)
- Dhinu J Jayaseelan
- Department of Physical Therapy and Health Care Sciences, The George Washington University, Washington, DC, USA
| | | | | | - Josiah D Sault
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
50
|
Ezzat AM, Schneeberg A, Huisman ES, White LD, Kennedy C, Levesque LA, Scott A, Hoens AM. A cross-sectional evaluation examining the use of the Achilles tendinopathy toolkit by physiotherapists in British Columbia, Canada. Disabil Rehabil 2016; 39:671-676. [PMID: 27007183 DOI: 10.3109/09638288.2016.1160447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the awareness and use of the Achilles tendinopathy toolkit (ATT), a knowledge translation (KT) strategy supporting evidence-informed management of midportion Achilles Tendinopathy (AT), by British Columbian physiotherapists (PTs). Secondarily, to assess PTs strategies for AT management by examining the association between exploring the ATT and following best practice in clinical care as recommended by the ATT. METHODS Members of the Physiotherapy Association of British Columbia (BC) completed an online cross-sectional survey collecting information on demographics; awareness and exposure; perceptions, usability and applicability to clinical practice; knowledge; and attitudes. A clinical vignette assessed if respondents adhered to recommendations made by the ATT. Multi-variable logistic regression examined the association between exploring the ATT and following its recommendations. RESULTS Of 238 participants, 81% (n = 154) were aware of the ATT and of those 53% (n = 81) explored its contents. Time was the most frequent barrier. Bi-variable analyses showed those who explored the ATT had over double the odds of following the best practice (odds ratio = OR = 2.8; 95% confidence interval = 95% CI = 1.3-6.0). This did not remain significant in the final adjusted model (OR = 2.2; 95% CI = 0.9-5.4). CONCLUSIONS Evaluation of KT strategies is critical. This study revealed high awareness and moderate use of the ATT. Future work should consider the impact of toolkits on patient outcomes. Implications for Rehabilitation A toolkit is a novel knowledge translation (KT) strategy designed to provide accessibleevidence-informed resources to facilitate best practice by clinicians. The evaluation of the Achilles tendinopathy toolkit (ATT) revealed favourable findingsregarding the impact of this KT strategy on the knowledge and attitudes of British Columbia(BC) PTs and the possibility of a positive impact on best practice in clinical care. This research suggests toolkits are a feasible and meaningful KT strategy to provide clinicianswith valuable synthesized resources that have the potential to benefit patient outcomes.
Collapse
Affiliation(s)
- Allison M Ezzat
- a School of Population and Public Health, University of British Columbia , Vancouver , BC , Canada.,b Child and Family Research Institute , Vancouver , BC , Canada
| | - Amy Schneeberg
- a School of Population and Public Health, University of British Columbia , Vancouver , BC , Canada
| | - Elise S Huisman
- c Department of Physiotherapy , University of British Columbia , Vancouver , BC , Canada.,d Centre for Hip Health and Mobility , Vancouver , BC , Canada
| | - Lynita D White
- c Department of Physiotherapy , University of British Columbia , Vancouver , BC , Canada.,d Centre for Hip Health and Mobility , Vancouver , BC , Canada
| | - Carol Kennedy
- e Treloar Physiotherapy Clinic, Clinician/Partner , Vancouver , BC , Canada
| | - Lenerdene A Levesque
- f Clinical Instructor and researcher School of Physical Therapy, Western University , London , ON , Canada
| | - Alex Scott
- c Department of Physiotherapy , University of British Columbia , Vancouver , BC , Canada.,d Centre for Hip Health and Mobility , Vancouver , BC , Canada
| | - Alison M Hoens
- c Department of Physiotherapy , University of British Columbia , Vancouver , BC , Canada
| |
Collapse
|