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Bechan Vergara I, Puig-Diví A, Amestoy Alonso B, Milà-Villarroel R. Effects of low-load blood flow restriction training in healthy adult tendons: A systematic review and meta-analysis. J Bodyw Mov Ther 2024; 39:13-23. [PMID: 38876617 DOI: 10.1016/j.jbmt.2023.11.048] [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: 06/28/2022] [Revised: 10/18/2023] [Accepted: 11/24/2023] [Indexed: 06/16/2024]
Abstract
OBJECTIVE To systematically review the effects of low-load blood flow restriction training (LL-BFR) on healthy adult tendons. DESIGN A systematic review with meta-analysis. LITERATURE SEARCH Six electronic databases were searched by two researchers. STUDY SELECTION CRITERIA Clinical trials comparing the effects of LL-BFR to high-load resistance training (HL-RT) or low-load resistance training (LL-RT) in healthy adult tendons. DATA SYNTHESIS Two reviewers selected the eligible clinical trials, and one reviewer exported the data. Two reviewers evaluated the study quality and risk of bias using the PEDro scale and the ROB2 scale. We performed meta-analysis where appropriate using a random-effects model. We rated the quality of evidence using GRADE. RESULTS Six studies were eligible. We analyzed tendon cross-sectional area (CSA) and tendon stiffness as the outcomes. Across all comparisons, there was low-to moderate-quality evidence of a difference between LL-BFR and LL-RT immediately after exercise. There was high-quality evidence of no difference between LL-BFR and HL-RT in the long term. CONCLUSION The effects of LL-BFR on the tendons depends on the time and dose of the intervention. LL-BFR could be useful to increase the CSA of the tendons in a similar or superior way to HL-RT after 8 weeks of intervention.
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Affiliation(s)
- Ilan Bechan Vergara
- Blanquerna School of Health Sciences - Ramon Llull University, c/ Padilla, 326, 08025, Barcelona, Spain.
| | - Albert Puig-Diví
- Blanquerna School of Health Sciences - Ramon Llull University, c/ Padilla, 326, 08025, Barcelona, Spain.
| | - Beñat Amestoy Alonso
- Neuroscience Lab (part of IDIBAPS, Barcelona), Calle Marina 312 3-4, 08025, Barcelona, Spain.
| | - Raimon Milà-Villarroel
- Blanquerna School of Health Sciences - Ramon Llull University, c/ Padilla, 326, 08025, Barcelona, Spain.
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DiIorio SE, Young B, Parker JB, Griffin MF, Longaker MT. Understanding Tendon Fibroblast Biology and Heterogeneity. Biomedicines 2024; 12:859. [PMID: 38672213 PMCID: PMC11048404 DOI: 10.3390/biomedicines12040859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Tendon regeneration has emerged as an area of interest due to the challenging healing process of avascular tendon tissue. During tendon healing after injury, the formation of a fibrous scar can limit tendon strength and lead to subsequent complications. The specific biological mechanisms that cause fibrosis across different cellular subtypes within the tendon and across different tendons in the body continue to remain unknown. Herein, we review the current understanding of tendon healing, fibrosis mechanisms, and future directions for treatments. We summarize recent research on the role of fibroblasts throughout tendon healing and describe the functional and cellular heterogeneity of fibroblasts and tendons. The review notes gaps in tendon fibrosis research, with a focus on characterizing distinct fibroblast subpopulations in the tendon. We highlight new techniques in the field that can be used to enhance our understanding of complex tendon pathologies such as fibrosis. Finally, we explore bioengineering tools for tendon regeneration and discuss future areas for innovation. Exploring the heterogeneity of tendon fibroblasts on the cellular level can inform therapeutic strategies for addressing tendon fibrosis and ultimately reduce its clinical burden.
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Affiliation(s)
- Sarah E. DiIorio
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.E.D.); (B.Y.); (J.B.P.); (M.F.G.)
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Bill Young
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.E.D.); (B.Y.); (J.B.P.); (M.F.G.)
| | - Jennifer B. Parker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.E.D.); (B.Y.); (J.B.P.); (M.F.G.)
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michelle F. Griffin
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.E.D.); (B.Y.); (J.B.P.); (M.F.G.)
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (S.E.D.); (B.Y.); (J.B.P.); (M.F.G.)
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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d’Almeida SM, Silva RMVD, Ronzio OA. Nivel de satisfacción sobre la seguridad y complicaciones a cuatro años de la introducción de la técnica Microelectrólisis Percutánea (MEP®) Sport como práctica fisioterapéutica. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18038726022019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMEN El objetivo de este trabajo es investigar la experiencia de los fisioterapeutas formados en microeletrólisis percutánea sport y conocer la cantidad de aplicaciones realizadas semanalmente, los efectos adversos presentados y el nivel de satisfacción de los terapeutas con sus pacientes. Se realizó una encuesta que evaluó la opinión y la experiencia de profesionales certificados en microelectrolisis percutánea sport. Los datos fueron obtenidos a través de la plataforma virtual SurveyMonkey, enviando por correo electrónico una invitación a 1.096 fisioterapeutas de América Latina. Respondieron el cuestionario 315 profesionales, entre los cuales 165 (56,51%) atienden de uno a cinco pacientes por semana. Las respuestas sobre efectos adversos fueron: nunca he tenido complicaciones (56,79% - 159 respuestas); choque hipotensivo (19,64% - 55 respuestas.); alergia al metal (5,36% - 15 respuestas). Los sitios/patologías a que más se aplican la microelectrolisis percutánea sport son: tendón rotuliano (10,77% - 198 respuestas.); tendón de aquiles (9,58% - 176 respuestas); tendón supraespino (9,36% - 172 respuestas.); fascitis plantar/espolón calcáneo (8,05% - 148 respuestas.); y puntos-gatillo (7,18% - 132 respuestas.). La satisfacción de los profesionales fue: satisfecho (51,87% - 152 respuestas) y muy satisfecho (40,96% - 120 respuestas). Las respuestas de los pacientes fueron: satisfecho (61,90% - 182 respuestas) y muy satisfecho (29,93% - 88 respuestas). La técnica MEP se aplica principalmente en tendinopatías y produce resultados satisfactorios y muy satisfactorios tanto para los pacientes como para los terapeutas, con baja presencia de efectos adversos.
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Kaplan K, Hanney WJ, Cheatham SW, Masaracchio M, Liu X, Kolber MJ. Rotator Cuff Tendinopathy: An Evidence-Based Overview for the Sports Medicine Professional. Strength Cond J 2018. [DOI: 10.1519/ssc.0000000000000364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bleichert S, Renaud G, MacDermid J, Watson L, Faber K, Lenssen R, Saulnier M, Phillips P, Evans T, Sadi J. Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management. J Hand Ther 2018. [PMID: 28641732 DOI: 10.1016/j.jht.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical Commentary. INTRODUCTION Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. PURPOSE OF THE STUDY The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. METHODS/RESULTS/DISCUSSION N/A for clinical commentary. CONCLUSIONS The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Sarah Bleichert
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Genevieve Renaud
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Ken Faber
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Marie Saulnier
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paul Phillips
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Tyler Evans
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jackie Sadi
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
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THE REHABILITATION OF A RUNNER WITH ILIOPSOAS TENDINOPATHY USING AN ECCENTRIC-BIASED EXERCISE-A CASE REPORT. Int J Sports Phys Ther 2017; 12:1150-1162. [PMID: 29234566 DOI: 10.26603/ijspt20171150] [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: 11/18/2022] Open
Abstract
Background and Purpose While there is much discussion about tendinopathy in the literature, there is little reference to the less common condition of iliopsoas tendinopathy, and no documentation of the condition in runners. The iliopsoas is a major decelerator of the hip and eccentric loading of the iliopsoas is an important component of energy transfer during running. Eccentric training is a thoroughly researched method of treating tendinopathy but has shown mixed results. The purpose of this case report is to describe the rehabilitation of a runner with iliopsoas tendinopathy, and demonstrate in a creative eccentric-biased technique to assist with treatment. A secondary objective is to illustrate how evidence on intervention for other tendinopathies was used to guide rehabilitation of this seldom described condition. Case Description The subject was a 39-year-old female middle distance runner diagnosed with iliopsoas tendinopathy via ultrasound, after sudden onset of left anterior groin pain. Symptoms began after a significant increase in running load, and persisted, despite rest, for three months. The intervention consisted of an eccentric-biased hip flexor exercise, with supportive kinetic chain exercises and progressive loading in a return to running program. Outcomes The Copenhagen Hip and Groin Outcome Score, the Visual Analogue Scale, the Global Rating of Change Scale and manual muscle testing scores all improved after 12 weeks of intervention with further improvement at the five-year follow up. After 12 weeks of intervention, the subject was running without restriction and had returned to her pre-injury running mileage at the five-year follow up. Discussion The eccentric-biased exercise in conjunction with exercises addressing the kinetic chain and a progressive tendon loading program, were successful in the rehabilitation of this subject with iliopsoas tendinopathy. This case report is the first to provide a description on the rehabilitation of iliopsoas tendinopathy, and offers clinicians suggestions and guidance for treatment and exercise choice in the clinical environment. Level of Evidence 5.
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Navarro-Ledesma S, Struyf F, Labajos-Manzanares MT, Fernandez-Sanchez M, Morales-Asencio JM, Luque-Suarez A. Does the acromiohumeral distance matter in chronic rotator cuff related shoulder pain? Musculoskelet Sci Pract 2017; 29:38-42. [PMID: 28315580 DOI: 10.1016/j.msksp.2017.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND/HYPOTHESIS The relation between acromiohumeral distance (AHD) and severity of pain, disability and range of movement (ROM) in patients with chronic rotator cuff related shoulder pain (RCRSP) has not been reported. OBJECTIVES The aim of this study was to investigate the level of association between AHD measured by ultrasonography and pain-disability and shoulder range of movement (ROM), in patients suffering from chronic RCRSP. As a secondary objective, the determination of the intrarater reliability of AHD at both 0 and 60 degrees of shoulder elevation was carried out. DESIGN This was a cross-sectional study. METHOD A sample comprised of 97 patients with chronic RCSRP symptoms was recruited from three different primary care centres. Acromio-humeral distance (AHD) measured by ultrasonography at 0 and 60 degrees of shoulder elevation, shoulder pain-function (SPADI) and range of movement (ROM) were taken. RESULTS There was no correlation between AHD at 0° (-0,215), and at 60° (-0,148), with SPADI. No correlations were found with AHD and shoulder ROM at both 0 and 60°. Intrarater reliability was excellent for AHD at 0 and 60°. CONCLUSIONS There was a small association between AHD and shoulder pain and function, as well as with shoulder ROM, in patients with chronic RCRSP. Hence, clinicians should consider other possibilities rather than focusing their therapies only in increasing AHD when patients with chronic RCRSP are treated.
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Affiliation(s)
- Santiago Navarro-Ledesma
- Department of Physiotherapy, University of Malaga, Spain; Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium.
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Abstract
Patients presenting with pain at the tendon, which is associated with physical tasks and activities that specifically load that tendon, are at the center of this special issue. The current terminology for a symptomatic tendon presentation is tendinopathy, as this does not denote an underlying pathology, but rather signals that all is not well in the tendon. Tendinopathy is a prevalent and substantial problem, as it interferes with a person's capacity to lead a physically active and healthy life, which has a considerable flow-on effect on society in general. This issue deals with the contemporary physical therapy management of tendinopathy by providing a mix of evidence review and clinical expert opinion on commonly presenting tendinopathies of the lower and upper limbs. J Orthop Sports Phys Ther 2015;45(11):816-818. doi:10.2519/jospt.2015.0110.
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