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Rio EK, Rabusin CL, Munteanu SE, Docking SI, Perrott M, Couch J, Murphy MC, Girdwood M. Where is Your Pain? Achilles Tendinopathy Pain Location on Loading Is Different to Palpation, Imaging and Recall Location. J Orthop Sports Phys Ther 2024; 54:1-9. [PMID: 38060345 DOI: 10.2519/jospt.2023.12131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE: To describe and compare pain maps reported during Achilles tendon loading exercises with recall pain location, in people with pain on palpation in their Achilles tendon and tendon pathology on imaging. DESIGN: Cross-sectional analysis of baseline RCT. METHOD: Participants were recruited from a larger Achilles tendinopathy clinical trial. Inclusion criteria were at least 2-month self-reported history of Achilles tendinopathy, midtendon palpation pain, and pathology on ultrasound tissue characterization. Participants were asked to identify their Achilles tendon pain location on a pain map with 8 prespecified locations while at rest prior to loading (recall pain), and subsequently during tendon loading exercises (loading pain). Participants could select multiple locations or select "other" if the locations did not represent their pain. RESULTS: Ninety-three participants were included (93% of participants from a clinical trial). The locations of pain on loading were diverse; all 8 pain locations (and an "other" option) were represented within this sample. Twenty-five percent of participants did not report pain with loading (n = 23 of 93). Of the 70 participants with loading pain, recall pain location differed to loading pain location in 40% (n = 28 of 70) of the participants. CONCLUSION: Palpation pain location, recall pain location, or location of pathology on imaging were not valid proxies for load-related pain in the Achilles tendon. How different pain locations respond to treatment is unknown. Some pathologies (eg, plantaris) have clear pain locations (eg, medial tendon), and assessing pain location may assist differential diagnosis. J Orthop Sports Phys Ther 2024;54(1):1-9. Epub 7 December 2023. doi:10.2519/jospt.2023.12131.
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Murphy MC, Travers M, Chivers P, Debenham J, Docking SI, Rio EK, Gibson W, Ardern C. Can we really say getting stronger makes your tendon feel better? No current evidence of a relationship between change in Achilles tendinopathy pain or disability and changes in triceps Surae structure or function when completing rehabilitation: a systematic review. J Sci Med Sport 2023:S1440-2440(23)00045-2. [PMID: 36990866 DOI: 10.1016/j.jsams.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 12/26/2022] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Determine if improvements in pain and disability in patients with mid-portion Achilles tendinopathy relate to changes in muscle structure and function whilst completing exercise rehabilitation. DESIGN A systematic review exploring the relationship between changes in pain/disability and muscle structure/function over time, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Six online databases and the grey literature were searched from database inception to 16th December 2022 whereas clinical trial registries were searched from database inception to 11th February 2020. We included clinical studies where participants received exercise rehabilitation (±placebo interventions) for mid-portion Achilles tendinopathy if pain/disability and Triceps Surae structure/function were measured. We calculated Cohen's d (95 % confidence intervals) for changes in muscle structure/function over time for individual studies. Data were not pooled due to heterogeneity. Study quality was assessed using a modified Newcastle-Ottawa Scale. RESULTS Seventeen studies were included for synthesis. No studies reported the relationship between muscle structure/function and pain/disability changes. Twelve studies reported muscle structure/function outcome measures at baseline and at least one follow-up time-point. Three studies reported improvements in force output after treatment; eight studies demonstrated no change in structure or function; one study did not provide a variation measure, precluding within group change over time calculation. All studies were low quality. CONCLUSIONS No studies explored the relationship between changes in tendon pain and disability and changes in muscle structure and function. It is unclear whether current exercise-based rehabilitation protocols for mid-portion Achilles tendinopathy improve muscle structure or function. SYSTEMATIC REVIEW REGISTRATION PROSPERO (registration number: CRD42020149970).
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Pietrosimone LS, Blackburn JT, Wikstrom EA, Berkoff DJ, Docking SI, Cook J, Padua DA. Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy. J Athl Train 2021; 57:464343. [PMID: 33887762 PMCID: PMC9875712 DOI: 10.4085/1062-6050-0548.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CONTEXT Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes. OBJECTIVE The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy. DESIGN Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg). MAIN OUTCOME MEASURES 3D biomechanics were collected during double-limb jump-landing. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0-100%), and plotted with 95% confidence intervals. Statistical significance was defined as a lack of 95% CI overlap for ≥ 6 consecutive data points. RESULTS SYM-PTA had lesser KF than CON throughout the stance phase. ASYM-PTA had lesser KF than CON in the early and late stance phase. SYM-PTA group had lesser KEM and FPT than CON in early stance, as well as ASYM-PTA in mid-stance. CONCLUSIONS Male athletes with SYM-PTA demonstrated a patellar tendon load-avoidance profile compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load-capacity. TRIAL REGISTRY ClinicalTrials.gov (#XXX).
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Affiliation(s)
| | - J. Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Erik A. Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - David J. Berkoff
- Department of Orthopaedics, University of North Carolina at Chapel Hill
| | - Sean I. Docking
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Jill Cook
- La Trobe Sports and Exercise Research Centre, La Trobe University, Bundoora, Australia
| | - Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Department of Orthopaedics, University of North Carolina at Chapel Hill
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Bonello C, Girdwood M, De Souza K, Trinder NK, Lewis J, Lazarczuk SL, Gaida JE, Docking SI, Rio EK. Does isometric exercise result in exercise induced hypoalgesia in people with local musculoskeletal pain? A systematic review. Phys Ther Sport 2021; 49:51-61. [PMID: 33601254 DOI: 10.1016/j.ptsp.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this review was to investigate if exercise induced hypoalgesia (EIH) occurs following isometric muscle contraction in people with local musculoskeletal symptoms. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL & SportDiscus electronic databases were searched (inception to April 2020). ELIGIBILITY CRITERIA Two authors independently evaluated eligibility. Randomised controlled and crossover (repeated measures) trials that measured the effects of isometric exercise in participants with localised musculoskeletal pain during, and up to 2 hours after isometric exercise were included. Other inclusion criteria included comparison to another intervention, or comparison to healthy controls. Primary outcomes were experimentally induced pain thresholds and secondary outcomes included measures of pain sensitivity from clinical testing. RESULTS 13 studies with data from 346 participants were included for narrative synthesis. EIH was reported in some upper and lower limb studies but there were no consistent data to show isometric exercises were superior to comparison interventions. CONCLUSION There was no consistent evidence for EIH following isometric exercise in people with musculoskeletal pain. These findings are different to those reported in asymptomatic populations (where EIH is consistently demonstrated) as well as conditions associated with widespread symptoms such as fibromyalgia (where isometric exercise may induce hyperalgesia). Although well tolerated when prescribed, isometric exercise did not induce EIH consistently for people seeking care for local musculoskeletal symptoms. The variance in the dose, location of contraction and intensity of protocols included in this review may explain the inconsistent findings. Further work is required to better understand endogenous analgesia in musculoskeletal pain conditions.
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Affiliation(s)
- Christian Bonello
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Michael Girdwood
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Keith De Souza
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Nicola K Trinder
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Jeremy Lewis
- School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom; Therapy Department, Central London Community Healthcare National Health Service Trust, London, United Kingdom; Department of Physical Therapy & Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Stephanie L Lazarczuk
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Jamie E Gaida
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Australian Capital Territory, Australia
| | - Sean I Docking
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ebonie K Rio
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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Docking SI, Girdwood MA, Cook J, Fortington LV, Rio E. Reduced Levels of Aligned Fibrillar Structure Are Not Associated With Achilles and Patellar Tendon Symptoms. Clin J Sport Med 2020; 30:550-555. [PMID: 30067515 DOI: 10.1097/jsm.0000000000000644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether the mean cross-sectional area (mCSA) of aligned fibrillar structure (AFS) was associated with the presence and severity of symptoms. DESIGN Prospective cohort study. PARTICIPANTS One hundred seventy-five elite male Australian football players completed monthly Oslo Sports Trauma Research Center overuse injury questionnaires for both the Achilles and patellar tendon over the season to ascertain the presence and severity of symptoms. At the start of the preseason, participants underwent ultrasound tissue characterization (UTC) imaging of the Achilles and patellar tendon. MAIN OUTCOME MEASURES Images were classified as normal or abnormal based on gray-scale ultrasound. Based on UTC quantification, the mCSA of AFS was compared between those with and without current symptoms. RESULTS No difference in the mCSA of AFS was observed between those with or without tendon symptoms (P < 0.05). Similar to previous findings, 80% to 92% of abnormal tendons had similar amounts of mCSA of AFS compared with normal tendon. If reduced mCSA of AFS was present, it was not associated with the presence or severity of symptoms. CONCLUSIONS The prevalence, development, or severity of symptoms was not associated with decreased levels of AFS in the Achilles or patellar tendon. This suggests that a lack of structural integrity is not linked to symptoms and questions the rationale behind regenerative medicine. Most tendons are able to compensate for areas of disorganization and maintain tissue homeostasis.
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Affiliation(s)
- Sean I Docking
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Michael A Girdwood
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Lauren V Fortington
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Center, College of Science, Health and Engineering; La Trobe University; Australia; and
- Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
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Rabusin CL, Menz HB, McClelland JA, Evans AM, Malliaras P, Docking SI, Landorf KB, Gerrard JM, Munteanu SE. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial. Br J Sports Med 2020; 55:486-492. [PMID: 32988930 DOI: 10.1136/bjsports-2019-101776] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To compare the efficacy of in-shoe heel lifts to calf muscle eccentric exercise in reducing pain and improving function in mid-portion Achilles tendinopathy. METHODS This was a parallel-group randomised superiority trial at a single centre (La Trobe University Health Sciences Clinic, Discipline of Podiatry, Melbourne, Victoria, Australia). One hundred participants (52 women and 48 men, mean age 45.9, SD 9.4 years) with clinically diagnosed and ultrasonographically confirmed mid-portion Achilles tendinopathy were randomly allocated to either a (1) heel lifts (n=50) or (2) eccentric exercise (n=50) group. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 12 weeks. Differences between groups were analysed using intention to treat with analysis of covariance. RESULTS There was 80% follow-up of participants (n=40 per group) at 12 weeks. The mean VISA-A score improved by 26.0 points (95% CI 19.6 to 32.4) in the heel lifts group and by 17.4 points (95% CI 9.5 to 25.3) in the eccentric exercise group. On average, there was a between-group difference in favour of the heel lifts for the VISA-A (adjusted mean difference 9.6, 95% CI 1.8 to 17.4, p=0.016), which approximated, but did not meet our predetermined minimum important difference of 10 points. CONCLUSION In adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks. However, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions. TRIAL REGISTRATION NUMBER ACTRN12617001225303.
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Affiliation(s)
- Chantel L Rabusin
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia .,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Angela M Evans
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Peter Malliaras
- Department of Physiotherapy, Monash University Faculty of Medicine Nursing and Health Sciences, Frankston, Victoria, Australia
| | - Sean I Docking
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - James M Gerrard
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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Pietrosimone LS, Blackburn JT, Wikstrom EA, Berkoff DJ, Docking SI, Cook J, Padua DA. Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial. Phys Ther Sport 2020; 46:177-185. [PMID: 32957034 DOI: 10.1016/j.ptsp.2020.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To a) determine the acute effects of a single-dose patellar tendon isometric exercise protocol on involved limb landing biomechanics in individuals with patellar tendinopathy and asymptomatic patellar tendon pathology, and b) determine if individuals with patellar tendinopathy demonstrated changes in pain following a single-dose patellar tendon isometric exercise protocol. DESIGN Single-blinded randomized cross-over trial. SETTING Laboratory; PARTICIPANTS: 28 young male athletes with symptomatic (n = 13, age: 19.62 ± 1.61) and asymptomatic (n = 15, age: 21.13 ± 1.88) patellar tendinopathy. MAIN OUTCOME MEASURES Participants completed a single-dose patellar tendon isometric exercise protocol and a sham-TENS protocol, randomized and separated by 7-10 days. Pain-levels during a single-limb decline squat (SLDS) and three-dimensional biomechanics were collected during a double-limb jump-landing task before and after each intervention protocol. A mixed-model repeated measures ANOVA was conducted to compare change scores for all dependent variables. RESULTS There were no group × intervention interactions for change in pain (F(1, 26) = 0.555, p = 0.463). There was one significant group × intervention interaction for vertical ground reaction force (VGRF) (F(1, 26) = 5.33, p = 0.029). However, post-hoc testing with Bonferroni correction demonstrated no statistical significance for group (SYM: t = -1.679, p = 0.119; ASYM: t = -1.7, p = 0.107) or intervention condition (isometric: t = -2.58, p = 0.016; sham-TENS: 0.72, p = 0.460). There were no further significant group × intervention interactions (p > 0.05). CONCLUSIONS A single-dose patellar tendon isometric exercise protocol did not have acute effects on landing biomechanics or pain levels in male athletes with patellar tendinopathy or asymptomatic patellar tendon pathology.
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Affiliation(s)
- Laura S Pietrosimone
- Doctor of Physical Therapy Division, Department of Orthopedic Surgery, School of Medicine, Duke University, Durham, NC, USA.
| | - J Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erik A Wikstrom
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David J Berkoff
- Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sean I Docking
- La Trobe Sports and Exercise Research Centre, LaTrobe University, Bundooram, Australia
| | - Jill Cook
- La Trobe Sports and Exercise Research Centre, LaTrobe University, Bundooram, Australia
| | - Darin A Padua
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Nealon AR, Docking SI, Lucas PE, Connell DA, Koh ES, Cook JL. MRI findings are associated with time to return to play in first class cricket fast bowlers with side strain in Australia and England. J Sci Med Sport 2019; 22:992-996. [PMID: 31239202 DOI: 10.1016/j.jsams.2019.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/27/2019] [Accepted: 05/30/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the reliability of reporting and relationship between MRI parameters at injury and time to return to play (RTP) in first class cricket fast bowlers with side strain in Australia and England. DESIGN Cohort study. METHODS Eighty MRI scans of side strain injuries to 57 fast bowlers were sourced. Ten scans were reported by three experienced radiologists to determine intra- and inter-rater reliability. The relationship between six MRI parameters (muscle injured, presence of a muscle tear, rib level of injury, presence of blood fluid products/haematoma, periosteal stripping, rib oedema) and time to RTP was investigated with 39 scans reported by a single radiologist with known intra-rater reliability. The association between parameters and time to RTP was analysed with an ordinal logistic regression model. RESULTS Recovery time was prolonged with a mean of 39days (standard deviation: 14days) and 44% of bowlers requiring more than 6weeks to RTP. Reliability levels between parameters varied widely. The presence or absence of a muscle tear was the only MRI parameter associated with time to RTP. Players with a muscle tear were 8 times more likely to take more than 6weeks to RTP. The multifactorial model was predictive of recovery time in only 53% of this cohort, leaving 47% of total variance in time to RTP unexplained. CONCLUSIONS The presence of a muscle tear was associated with time to RTP in cricket fast bowlers with side strain injury in first class cricket in Australia and England.
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Affiliation(s)
| | - Sean I Docking
- La Trobe Sport and Exercise Medicine Research Centre La Trobe University, Australia
| | | | | | | | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre La Trobe University, Australia
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Rabusin CL, Menz HB, McClelland JA, Evans AM, Landorf KB, Malliaras P, Docking SI, Munteanu SE. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial. J Foot Ankle Res 2019; 12:20. [PMID: 30949243 PMCID: PMC6429802 DOI: 10.1186/s13047-019-0325-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Mid-portion Achilles tendinopathy is a common musculoskeletal condition characterised by degeneration of the Achilles tendon, which causes pain and disability. Multiple non-surgical treatments have been advocated for this condition including calf muscle eccentric exercise and in-shoe heel lifts. Although adherence is challenging, there is evidence to suggest that calf muscle eccentric exercise is effective in decreasing pain and improving function in people with Achilles tendinopathy. Heel lifts reduce ankle joint dorsiflexion and Achilles tendon strain, however their efficacy in the management of Achilles tendinopathy is unclear. This article describes the design of a parallel-group randomised trial comparing the efficacy of heel lifts to calf muscle eccentric exercise for Achilles tendinopathy. Methods Ninety-two participants with Achilles tendinopathy will be randomised to one of two groups: (i) a heel lift group that will receive pre-fabricated 12 mm in-shoe heel lifts (Clearly Adjustable®), or (ii) an exercise group that will be advised to carry out a calf muscle eccentric exercise program (twice a day, 7 days a week, for 12 weeks). Outcome measures will be obtained at baseline, 2, 6 and 12 weeks; the primary endpoint for assessing efficacy being 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment - Achilles (VISA-A) questionnaire. Secondary outcome measures will include thickness and integrity of the Achilles tendon (using ultrasound tissue characterisation [UTC]), participant perception of treatment effect on pain and function (using the 7-point Patient Global Impression of Change scale), severity of pain at the Achilles tendon (using a 100 mm visual analogue scale) in the previous week, health status (using the EuroQol-5D-5L™ questionnaire), physical activity levels (using the 7-day Recall Physical Activity Questionnaire) and calf muscle function (using the standing heel rise test). Data will be analysed using the intention to treat principle. Discussion The HEALTHY trial (Heel lifts versus calf muscle eccentric Exercise for AchiLles TendinopatHY) is the first randomised trial to compare the efficacy of heel lifts to calf muscle eccentric exercise in reducing pain and improving function in people with Achilles tendinopathy. A pragmatically designed trial was developed to ensure that if the interventions are found to be effective, the findings can be readily implemented in clinical practice. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12617001225303. Registered on August 22nd, 2017.
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Affiliation(s)
- Chantel L Rabusin
- 1Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia.,3La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Hylton B Menz
- 1Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia.,3La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Jodie A McClelland
- 2Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia.,3La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Angela M Evans
- 1Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Karl B Landorf
- 1Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia.,3La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Peter Malliaras
- 4Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria 3199 Australia
| | - Sean I Docking
- 3La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
| | - Shannon E Munteanu
- 1Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia.,3La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086 Australia
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Docking SI, Cook J. How do tendons adapt? Going beyond tissue responses to understand positive adaptation and pathology development: A narrative review. J Musculoskelet Neuronal Interact 2019; 19:300-310. [PMID: 31475937 PMCID: PMC6737558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Understanding how tendons adapt to load is crucial to understanding how training can improve performance, minimise the risk of injury and aid rehabilitation. Adaptation is the positive response of an organism or tissue to benefit its function. In tendons, numerous tissue responses to load have been identified in vivo. Changes in tendon dimensions, structure on imaging, mechanical properties, and blood flow have been reported in response to mechanical stimuli. However, research has focused on tissue level changes with little understanding of how changes at the tissue level affect the person, their athletic performance or injury risk. Tendons can have a paradoxical response to load, load can induce positive adaptation, however it is also a major factor in the development of tendon pathology and pain. Tendon pathology is a risk factor for developing symptoms, yet the high rate of asymptomatic pathology suggests that the pathological tendon must adapt to be able to tolerate load. Similarly, there is mounting evidence to suggest that tendon remodelling or repair is not necessary for a positive clinical outcome following rehabilitation, suggesting that the tendon must adapt via other mechanisms. This narrative review synthesises evidence of how normal and pathological tendons adapts to load, and how this relates to adaptation of load capacity and function of the individual.
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Affiliation(s)
- Sean I. Docking
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Australia,Corresponding author: Dr Sean Docking, La Trobe University Sport & Exercise Medicine Research Centre, La Trobe University, Bundoora VIC 3086, Australia E-mail:
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Australia
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Docking SI, Rio E, Cook J, Orchard JW, Fortington LV. The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition. Scand J Med Sci Sports 2018; 28:2016-2022. [PMID: 29572969 DOI: 10.1111/sms.13086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC) overuse questionnaire, compared to a time-loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9-month period in the 2016 pre- and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match-loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI: 17.9-25.6) and 25.2% (95% CI 21.3-29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match-loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre-season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match-loss definition. Prevention of these injuries may be best targeted during the off- and pre-season due to higher prevalence of symptoms during the pre-season compared to during the competitive season.
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Affiliation(s)
- S I Docking
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Vic., Australia.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), La Trobe University, Bundoora, Vic., Australia
| | - E Rio
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Vic., Australia.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), La Trobe University, Bundoora, Vic., Australia
| | - J Cook
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Vic., Australia.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), La Trobe University, Bundoora, Vic., Australia
| | - J W Orchard
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - L V Fortington
- Australian Centre for Research into Injury in Sports and its Prevention (ACRISP), Federation University Australia, Ballarat, Vic., Australia
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Spang C, Alfredson H, Docking SI, Masci L, Andersson G. The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. Bone Joint J 2017; 98-B:1312-1319. [PMID: 27694583 DOI: 10.1302/0301-620x.98b10.37939] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/24/2016] [Indexed: 11/05/2022]
Abstract
In recent years, the plantaris tendon has been implicated in the development of chronic painful mid-portion Achilles tendinopathy. In some cases, a thickened plantaris tendon is closely associated with the Achilles tendon, and surgical excision of the plantaris tendon has been reported to be curative in patients who have not derived benefit following conservative treatment and surgical interventions. The aim of this review is to outline the basic aspects of, and the recent research findings, related to the plantaris tendon, covering anatomical and clinical studies including those dealing with histology, imaging and treatment. Cite this article: Bone Joint J 2016;98-B:1312-19.
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Affiliation(s)
- C Spang
- Umeå University, 901 87 Umeå, Sweden
| | - H Alfredson
- University College London Hospitals, 170 Tottenham Court Road, London W1T 7HA, UK
| | - S I Docking
- Federation University, Lydiard Street South, Ballarat VIC 3350, Australia
| | - L Masci
- Pure Sports Medicine Clinic, Cabot Place West, London E14 4QS, UK
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van Ark M, Cook JL, Docking SI, Zwerver J, Gaida JE, van den Akker-Scheek I, Rio E. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. J Sci Med Sport 2016; 19:702-6. [DOI: 10.1016/j.jsams.2015.11.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 11/14/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
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Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med 2016; 50:1187-91. [PMID: 27127294 PMCID: PMC5118437 DOI: 10.1136/bjsports-2015-095422] [Citation(s) in RCA: 210] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/25/2022]
Abstract
The pathogenesis of tendinopathy and the primary biological change in the tendon that precipitates pathology have generated several pathoaetiological models in the literature. The continuum model of tendon pathology, proposed in 2009, synthesised clinical and laboratory-based research to guide treatment choices for the clinical presentations of tendinopathy. While the continuum has been cited extensively in the literature, its clinical utility has yet to be fully elucidated. The continuum model proposed a model for staging tendinopathy based on the changes and distribution of disorganisation within the tendon. However, classifying tendinopathy based on structure in what is primarily a pain condition has been challenged. The interplay between structure, pain and function is not yet fully understood, which has partly contributed to the complex clinical picture of tendinopathy. Here we revisit and assess the merit of the continuum model in the context of new evidence. We (1) summarise new evidence in tendinopathy research in the context of the continuum, (2) discuss tendon pain and the relevance of a model based on structure and (3) describe relevant clinical elements (pain, function and structure) to begin to build a better understanding of the condition. Our goal is that the continuum model may help guide targeted treatments and improved patient outcomes.
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Affiliation(s)
- J L Cook
- School of Allied Health, La Trobe University, Bundoora, Australia Australian Centre for Research into Injury in Sport and its Prevention, Federation University
| | - E Rio
- School of Allied Health, La Trobe University, Bundoora, Australia Australian Centre for Research into Injury in Sport and its Prevention, Federation University
| | - C R Purdam
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Department of Physical Therapies, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
| | - S I Docking
- School of Allied Health, La Trobe University, Bundoora, Australia Australian Centre for Research into Injury in Sport and its Prevention, Federation University
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Docking SI, Cook J, Rio E. The diagnostic dartboard: is the bullseye a correct pathoanatomical diagnosis or to guide treatment? Br J Sports Med 2016; 50:959-60. [DOI: 10.1136/bjsports-2015-095484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 11/03/2022]
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Tilley BJ, Cook JL, Docking SI, Gaida JE. Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review. Br J Sports Med 2015; 49:1504-9. [PMID: 26474596 PMCID: PMC4680137 DOI: 10.1136/bjsports-2015-095100] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 01/05/2023]
Abstract
Background Tendon pain occurs in individuals with extreme cholesterol levels (familial hypercholesterolaemia). It is unclear whether the association with tendon pain is strong with less extreme elevations of cholesterol. Objective To determine whether lipid levels are associated with abnormal tendon structure or the presence of tendon pain. Methods We conducted a systematic review and meta-analysis. Relevant articles were found through an electronic search of 6 medical databases—MEDLINE, Cochrane, AMED, EMBASE, Web of Science and Scopus. We included all case–control or cross-sectional studies with data describing (1) lipid levels or use of lipid-lowering drugs and (2) tendon structure or tendon pain. Results 17 studies (2612 participants) were eligible for inclusion in the review. People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol; with mean difference values of 0.66, 1.00, 0.33, and −0.19 mmol/L, respectively. Conclusions The results of this review indicate that a relationship exists between an individual’s lipid profile and tendon health. However, further longitudinal studies are required to determine whether a cause and effect relationship exists between tendon structure and lipid levels. This could lead to advancement in the understanding of the pathoaetiology and thus treatment of tendinopathy.
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Affiliation(s)
- Benjamin J Tilley
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Jill L Cook
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia
| | - Sean I Docking
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia
| | - James E Gaida
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia University of Canberra, Research Institute for Sport and Exercise (UCRISE) Canberra, Australian Capital Territory, Australia
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Cook JL, Docking SI. "Rehabilitation will increase the 'capacity' of your …insert musculoskeletal tissue here…." Defining 'tissue capacity': a core concept for clinicians. Br J Sports Med 2015; 49:1484-5. [PMID: 26255142 DOI: 10.1136/bjsports-2015-094849] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/17/2015] [Indexed: 11/03/2022]
Affiliation(s)
- J L Cook
- Centre for Sport & Exercise Medicine, La Trobe University, Bundoora, Australia . Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia
| | - S I Docking
- Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Australia School of Primary Health Care, Monash University, Frankston, Australia
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Docking SI, Rosengarten SD, Daffy J, Cook J. Structural integrity is decreased in both Achilles tendons in people with unilateral Achilles tendinopathy. J Sci Med Sport 2015; 18:383-7. [DOI: 10.1016/j.jsams.2014.06.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 06/02/2014] [Accepted: 06/07/2014] [Indexed: 10/25/2022]
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Docking SI, Rosengarten SD, Cook J. Achilles tendon structure improves on UTC imaging over a 5-month pre-season in elite Australian football players. Scand J Med Sci Sports 2015; 26:557-63. [PMID: 25943892 DOI: 10.1111/sms.12469] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/28/2023]
Abstract
Pre-season injuries are common and may be due to a reintroduction of training loads. Tendons are sensitive to changes in load, making them vulnerable to injury in the pre-season. This study investigated changes in Achilles tendon structure on ultrasound tissue characterization (UTC) over the course of a 5-month pre-season in elite male Australian football players. Eighteen elite male Australian football players with no history of Achilles tendinopathy and normal Achilles tendons were recruited. The left Achilles tendon was scanned with UTC to quantify the stability of the echopattern. Participants were scanned at the start and completion of a 5-month pre-season. Fifteen players remained asymptomatic over the course of the pre-season. All four echo-types were significantly different at the end of the pre-season, with the overall echopattern suggesting an improvement in Achilles tendon structure. Three of the 18 participants developed Achilles tendon pain that coincided with a change in the UTC echopattern. This study demonstrates that the UTC echopattern of the Achilles tendon improves over a 5-month pre-season training period, representing increased fibrillar alignment. However, further investigation is needed to elucidate with this alteration in the UTC echopattern results in improved tendon resilience and load capacity.
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Affiliation(s)
- S I Docking
- Monash Tendon Research Group (MONSTERs), Monash University, Melbourne, Victoria, Australia.,Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Victoria, Australia
| | - S D Rosengarten
- Department of Physiotherapy, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - J Cook
- Monash Tendon Research Group (MONSTERs), Monash University, Melbourne, Victoria, Australia.,Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Ballarat, Victoria, Australia
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van Ark M, Docking SI, van den Akker-Scheek I, Rudavsky A, Rio E, Zwerver J, Cook JL. Does the adolescent patellar tendon respond to 5 days of cumulative load during a volleyball tournament? Scand J Med Sci Sports 2015; 26:189-96. [PMID: 25694241 DOI: 10.1111/sms.12426] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2015] [Indexed: 12/15/2022]
Abstract
Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The critical tendon load that affects tendon structure is unknown. The aim of this study was to investigate patellar tendon structure on each day of a 5-day volleyball tournament in an adolescent population (16-18 years). The right patellar tendon of 41 players in the Australian Volleyball Schools Cup was scanned with ultrasound tissue characterization (UTC) on every day of the tournament (Monday to Friday). UTC can quantify structure of a tendon into four echo types based on the stability of the echo pattern. Generalized estimating equations (GEE) were used to test for change of echo type I and II over the tournament days. Participants played between eight and nine matches during the tournament. GEE analysis showed no significant change of echo type percentages of echo type I (Wald chi-square = 4.603, d.f. = 4, P = 0.331) and echo type II (Wald chi-square = 6.070, d.f. = 4, P = 0.194) over time. This study shows that patellar tendon structure of 16-18-year-old volleyball players is not affected during 5 days of cumulative loading during a volleyball tournament.
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Affiliation(s)
- M van Ark
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - S I Docking
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - I van den Akker-Scheek
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Rudavsky
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - E Rio
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - J Zwerver
- Center for Sports Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - J L Cook
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
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Wong AMY, Docking SI, Cook JL, Gaida JE. 110 Is Type 1 Diabetes Mellitus Associated With Lower Limb Tendon Pathology? A Systematic Review. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-094114.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rosengarten SD, Cook JL, Bryant AL, Cordy JT, Daffy J, Docking SI. Australian football players’ Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study. Br J Sports Med 2014; 49:183-7. [DOI: 10.1136/bjsports-2013-092713] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Docking SI, van Schie JTM, Daffy J, Rosengarten S, Cook JL. BILATERAL CHANGES IN UNILATERAL ACHILLES TENDINOPATHY QUANTIFIED USING ULTRASOUND TISSUE CHARACTERISATION. Br J Sports Med 2013. [DOI: 10.1136/bjsports-2013-092459.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rosengarten S, Docking SI, van Schie JTM, Daffy J, Cook JL. TENDON RESPONSE IN ACHILLES TENDON OF AUSTRALIAN FOOTBALL PLAYERS USING ULTRASOUND TISSUE CHARACTERISATION. Br J Sports Med 2013. [DOI: 10.1136/bjsports-2013-092459.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Schie HTM, Docking SI, Daffy J, Praet SE, Rosengarten S, Cook. JL. ULTRASOUND TISSUE CHARACTERISATION, AN INNOVATIVE TECHNIQUE FOR INJURY-PREVENTION AND MONITORING OF TENDINOPATHY. Br J Sports Med 2013. [DOI: 10.1136/bjsports-2013-092459.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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