1
|
Klich S, Michalik K, Pietraszewski B, Hansen EA, Madeleine P, Kawczyński A. Effect of applied cadence in repeated sprint cycling on muscle characteristics. Eur J Appl Physiol 2024; 124:1609-1620. [PMID: 38175273 PMCID: PMC11055783 DOI: 10.1007/s00421-023-05393-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE This study aimed to investigate physiological responses, muscle-tendon unit properties of the quadriceps muscle, and mechanical performance after repeated sprint cycling at optimal and 70% of optimal cadence. METHODS Twenty recreational cyclists performed as first sprint performance cycling test and during subsequent sessions two repeated sprint cycling protocols at optimal and 70% of optimal cadence, in random order. The muscle-tendon unit outcome measures on the dominant leg included muscle thickness, fascicle length (Lf), pennation angle (θp), and stiffness for the rectus femoris (RF), vastus lateralis (VL), and vastus medialis muscle (VM) at baseline, immediately after repeated sprint cycling, and 1-h post-exercise. RESULTS The results showed an increase in muscle thickness and θp in RF, VL, and VM for both cadences from baseline to immediately after exercise. The Lf decreased in RF (both cadences), while stiffness decreased in RF, VL, and VM at optimal cadence, and in VL at 70% of optimal cadence from baseline to immediately after exercise. CONCLUSION The present study revealed that the alterations in muscle characteristics were more marked after repeated sprint cycling at optimal cadence compared with a lower cadence most likely as a result of higher load on the muscle-tendon unit at optimal cadence.
Collapse
Affiliation(s)
- Sebastian Klich
- Department of Paralympic Sport, Wrocław University of Health and Sport Sciences, 51-612, Wrocław, Poland.
| | - Kamil Michalik
- Department of Human Motor Skills, Wrocław University of Health and Sport Sciences, 51-612, Wroclaw, Poland
| | - Bogdan Pietraszewski
- Department of Biomechanics, Wrocław University of Health and Sport Sciences, 51-612, Wroclaw, Poland
| | - Ernst A Hansen
- Centre for Health and Rehabilitation, University College Absalon, 4200, Slagelse, Denmark
| | - Pascal Madeleine
- Department of Health Science and Technology, Aalborg University, ExerciseTech, 9260, Gistrup, Denmark
| | - Adam Kawczyński
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, 80-336, Gdansk, Poland
| |
Collapse
|
2
|
Carroll CC, Campbell NW, Lewis RL, Preston SE, Garrett CM, Winstone HM, Barker AC, Vanos JM, Stouder LS, Reyes C, Fortino MA, Goergen CJ, Hass ZJ, Campbell WW. Greater Protein Intake Emphasizing Lean Beef Does Not Affect Resistance Training-Induced Adaptations in Skeletal Muscle and Tendon of Older Women: A Randomized Controlled Feeding Trial. J Nutr 2024:S0022-3166(24)00169-X. [PMID: 38604504 DOI: 10.1016/j.tjnut.2024.04.001] [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: 11/29/2023] [Revised: 03/22/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Although experimental research supports that resistance training (RT), especially with greater dietary protein intake, improves muscle mass and strength in older adults, comparable research on tendons is needed. OBJECTIVES We assessed the effects of a protein-rich diet emphasizing lean beef, compared with 2 control diets, on RT-induced changes in skeletal muscle and tendon size and strength in older women. METHODS We randomly assigned women [age: 66 ± 1 y, body mass index (BMI): 28 ± 1] to groups that consumed 1) 0.8 g total protein/kg body weight/day from mixed food sources (normal protein control, n = 16); 2) 1.4 g/kg/d protein from mixed food sources (high protein control, n = 17); or 3) 1.4 g/kg/d protein emphasizing unprocessed lean beef (high protein experimental group, n = 16). Participants were provided with all foods and performed RT 3 times/wk, 70% of 1-repetition maximum for 12 wk. We measured quadriceps muscle volume via magnetic resonance imaging (MRI). We estimated patellar tendon biomechanical properties and cross-sectional area (CSA) using ultrasound and MRI. RESULTS Dietary intake did not influence RT-induced increases in quadriceps strength (P < 0.0001) or muscle volume (P < 0.05). We noted a trend for an RT effect on mean tendon CSA (P = 0.07), with no differences among diets (P > 0.05). Proximal tendon CSA increased with RT (P < 0.05) with no difference between dietary groups (P > 0.05). Among all participants, midtendon CSA increased with RT (P ≤ 0.05). We found a decrease in distal CSA in the 0.8 g group (P < 0.05) but no change in the 1.4 g group (P > 0.05). Patellar tendon MRI signal or biomechanical properties were unchanged. CONCLUSIONS Our findings indicated that greater daily protein intake, emphasizing beef, did not influence RT-induced changes in quadriceps muscle strength or muscle volume of older women. Although we noted trends in tendon CSA, we did not find a statistically significant impact of greater daily protein intake from beef on tendon outcomes. This trial was registered at clinicaltrials.gov as NCT04347447.
Collapse
Affiliation(s)
- Chad C Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States.
| | - Nathan Wc Campbell
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Rebecca L Lewis
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Sarah E Preston
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Chloe M Garrett
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Hannah M Winstone
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Anna C Barker
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Johnny M Vanos
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Lucas S Stouder
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Camila Reyes
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Matthew A Fortino
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States
| | - Craig J Goergen
- Department of Health and Kinesiology, Purdue University, West Lafayette, IN, United States; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Zachary J Hass
- School of Nursing, Purdue University, West Lafayette, IN, United States; School of Industrial Engineering, Purdue University, West Lafayette, IN, United States; Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, United States
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, United States
| |
Collapse
|
3
|
Patel SH, Campbell NWC, Emenim CE, Farino DO, Damen FW, Rispoli JV, Goergen CJ, Haus JM, Sabbaghi A, Carroll CC. Patellar tendon biomechanical and morphologic properties and their relationship to serum clinical variables in persons with prediabetes and type 2 diabetes. J Orthop Res 2024. [PMID: 38400550 DOI: 10.1002/jor.25816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/08/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024]
Abstract
Tendon biomechanical properties and fibril organization are altered in patients with diabetes compared to healthy individuals, yet few biomarkers have been associated with in vivo tendon properties. We investigated the relationships between in vivo imaging-based tendon properties, serum variables, and patient characteristics across healthy controls (n = 14, age: 45 ± 5 years, body mass index [BMI]: 24 ± 1, hemoglobin A1c [HbA1c]: 5.3 ± 0.1%), prediabetes (n = 14, age: 54 ± 5 years, BMI: 29 ± 2; HbA1c: 5.7 ± 0.1), and type 2 diabetes (n = 13, age: 55 ± 3 years, BMI: 33 ± 2, HbA1c: 6.7 ± 0.3). We used ultrasound speckle-tracking and measurements from magnetic resonance imaging (MRI) to estimate the patellar tendon in vivo tangent modulus. Analysis of plasma c-peptide, interleukin-1β (IL-1β), IL-6, IL-8, tumor necrosis factor-α (TNF-α), adiponectin, leptin, insulin-like growth factor 1 (IGF-1), and C-reactive protein (CRP) was completed. We built regression models incorporating statistically significant covariates and indicators for the clinically defined groups. We found that tendon cross-sectional area normalized to body weight (BWN CSA) and modulus were lower in patients with type 2 diabetes than in healthy controls (p < 0.05). Our regression analysis revealed that a model that included BMI, leptin, high-density lipoprotein (HDL), low-density lipoprotein (LDL), age, and group explained ~70% of the variability in BWN CSA (R2 = 0.70, p < 0.001). For modulus, including the main effects LDL, groups, HbA1c, age, BMI, cholesterol, IGF-1, c-peptide, leptin, and IL-6, accounted for ~54% of the variability in modulus (R2 = 0.54, p < 0.05). While BWN CSA and modulus were lower in those with diabetes, group was a poor predicter of tendon properties when considering the selected covariates. These data highlight the multifactorial nature of tendon changes with diabetes and suggest that blood variables could be reliable predictors of tendon properties.
Collapse
Affiliation(s)
- Shivam H Patel
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Nathan W C Campbell
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Chinonso E Emenim
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Dominick O Farino
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| | - Frederick W Damen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Joseph V Rispoli
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Craig J Goergen
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
| | - Jacob M Haus
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Arman Sabbaghi
- Head of Clinical Methods, Unlearn.AI, San Francisco, California, USA
| | - Chad C Carroll
- Department of Health and Kinesiology, Purdue University, West Lafayette, Indiana, USA
| |
Collapse
|
4
|
Martínez F, Abián P, Jiménez F, Abián-Vicén J. The Effects of Eccentric Contraction Execution Time on the Properties of the Patellar Tendon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159296. [PMID: 35954651 PMCID: PMC9367933 DOI: 10.3390/ijerph19159296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to assess the effects of eccentric contraction execution time on the morphological and elastic properties of the patellar tendon (PT) in a six-week, single-leg decline squat (SLDS) exercise training program. In addition, the effects of a six-week detraining period on the same variables were evaluated. Fifty participants were randomized into the control group (CG; n = 15), experimental group 1 (EG6s; n = 17; eccentric contraction execution time = 6 s) and experimental group 2 (EG3s; n = 18; eccentric contraction execution time = 3 s). The thickness and elastographic index (EI) in different regions of interest (ROIs) in the PT were measured after 6 weeks of eccentric training using the single-leg decline squat exercise (three sessions per week, 80% of the eccentric one-repetition maximum) and after 6 weeks of detraining. There was an increase in the thickness of the PT in the different ROIs analyzed in both experimental groups at the end of the training period. Especially worth noting was the increase in the thickness of the PT at the proximal level in EG3s (p = 0.001), and the increase at the distal level in EG6s (p = 0.001). On the other hand, there was a reduction in EI in EG6S at the end of the intervention program (p = 0.021), and both experimental groups increased EI in the three regions of interest analyzed after the detraining period (p < 0.01). In conclusion, the execution time of the eccentric contraction in the SLDS exercise determines the anatomical level of the morphological adaptations in the PT. These morphological adaptations are lost after 6 weeks of detraining, producing an increase in tendon stiffness.
Collapse
Affiliation(s)
- Fernando Martínez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Pablo Abián
- Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain;
| | - Fernando Jiménez
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
| | - Javier Abián-Vicén
- Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; (F.M.); (F.J.)
- Correspondence: ; Tel.: +34-925268800 (ext. 5522)
| |
Collapse
|
5
|
Marcoux JT, Tong L. Fibrocartilaginous Tissue: Why Does It Fail to Heal? Clin Podiatr Med Surg 2022; 39:437-450. [PMID: 35717061 DOI: 10.1016/j.cpm.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tendons and ligaments are critical components in the function of the musculoskeletal system, as they provide stability and guide motion for the biomechanical transmission of forces into bone. Several common injuries in the foot and ankle require the repair of ruptured or attenuated tendon or ligament to its osseous insertion. Understanding the structure and function of injured ligaments and tendons is complicated by the variability and unpredictable nature of their healing. The healing process at the tendon/ligament to bone interface is challenging and often frustrating to foot and ankle surgeons, as they have a high failure rate necessitating the need for revision.
Collapse
Affiliation(s)
- John T Marcoux
- Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Span 3, Boston, MA 02215, USA.
| | - Lowell Tong
- Division of Podiatry, Department of Surgery, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Span 3, Boston, MA 02215, USA
| |
Collapse
|
6
|
Merza EY, Pearson SJ, Lichtwark GA, Malliaras P. The acute effects of higher versus lower load duration and intensity on morphological and mechanical properties of the healthy Achilles tendon: a randomized crossover trial. J Exp Biol 2022; 225:275126. [PMID: 35470387 PMCID: PMC9167578 DOI: 10.1242/jeb.243741] [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: 11/01/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022]
Abstract
The Achilles tendon (AT) exhibits volume changes related to fluid flow under acute load which may be linked to changes in stiffness. Fluid flow provides a mechanical signal for cellular activity and may be one mechanism that facilitates tendon adaptation. This study aimed to investigate whether isometric intervention involving a high level of load duration and intensity could maximize the immediate reduction in AT volume and stiffness compared with interventions involving a lower level of load duration and intensity. Sixteen healthy participants (12 males, 4 females; age 24.4±9.4 years, body mass 70.9±16.1 kg, height 1.7±0.1 m) performed three isometric interventions of varying levels of load duration (2 s and 8 s) and intensity (35% and 75% maximal voluntary isometric contraction) over a 3 week period. Freehand 3D ultrasound was used to measure free AT volume (at rest) and length (at 35%, 55% and 75% of maximum plantarflexion force) pre- and post-interventions. The slope of the force–elongation curve over these force levels represented individual stiffness (N mm−1). Large reductions in free AT volume and stiffness resulted in response to long-duration high-intensity loading whilst less reduction was produced with a lower load intensity. In contrast, no change in free AT volume and a small increase in AT stiffness occurred with lower load duration. These findings suggest that the applied load on the AT must be heavy and sustained for a long duration to maximize immediate volume reduction, which might be an acute response that enables optimal long-term tendon adaptation via mechanotransduction pathways. Summary: High levels of load duration and intensity have the greatest acute effect on the free Achilles tendon volume and stiffness.
Collapse
Affiliation(s)
- Eman Y Merza
- Department of physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston Vic 3199, Melbourne, Australia
| | - Stephen J Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester, M5 4WT, UK
| | - Glen A Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4072, Brisbane, Australia
| | - Peter Malliaras
- Department of physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston Vic 3199, Melbourne, Australia
| |
Collapse
|
7
|
Merza E, Pearson S, Lichtwark G, Ollason M, Malliaras P. Immediate and long-term effects of mechanical loading on Achilles tendon volume: A systematic review and meta-analysis. J Biomech 2021; 118:110289. [PMID: 33556887 DOI: 10.1016/j.jbiomech.2021.110289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 01/07/2023]
Abstract
The Achilles tendon (AT) may experience changes in dimensions related to fluid flow under load. The extent to which fluid flow involves redistribution within or flow out of the tendon is not known and could be determined by investigating volume changes. This study aimed to synthesize data on immediate and long-term effects of loading on tendon volume among people with a healthy AT and midportion Achilles tendinopathy (MAT). A secondary aim was to synthesise data from the included studies investigating parallel change in cross-sectional area and length. Systematic electronic search was performed in MEDLINE, EMBASE, CINAHL, AMED, and Scopus from inception until May 2020. Standardized mean differences (SMDs) were calculated for intervention-induced changes from baseline for all outcomes. Methodological quality was assessed using modified version of Newcastle Ottawa Scale (NOS). Twelve studies were included in meta-analysis. For healthy AT, there were negligible to small changes in volume following cross-country running (-0.33 [95% CI = -1.11 to 0.45] (P = 0.41)) and isometric exercise (0.01 [95% CI = -0.54 to 0.55] (P = 0.98)) and a large increase at the short-term with 12-week isometric protocol (0.88 [95% CI = -0.10 to1.86] (P = 0.08)). For MAT, there was an immediate large reduction in volume with isometric exercise (-1.24 [95% CI = -1.93 to -0.55] (P = 0.0004)), small increase with eccentric exercise (0.41 [95% CI = -0.18 to 1.01](P = 0.18)) and small reduction at the short-term with long-term interventions (-0.46 [95% CI = -0.87 to -0.05] (P = 0.03)). This meta-analysis suggests that healthy AT remain isovolumetric with acute interventions while MAT exhibit immediate and short-term volume reductions in response to different interventions.
Collapse
Affiliation(s)
- Eman Merza
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
| | - Stephen Pearson
- Centre for Health, Sport and Rehabilitation Sciences Research, University of Salford, Greater Manchester M5 4WT, United Kingdom.
| | - Glen Lichtwark
- Centre for Sensorimotor Performance, School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD 4072, Brisbane, Australia.
| | - Meg Ollason
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Vic 3800, Melbourne, Australia.
| | - Peter Malliaras
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Science, Monash University, Frankston, Vic 3199, Melbourne, Australia.
| |
Collapse
|
8
|
Okewunmi J, Guzman J, Vulcano E. Achilles Tendinosis Injuries-Tendinosis to Rupture (Getting the Athlete Back to Play). Clin Sports Med 2020; 39:877-891. [PMID: 32892973 DOI: 10.1016/j.csm.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recreational athletes are susceptible to experiencing pain in the Achilles tendon, affecting their ability to complete daily activities. Achilles tendinosis is a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation, which can be categorized by location into insertional and noninsertional tendinosis. This condition is one that can be treated conservatively with great success or surgically for refractory cases. Currently, there is a lack of consensus regarding the best treatment options. This review aims to explore both conservative and operative treatment options for Achilles tendinopathy and Achilles tendon rupture.
Collapse
Affiliation(s)
- Jeffrey Okewunmi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Javier Guzman
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Ettore Vulcano
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
| |
Collapse
|
9
|
Wiesinger HP, Seynnes OR, Kösters A, Müller E, Rieder F. Mechanical and Material Tendon Properties in Patients With Proximal Patellar Tendinopathy. Front Physiol 2020; 11:704. [PMID: 32733263 PMCID: PMC7358637 DOI: 10.3389/fphys.2020.00704] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/28/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction The effect of chronic patellar tendinopathy on tissue function and integrity is currently unclear and underinvestigated. The aim of this cohort comparison was to examine morphological, material, and mechanical properties of the patellar tendon and to extend earlier findings by measuring the ability to store and return elastic energy in symptomatic tendons. Methods Seventeen patients with chronic (>3 months, VISA-P < 80), inferior pole patellar tendinopathy (24 ± 4 years; male = 12, female = 5) were carefully matched to controls (25 ± 3 years) for training status, pattern, and history of loading of the patellar tendon. Individual knee extension force, patellar tendon stiffness, stress, strain, Young’s modulus, hysteresis, and energy storage capacity, were obtained with combined dynamometry, ultrasonography, magnetic resonance imaging, and electromyography. Results Anthropometric parameters did not differ between groups. VISA-P scores ranged from 28 to 78 points, and symptoms had lasted from 10 to 120 months before testing. Tendon proximal cross-sectional area was 61% larger in the patellar tendinopathy group than in the control group. There were no differences between groups in maximal voluntary isometric knee extension torque (p = 0.216; d < −0.31) nor in tensile tendon force produced during isometric ramp contractions (p = 0.185; d < −0.34). Similarly, tendon strain (p = 0.634; d < 0.12), hysteresis (p = 0.461; d < 0.18), and strain energy storage (p = 0.656; d < 0.36) did not differ between groups. However, patellar tendon stiffness (−19%; p = 0.007; d < −0.74), stress (−27%; p< 0.002; d < −0.90) and Young’s modulus (−32%; p = 0.001; d < −0.94) were significantly lower in tendinopathic patients compared to healthy controls. Discussion In this study, we observed lower stiffness in affected tendons. However, despite the substantial structural and histological changes occurring with tendinopathy, the tendon capacity to store and dissipate energy did not differ significantly.
Collapse
Affiliation(s)
- Hans-Peter Wiesinger
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Olivier R Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Alexander Kösters
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Erich Müller
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria
| | - Florian Rieder
- Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria.,Institute of Physical Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
10
|
Devaprakash D, Lloyd DG, Barrett RS, Obst SJ, Kennedy B, Adams KL, Hunter A, Vlahovich N, Pease DL, Pizzolato C. Magnetic Resonance Imaging and Freehand 3-D Ultrasound Provide Similar Estimates of Free Achilles Tendon Shape and 3-D Geometry. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2898-2905. [PMID: 31471069 DOI: 10.1016/j.ultrasmedbio.2019.07.679] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to assess the similarity of free Achilles tendon shape and 3-D geometry between magnetic resonance imaging (MRI) and freehand 3-D ultrasound (3-DUS) imaging methods. Fourteen elite/sub-elite middle-distance runners participated in the study. MRI and 3-DUS scans of the Achilles tendon were acquired on two separate imaging sessions, and all 3-D reconstructions were performed using identical methods. Shape similarity of free Achilles tendon reconstructed from MRI and 3-DUS data was assessed using Jaccard index, Hausdorff distance and root mean square error (RMSE). The Jaccard index, Hausdorff distance and RMSE values were 0.76 ± 0.05, 2.70 ± 0.70 and 0.61 ± 0.10 mm, respectively. The level of agreement between MRI and 3-DUS for free Achilles tendon volume, length and average cross-sectional area (CSA) was assessed using Bland-Altman analysis. Compared to MRI, freehand 3-DUS overestimated volume, length and average CSA by 30.6 ± 15.8 mm3 (1.1% ± 0.6%), 0.3 ± 0.7 mm (0.6% ± 1.9%) and 0.3 ± 1.42 mm2 (0.4% ± 2.0%), respectively. The upper and lower limits of agreement between MRI and 3-DUS for volume, length and average CSA were -0.4 to 61.7 mm3 (-0.2% to 2.3%), -1.0 to 1.5 mm (-3.2% to 4.5%) and -2.5 to 3.1 mm2 (-3.5% to 4.3%), respectively. There were no significant differences between imaging methods in CSA along the length of the tendon. In conclusion, MRI and freehand 3-DUS may be considered equivalent methods for estimating shape and 3-D geometry of the free Achilles tendon. These findings, together with the practical benefits of being able to assess 3-D Achilles tendon shape and geometry in a laboratory environment and under isometric loading, make 3-DUS an attractive alternative to MRI for assessing 3-D free Achilles tendon macro-structure in future studies.
Collapse
Affiliation(s)
- Daniel Devaprakash
- School of Allied Health Sciences, Griffith University, Queensland, Australia; Gold Coast Orthopaedic Research Engineering and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
| | - David G Lloyd
- School of Allied Health Sciences, Griffith University, Queensland, Australia; Gold Coast Orthopaedic Research Engineering and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Rod S Barrett
- School of Allied Health Sciences, Griffith University, Queensland, Australia; Gold Coast Orthopaedic Research Engineering and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Steven J Obst
- School of Allied Health Sciences, Griffith University, Queensland, Australia; School of Health, Medical, and Applied Sciences, Central Queensland University, Bundaberg, Queensland, Australia
| | - Ben Kennedy
- School of Allied Health Sciences, Griffith University, Queensland, Australia; QSCAN Radiology Clinics, Queensland, Australia
| | - Kahlee L Adams
- Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Adam Hunter
- Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Nicole Vlahovich
- Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - David L Pease
- Australian Institute of Sport, Canberra, Australian Capital Territory, Australia
| | - Claudio Pizzolato
- School of Allied Health Sciences, Griffith University, Queensland, Australia; Gold Coast Orthopaedic Research Engineering and Education Alliance (GCORE), Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| |
Collapse
|
11
|
Eriksen CS, Svensson RB, Gylling AT, Couppé C, Magnusson SP, Kjaer M. Load magnitude affects patellar tendon mechanical properties but not collagen or collagen cross-linking after long-term strength training in older adults. BMC Geriatr 2019; 19:30. [PMID: 30704412 PMCID: PMC6357404 DOI: 10.1186/s12877-019-1043-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/23/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Regular loading of tendons may counteract the negative effects of aging. However, the influence of strength training loading magnitude on tendon mechanical properties and its relation to matrix collagen content and collagen cross-linking is sparsely described in older adults. The purpose of the present study was to compare the effects of moderate or high load resistance training on tendon matrix and its mechanical properties. METHODS Seventeen women and 19 men, age 62-70 years, were recruited and randomly allocated to 12 months of heavy load resistance training (HRT), moderate load resistance training (MRT) or control (CON). Pre- and post-intervention testing comprised isometric quadriceps strength test (IsoMVC), ultrasound based testing of in vivo patellar tendon (PT) mechanical properties, MRI-based measurement of PT cross-sectional area (CSA), PT biopsies for assessment of fibril morphology, collagen content, enzymatic cross-links, and tendon fluorescence as a measure of advanced glycation end-products (AGEs). RESULTS Thirty three participants completed the intervention and were included in the data analysis. IsoMVC increased more after HRT (+ 21%) than MRT (+ 8%) and CON (+ 7%) (p < 0.05). Tendon stiffness (p < 0.05) and Young's modulus (p = 0.05) were also differently affected by training load with a reduction in CON and MRT but not in HRT. PT-CSA increased equally after both MRT and HRT. Collagen content, fibril morphology, enzymatic cross-links, and tendon fluorescence were unaffected by training. CONCLUSION Despite equal improvements in tendon size after moderate and heavy load resistance training, only heavy. load training seemed to maintain tendon mechanical properties in old age. The effect of load magnitude on tendon biomechanics was unrelated to changes of major load bearing matrix components in the tendon core. The study is a sub-study of the LISA study, which was registered at http://clinicaltrials.gov (NCT02123641) April 25th 2014.
Collapse
Affiliation(s)
- Christian S Eriksen
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Nielsine Nielsens Vej 11, building 8, 1st floor, DK-2400, Copenhagen, Denmark. .,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, N, Denmark.
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Nielsine Nielsens Vej 11, building 8, 1st floor, DK-2400, Copenhagen, Denmark
| | - Anne T Gylling
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Nielsine Nielsens Vej 11, building 8, 1st floor, DK-2400, Copenhagen, Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, N, Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Nielsine Nielsens Vej 11, building 8, 1st floor, DK-2400, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital, Nielsine Nielsens Vej 11, DK-2400, Copenhagen, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Nielsine Nielsens Vej 11, building 8, 1st floor, DK-2400, Copenhagen, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital, Nielsine Nielsens Vej 11, DK-2400, Copenhagen, Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital, Nielsine Nielsens Vej 11, building 8, 1st floor, DK-2400, Copenhagen, Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, N, Denmark
| |
Collapse
|
12
|
Eriksen CS, Henkel C, Svensson RB, Agergaard AS, Couppé C, Kjaer M, Magnusson SP. Lower tendon stiffness in very old compared with old individuals is unaffected by short-term resistance training of skeletal muscle. J Appl Physiol (1985) 2018; 125:205-214. [PMID: 29596014 DOI: 10.1152/japplphysiol.00028.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aging negatively affects collagen-rich tissue, like tendons, but in vivo tendon mechanical properties and the influence of physical activity after the 8th decade of life remain to be determined. This study aimed to compare in vivo patellar tendon mechanical properties in moderately old (old) and very old adults and the effect of short-term resistance training. Twenty old (9 women, 11 men, >65 yr) and 30 very old (11 women, 19 men, >83 yr) adults were randomly allocated to heavy resistance training (HRT) or no training (CON) and underwent testing of in vivo patellar tendon (PT) mechanical properties and PT dimensions before and after a 3-mo intervention. Previous measurements of muscle properties, blood parameters, and physical activity level were included in the analysis. Data from 9 old HRT, 10 old CON, 14 very old CON, and 12 old HRT adults were analyzed. In addition to lower quadriceps muscle strength and cross-sectional area (CSA), we found lower PT stiffness and Young's modulus ( P < 0.001) and a trend toward the lower mid-portion PT-CSA ( P = 0.09) in very old compared with old subjects. Daily step count was also lower in very old subjects ( P < 0.001). Resistance training improved muscle strength and cross-sectional area equally in old and very old subjects ( P < 0.05) but did not affect PT mechanical properties or dimension. We conclude that PT material properties are reduced in very old age, and this may likely be explained by reduced physical activity. Three months of resistance training however, could not alter PT mechanical properties in very old individuals. NEW & NOTEWORTHY This research is the first to quantify in vivo tendon mechanical properties in a group of very old adults in their eighties. Patellar tendon stiffness was lower in very old (87 yr on average) compared with moderately old (68 yr on average) individuals. Reduced physical activity with aging may explain some of the loss in tendon stiffness, but regular heavy resistance training for 3 mo was not sufficient to change tendon mechanical properties.
Collapse
Affiliation(s)
- Christian Skou Eriksen
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Cecilie Henkel
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark
| | - Rene B Svensson
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Anne-Sofie Agergaard
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital , Copenhagen , Denmark
| | - Christian Couppé
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital , Copenhagen , Denmark
| | - Michael Kjaer
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Bispebjerg Hospital , Copenhagen , Denmark.,Center for Healthy Aging, Department of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark.,Department of Physical and Occupational Therapy, Bispebjerg Hospital , Copenhagen , Denmark
| |
Collapse
|
13
|
McCreesh KM, Purtill H, Donnelly AE, Lewis JS. Increased supraspinatus tendon thickness following fatigue loading in rotator cuff tendinopathy: potential implications for exercise therapy. BMJ Open Sport Exerc Med 2017; 3:e000279. [PMID: 29333279 PMCID: PMC5759726 DOI: 10.1136/bmjsem-2017-000279] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 12/29/2022] Open
Abstract
Background/aim Exercise imparts a load on tendon tissue that leads to changes in tendon properties. Studies suggest that loading immediately reduces tendon thickness, with a loss of this response in symptomatic tendinopathy. No studies investigating the response of tendon dimensions to load for the rotator cuff tendons exist. This study aimed to examine the short-term effect of loading on the thickness of the supraspinatus tendon and acromiohumeral distance those with and without rotator cuff tendinopathy. Methods Participants were 20 painfree controls, and 23 people with painful rotator cuff tendinopathy. Supraspinatus tendon thickness and acromiohumeral distance were measured using ultrasound scans before, and at three time points after loading (1, 6 and 24 hours). Loading involved isokinetic eccentric and concentric external rotation and abduction. Results There was a significant increase in supraspinatus tendon thickness in the pain group at 1 (7%, ∆=0.38, 95% CI 0.19 to 0.57) and 6 hours (11%, ∆=0.53, 95% CI 0.34 to 0.71), although only the 6 hours difference exceeded minimal detectable difference. In contrast, there was a small non-significant reduction in thickness in controls. The acromiohumeral distance reduced significantly in both groups at 1 hour (controls: ∆=0.64, 95% CI 0.38 to 0.90; pain: ∆=1.1, 95% CI 0.85 to 1.33), with a larger change from baseline in the pain group. Conclusion Those diagnosed with painful supraspinatus tendinopathy demonstrated increased thickening with delayed return to baseline following loading. Rehabilitation professionals may need to take into account the impact of loading to fatigue when planning rehabilitation programmes.
Collapse
Affiliation(s)
- Karen M McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Helen Purtill
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Alan E Donnelly
- Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
| | - Jeremy S Lewis
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland.,Department of Musculoskeletal Services, Central London Community Healthcare NHS Trust, London, UK.,Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
14
|
Waugh CM, Alktebi T, de Sa A, Scott A. Impact of rest duration on Achilles tendon structure and function following isometric training. Scand J Med Sci Sports 2017; 28:436-445. [PMID: 28603874 DOI: 10.1111/sms.12930] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 12/14/2022]
Abstract
Intervention programs are often sought to strengthen the Achilles tendon (AT) due to its high injury rate. Long rest periods between loading cycles have been found to increase collagen synthesis by tenocytes, suggesting rest duration may be important for tendon adaptation in vivo; however, exercise programs comparing long and short rest duration have not been directly compared. Fourteen adults completed a 12-week progressive training intervention; training sessions consisted of 5×10 isometric plantarflexion contractions each of 3-s duration performed at 90% of MVC three times weekly. Each leg was randomly allocated to long (LRT, 10-s rest) or short rest training (SRT, 3-s rest). We hypothesized that the leg allocated to LRT would demonstrate superior AT collagen organization compared to the leg receiving SRT, which would be related to improved biomechanical function. AT collagen organization and morphology were measured using ultrasound tissue characterization. AT properties were assessed before and after the intervention using a combination of dynamometry, ultrasound imaging, EMG, and motion capture. Contrary to our hypothesis, collagen organization did not improve following either training protocol; conversely, an unexpected decrease in echotype I proportion was seen after SRT (P<.001) but not LRT (P=.58), indicating an apparent protective effect of rest on collagen organization during isometric training. In contrast, AT adaptation was not appreciably enhanced by increasing intercycle rest duration; both protocols were equally effective at inducing significant strength gains and AT mechanical and material adaptation (P≤.001). Further research is necessary to identify optimal loading characteristics for injury prevention and rehabilitation.
Collapse
Affiliation(s)
- C M Waugh
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - T Alktebi
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - A de Sa
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - A Scott
- Faculty of Medicine, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
15
|
POPCHAK ADAMJ, HOGABOOM NATHANS, VYAS DHARMESH, ABT JOHNP, DELITTO ANTHONY, IRRGANG JAMESJ, BONINGER MICHAELL. Acute Response of the Infraspinatus and Biceps Tendons to Pitching in Youth Baseball. Med Sci Sports Exerc 2017; 49:1168-1175. [DOI: 10.1249/mss.0000000000001205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
16
|
Abstract
Synopsis Tendinopathy is frequently associated with structural disorganization within the tendon. As such, the clinical use of ultrasound and magnetic resonance imaging for tendinopathy has been the focus of numerous academic studies and clinical discussions. However, similar to other musculoskeletal conditions (osteoarthritis and intervertebral disc degeneration), there is no direct link between tendon structural disorganization and clinical symptoms, with findings on imaging potentially creating a confusing clinical picture. While imaging shows the presence and extent of structural changes within the tendon, the clinical interpretation of the images requires context in regard to the features of pain and the aggravating loads. This review will critically evaluate studies that have investigated the accuracy and sensitivity of imaging in the detection of clinical tendinopathy and the methodological issues associated with these studies (subject selection, lack of a robust gold standard, reliance on subjective measures). The advent of new imaging modalities allowing for the quantification of tendon structure or mechanical properties has allowed new critical insight into tendon pathology. A strength of these novel modalities is the ability to quantify properties of the tendon. Research utilizing ultrasound tissue characterization and sonoelastography will be discussed. This narrative review will also attempt to synthesize current research on whether imaging can predict the onset of pain or clinical outcome, the role of monitoring tendon structure during rehabilitation (ie, does tendon structure need to improve to get a positive clinical outcome?), and future directions for research, and to propose the clinical role of imaging in tendinopathy. J Orthop Sports Phys Ther 2015;45(11):842-852. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5880.
Collapse
|
17
|
Grosse U, Syha R, Gatidis S, Grözinger G, Martirosian P, Partovi S, Nikolaou K, Robbin MR, Schick F, Springer F. MR-basedin vivofollow-up study of Achilles tendon volume and hydration state after ankle-loading activity. Scand J Med Sci Sports 2015; 26:1200-8. [DOI: 10.1111/sms.12550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- U. Grosse
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
- Department of Radiology; University Hospital Case Medical Center; Case Western Reserve University; Cleveland Ohio USA
| | - R. Syha
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - S. Gatidis
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - G. Grözinger
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - P. Martirosian
- Section on Experimental Radiology; Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - S. Partovi
- Department of Radiology; University Hospital Case Medical Center; Case Western Reserve University; Cleveland Ohio USA
| | - K. Nikolaou
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - M. R. Robbin
- Department of Radiology; University Hospital Case Medical Center; Case Western Reserve University; Cleveland Ohio USA
| | - F. Schick
- Section on Experimental Radiology; Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
| | - F. Springer
- Department of Diagnostic and Interventional Radiology; University Hospital Tübingen; Tübingen Germany
- Musculoskeletal Centre X-Ray Department; Chapel Allerton Hospital; Leeds UK
| |
Collapse
|
18
|
Sevier TL, Stegink-Jansen CW. Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ 2015; 3:e967. [PMID: 26038722 PMCID: PMC4451036 DOI: 10.7717/peerj.967] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/30/2015] [Indexed: 12/27/2022] Open
Abstract
Introduction. Patients with chronic lateral elbow (LE) tendinopathy, commonly known as tennis elbow, often experience prolonged symptoms and frequent relapses. Astym treatment, evidenced in animal studies to promote the healing and regeneration of soft tissues, is hypothesized to improve outcomes in LE tendinopathy patients. This study had two objectives: (1) to compare the efficacy of Astym treatment to an evidence-based eccentric exercise program (EE) for patients with chronic LE tendinopathy, and (2) to quantify outcomes of subjects non-responsive to EE who were subsequently treated with Astym treatment. Study Design. Prospective, two group, parallel, randomized controlled trial completed at a large orthopedic center in Indiana. Inclusion criteria: age range of 18–65 years old, with clinical indications of LE tendinopathy greater than 12 weeks, with no recent corticosteriod injection or disease altering comorbidities. Methods. Subjects with chronic LE tendinopathy (107 subjects with 113 affected elbows) were randomly assigned using computer-generated random number tables to 4 weeks of Astym treatment (57 elbows) or EE treatment (56 elbows). Data collected at baseline, 4, 8, 12 weeks, 6 and 12 months. Primary outcome measure: DASH; secondary outcome measures: pain with activity, maximum grip strength and function. The treating physicians and the rater were blinded; subjects and treating clinicians could not be blinded due to the nature of the treatments. Results. Resolution response rates were 78.3% for the Astym group and 40.9% for the EE group. Astym subjects showed greater gains in DASH scores (p = 0.047) and in maximum grip strength (p = 0.008) than EE subjects. Astym therapy also resolved 20/21 (95.7%) of the EE non-responders, who showed improvements in DASH scores (p < 0.005), pain with activity (p = 0.002), and function (p = 0.004) following Astym treatment. Gains continued at 6 and 12 months. No adverse effects were reported. Conclusion. This study suggests Astym therapy is an effective treatment option for patients with LE tendinopathy, as an initial treatment, and after an eccentric exercise program has failed. Registration/Funding. Ball Memorial Hospital provided limited funding. Trial registration was not required by FDAAA 801. Known about the Subject. Under the new paradigm of degenerative tendinopathy, eccentric exercise (EE) is emerging as a first line conservative treatment for LE tendinopathy. EE and Astym treatment are among the few treatment options aiming to improve the degenerative pathophysiology of the tendon. In this trial, Astym therapy, which has shown success in the treatment of tendinopathy, is compared to EE, which has also shown success in the treatment of tendinopathy. Clinical Relevance. There is a need for more effective, conservative treatment options. Based on the current efficacy study, Astym therapy appears to be a promising, non-invasive treatment option.
Collapse
Affiliation(s)
- Thomas L Sevier
- Performance Dynamics, IU Health Ball Memorial Hospital , Muncie, IN , USA
| | - Caroline W Stegink-Jansen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch , Galveston, TX , USA
| |
Collapse
|
19
|
Obst SJ, Newsham-West R, Barrett RS. Changes in Achilles tendon mechanical properties following eccentric heel drop exercise are specific to the free tendon. Scand J Med Sci Sports 2015; 26:421-31. [DOI: 10.1111/sms.12466] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 01/23/2023]
Affiliation(s)
- S. J. Obst
- School of Allied Health Sciences; Centre for Musculoskeletal Research; Griffith Health Institute; Griffith University; Gold Coast Queensland Australia
| | - R. Newsham-West
- School of Allied Health Sciences; Centre for Musculoskeletal Research; Griffith Health Institute; Griffith University; Gold Coast Queensland Australia
| | - R. S. Barrett
- School of Allied Health Sciences; Centre for Musculoskeletal Research; Griffith Health Institute; Griffith University; Gold Coast Queensland Australia
| |
Collapse
|
20
|
Abstract
Athletes usually complain of an ongoing or chronic pain over the Achilles tendon, but recently even non-athletes are experiencing the same kind of pain which affects their daily activities. Achilles tendinosis refers to a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation. Treatment is based on whether to stimulate or prevent neovascularization. Thus, until now, there is no consensus as to the best treatment for this condition. This paper aims to review the common ways of treating this condition from the conservative to the surgical options.
Collapse
Affiliation(s)
| | - Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Obst SJ, Newsham-West R, Barrett RS. Three-dimensional morphology and strain of the Achilles free tendon immediately following eccentric heel drop exercise. J Exp Biol 2015; 218:3894-900. [DOI: 10.1242/jeb.127175] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/10/2015] [Indexed: 12/12/2022]
Abstract
Our understanding of the immediate effects of exercise on Achilles free tendon transverse morphology is limited to single site measurements acquired at rest using 2D ultrasound. The purpose of this study was to provide a detailed 3D description of changes in Achilles free tendon morphology immediately following a single clinical dose of exercise. Freehand 3D ultrasound was used to measure Achilles free tendon length, and regional cross-sectional area (CSA), medio-lateral (ML) diameter and antero-posterior (AP) diameter in healthy young adults (n=14) at rest and during isometric muscle contraction, immediately before and after 3×15 eccentric heel drops. Post-exercise reductions in transverse strain were limited to CSA and AP diameter in the mid-proximal region of the Achilles free tendon during muscle contraction. The change in CSA strain during muscle contraction was significantly correlated to the change in longitudinal strain (r=−0.72); and the change in AP diameter strain (r=0.64). Overall findings suggest the Achilles free tendon experiences a complex change in 3D morphology following eccentric heel drop exercise that manifests under contractile, but not rest conditions, is most pronounced in the mid-proximal tendon, and primarily driven by changes in AP diameter strain and not ML diameter strain.
Collapse
Affiliation(s)
- Steven J. Obst
- School of Allied Health Sciences and Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Australia
| | - Richard Newsham-West
- School of Allied Health Sciences and Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Australia
| | - Rod S. Barrett
- School of Allied Health Sciences and Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Australia
| |
Collapse
|
22
|
Jeong S, Lee DY, Choi DS, Lee HD. Acute effect of heel-drop exercise with varying ranges of motion on the gastrocnemius aponeurosis-tendon's mechanical properties. J Electromyogr Kinesiol 2014; 24:375-9. [PMID: 24717405 DOI: 10.1016/j.jelekin.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 02/11/2014] [Accepted: 03/10/2014] [Indexed: 11/28/2022] Open
Abstract
The objectives of this study was to investigate the acute effects of various magnitudes of tendon strain on the mechanical properties of the human medial gastrocnemius (MG) in vivo during controlled heel-drop exercises. Seven male and seven female volunteers performed two different exercises executed one month apart: one was a heel-drop exercise on a block (HDB), and the other was a heel-drop exercise on level floor (HDL). In each regimen, the subjects completed a session of 150 heel-drop exercises (15 repetitions×10 sets; with a 30 s rest following each set). Before and immediately after the heel-drop exercise, the ankle plantar flexor torque and elongation of the MG were measured using a combined measurement system of dynamometry and ultrasonography and then the MG tendon strain and stiffness were evaluated in each subject. The tendon stiffness measured prior to the exercises was not significantly different between the two groups 23.7±10.6N/mm and 24.1±10.0N/mm for the HDB and HDL, respectively (p>.05). During the heel-drop exercise, it was found that the tendon strain during the heel-drop exercise on a block (8.4±3.7%) was significantly higher than the strain measured on the level floor (5.4±3.8%) (p<.05). In addition, the tendon stiffness following the heel-drop exercise on a block (32.3±12.2N/mm) was significantly greater than the tendon stiffness measured following the heel-drop exercise on the level floor (25.4±11.4N/mm) (p<.05). The results of this study suggest that tendon stiffness immediately following a heel-drop exercise depends on the magnitude of tendon strain.
Collapse
Affiliation(s)
- Siwoo Jeong
- Department of Physical Education, College of Sciences in Education, Yonsei University, Seoul, Republic of Korea
| | - Dae-Yeon Lee
- Department of Silver Industrial Engineering, College of Future Human Resource Development, Kangnam University, Yongin, Republic of Korea
| | - Dong-Sung Choi
- Department of Physical Education, College of Sciences in Education, Yonsei University, Seoul, Republic of Korea
| | - Hae-Dong Lee
- Department of Physical Education, College of Sciences in Education, Yonsei University, Seoul, Republic of Korea.
| |
Collapse
|
23
|
Obst SJ, Barrett RS, Newsham-West R. Immediate effect of exercise on achilles tendon properties: systematic review. Med Sci Sports Exerc 2014; 45:1534-44. [PMID: 23439426 DOI: 10.1249/mss.0b013e318289d821] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Understanding the mechanical and morphological adaptation of the Achilles tendon (AT) in response to acute exercise could have important implications for athletic performance, injury prevention, and rehabilitation. The purpose of this study was to conduct a systematic review and critical evaluation of the literature to determine the immediate effect of a single bout of exercise on the mechanical and morphological properties of the AT in vivo. METHODS Five electronic research databases were systematically searched for intervention-based studies reporting mechanical and morphological properties of the AT after a single bout of exercise. RESULTS Searches revealed 3292 possible articles; 21 met the inclusion criteria. There is evidence that maximal isometric contractions and prolonged static stretching (>5 min) of the triceps surae complex cause an immediate decrease in AT stiffness, whereas prolonged running and hopping have minimal effect. Limited but consistent evidence exists, indicating that AT hysteresis is reduced after prolonged static stretching. Consistent evidence supports a reduction in free AT diameter (anterior-posterior) after dynamic ankle exercise, and this change appears most pronounced in the healthy tendon and after eccentric exercise. CONCLUSIONS The mechanical and morphological properties of the AT in vivo are affected by acute exercise in a mode- and dose-dependent manner. Transient changes in AT stiffness, hysteresis, and diameter after unaccustomed exercise modes and doses may expose the tendon to increased risk of strain injury and impact on the mechanical function of the triceps surae muscle-tendon unit.
Collapse
Affiliation(s)
- Steven J Obst
- School of Rehabilitation Sciences and Center for Musculoskeletal Research, Griffith Health Institute, Griffith University, Queensland, Australia.
| | | | | |
Collapse
|
24
|
Obst SJ, Newsham-West R, Barrett RS. In vivo measurement of human achilles tendon morphology using freehand 3-D ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:62-70. [PMID: 24139914 DOI: 10.1016/j.ultrasmedbio.2013.08.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/17/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
This study investigated the accuracy of phantom volume and length measurements and the reliability of in vivo Achilles tendon (AT) volume, length and cross-sectional area measurements obtained using freehand 3-D ultrasound. Participants (n = 13) were scanned on consecutive days under active and passive loading conditions. In vivo AT length was evaluated using a two-point method and an approach that accounted for AT curvature (centroid method). Three-dimensional ultrasound provided accurate measures of phantom volume and length (mean difference = 0.05 mL and 0.2 mm, respectively) and reliable in vivo measures of AT volume, length and average cross-sectional area, with all intra-class correlations coefficients greater than 0.98. The mean minimally detectable changes for in vivo AT volume, two-point length and centroid length were 0.2 mL, 1.5 mm and 2.0 mm, respectively. Two-point AT length underestimated centroid AT length by 0.7 mm, suggesting that the effect of curvature on in vivo AT length is negligible.
Collapse
Affiliation(s)
- Steven J Obst
- School of Rehabilitation Sciences and Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Southport, Queensland, Australia.
| | | | | |
Collapse
|
25
|
Lewis JS. Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000027] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
26
|
Syha R, Springer F, Grözinger G, Würslin C, Ipach I, Ketelsen D, Schabel C, Gebhard H, Hein T, Martirosian P, Schick F, Claussen CD, Grosse U. Short-term exercise-induced changes in hydration state of healthy achilles tendons can be visualized by effects of off-resonant radiofrequency saturation in a three-dimensional ultrashort echo time MRI sequence applied at 3 tesla. J Magn Reson Imaging 2013; 40:1400-7. [DOI: 10.1002/jmri.24488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 09/25/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Roland Syha
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Fabian Springer
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Gerd Grözinger
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Christian Würslin
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Ingmar Ipach
- Department of Orthopaedic surgery; University hospital of Tübingen; Tübingen Germany
| | - Dominik Ketelsen
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Christoph Schabel
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Harry Gebhard
- Berufsgenossenschaftliche Unfallklinik Tübingen; Tübingen Germany
| | - Tobias Hein
- Department of Sports medicine; University of Tübingen; Tübingen Germany
| | - Petros Martirosian
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Fritz Schick
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Claus D. Claussen
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
| | - Ulrich Grosse
- Diagnostic and Interventional Radiology; Eberhard-Karls-University; Tübingen Germany
- Section on Experimental Radiology; Eberhard-Karls-University; Tübingen Germany
| |
Collapse
|
27
|
McCreesh K, Lewis J. Continuum model of tendon pathology - where are we now? Int J Exp Pathol 2013; 94:242-7. [PMID: 23837792 DOI: 10.1111/iep.12029] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/16/2013] [Indexed: 12/01/2022] Open
Abstract
Chronic tendon pathology is a common and often disabling condition, the causes of which remain poorly understood. The continuum model of tendon pathology was proposed to provide a model for the staging of tendon pathology and to assist clinicians in managing this often complex condition (Br. J. Sports Med., 43, 2009, 409). The model presents clinical, histological and imaging evidence for the progression of tendon pathology as a three-stage continuum: reactive tendinopathy, tendon disrepair and degenerative tendinopathy. It also provides clinical information to assist in identifying the stage of pathology, in addition to proposed treatment approaches for each stage. The usefulness of such a model is determined by its ability to incorporate and inform new and emerging research. This review examines the degree to which recent research supports or refutes the continuum model and proposes future directions for clinical and research application of the model.
Collapse
Affiliation(s)
- Karen McCreesh
- Department of Clinical Therapies, University of Limerick, Limerick, Ireland
| | | |
Collapse
|
28
|
Couppé C, Kongsgaard M, Aagaard P, Vinther A, Boesen M, Kjaer M, Magnusson SP. Differences in tendon properties in elite badminton players with or without patellar tendinopathy. Scand J Med Sci Sports 2012; 23:e89-95. [DOI: 10.1111/sms.12023] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 12/16/2022]
Affiliation(s)
| | - M. Kongsgaard
- Institute of Sports Medicine Copenhagen; Department of Orthopedic Surgery M; Bispebjerg Hospital and Centre for Healthy Aging; Faculty of Health Sciences; University of Copenhagen; Copenhagen; Denmark
| | - P. Aagaard
- Department of Clinical Biomechanics and Exercises Science; University of Southern Denmark; Odense; Denmark
| | - A. Vinther
- Department of Physical Therapy; Herlev Hospital; Herlev; Denmark
| | - M. Boesen
- Department of Radiology and the Parker Institute Bispebjerg; Frederiksberg Hospital; Copenhagen NV; Denmark
| | - M. Kjaer
- Institute of Sports Medicine Copenhagen; Department of Orthopedic Surgery M; Bispebjerg Hospital and Centre for Healthy Aging; Faculty of Health Sciences; University of Copenhagen; Copenhagen; Denmark
| | | |
Collapse
|
29
|
Tardioli A, Malliaras P, Maffulli N. Immediate and short-term effects of exercise on tendon structure: biochemical, biomechanical and imaging responses. Br Med Bull 2012; 103:169-202. [PMID: 22279080 DOI: 10.1093/bmb/ldr052] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introduction Tendons are metabolically active structures, and their biochemical, biomechanical and structural properties adapt to chronic exercise. However, abnormal adaptations may lead to the development of tendinopathy and pain. Acute and subacute adaptations might contribute to tendon pathology. Sources of data A systematic search of peer-reviewed articles was performed using a wide range of electronic databases. A total of 61 publications were selected. Areas of agreement Exercise induces acute responses in collagen turnover, blood flow, glucose, lactate and other inflammatory products (e.g. prostaglandins and interleukins). Mechanical properties are influenced by activity duration and intensity. Acute bouts of exercise affect tendon structure, with some of the changes resembling those reported in pathological tendons. Areas of controversy Given the variation in study designs, measured parameters and outcomes, it remains debatable how acute exercise influences overall tendon properties. There is discrepancy regarding which investigation modality and settings provide optimal assessment of each parameter. Growing points There is a need for greater homogeneity between study designs, including subject consortium and age, exercise protocols and time frames for parameter assessing. Areas timely for developing research Innovative methods, measuring each parameter simultaneously, would allow a greater understanding of how and when changes occur. This methodology is key to revealing pathological processes and pathways that alter tendon properties according to various activities. Optimal tendon properties differ between activities: more compliant tendons are beneficial for slow stretch shortening cycle (SSC) activities such as countermovement jumps, whereas stiffer tendons are considered beneficial for fast SSC movements such as sprinting.
Collapse
Affiliation(s)
- Alex Tardioli
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry,Mile End Hospital, London, UK
| | | | | |
Collapse
|
30
|
Standley RA, Harber MP, Lee JD, Konopka AR, Trappe SW, Trappe TA. Influence of aerobic cycle exercise training on patellar tendon cross-sectional area in older women. Scand J Med Sci Sports 2011; 23:367-73. [PMID: 22092782 DOI: 10.1111/j.1600-0838.2011.01396.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2011] [Indexed: 11/29/2022]
Abstract
Nine to 12 weeks of resistance exercise training in young individuals induces quadriceps muscle (∼6%) and region-specific patellar tendon (4-6%) hypertrophy. However, 12 weeks of resistance exercise training (∼1 h total exercise time) in older individuals (60-78 years) induces quadriceps muscle hypertrophy (9%) without impacting patellar tendon size. The current study examined if a different loading paradigm using cycle exercise would promote patellar tendon hypertrophy or alter the internal tendon properties, measured with magnetic resonance imaging signal intensity, in older individuals. Nine women (70 ± 2 years) completed 12 weeks of aerobic upright cycle exercise training (∼28 h total exercise time). Aerobic exercise training increased (P < 0.05) quadriceps muscle size (11 ± 2%) and VO2max (30 ± 9%). Mean patellar tendon cross-sectional area (CSA) (2 ± 1%) and signal intensity (-1 ± 2%) were unchanged (P > 0.05) over the 12 weeks of training. Region-specific CSA was unchanged (P > 0.05) at the proximal (-1 ± 3%) and mid regions (2 ± 2%) of the tendon but tended (P = 0.069) to increase at the distal region (5 ± 3%). Region-specific signal intensity differed along the tendon but was unchanged (P > 0.05) with training. Although more studies are needed, exercise-induced patellar tendon hypertrophy, compared with skeletal muscle, appears to be attenuated in older individuals, while the loading pattern associated with aerobic exercise seems to have more impact than resistance exercise in promoting patellar tendon hypertrophy.
Collapse
Affiliation(s)
- R A Standley
- Human Performance Laboratory, Ball State University, Muncie, Indiana, USA
| | | | | | | | | | | |
Collapse
|
31
|
Effect of an intense wheelchair propulsion task on quantitative ultrasound of shoulder tendons. PM R 2011; 2:920-5. [PMID: 20970761 DOI: 10.1016/j.pmrj.2010.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 06/11/2010] [Accepted: 06/12/2010] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To investigate acute ultrasound changes of biceps and supraspinatus tendon appearance after an intense wheelchair propulsion task, and how these changes relate to demographic and biomechanical risk factors. DESIGN A survey. SETTING Research laboratory and research space at the National Veterans Wheelchair Games. PARTICIPANTS A convenience sample of 60 manual wheelchair users were recruited through research registries and rehabilitation clinics as well as from participants at the 2007 and 2008 National Veterans Wheelchair Games. The subjects were between 18 and 65 years of age at least 1 year after injury and did not have progressive disabilities. MAIN OUTCOME MEASURES Quantitative ultrasound (QUS) measures of biceps and supraspinatus tendon appearance, stroke frequency, resultant force, tendinopathy score, and duration of wheelchair use. RESULTS Biceps tendon appearance after an intense propulsion task was significantly related to chronic biceps tendinopathy, duration of wheelchair use, stroke frequency, and resultant force. The subjects with a higher stroke frequency or resultant force tended to have a brighter, more organized tendon appearance compared with the prepropulsion imaging session (baseline). The subjects with tendinopathy or a longer duration of wheelchair use were more likely to have a darker, diffuse tendon appearance immediately after the propulsion task. Supraspinatus tendon appearance after propulsion was only significantly predicted by baseline QUS measures. CONCLUSIONS QUS has proven to be sensitive to risk factors for tendon pathology. Future studies can apply grayscale-based QUS to study the development and prevention of repetitive strain injuries, particularly on an individual basis.
Collapse
|
32
|
Malliaras P, Voss C, Garau G, Richards P, Maffulli N. Achilles tendon shape and echogenicity on ultrasound among active badminton players. Scand J Med Sci Sports 2010; 22:149-55. [DOI: 10.1111/j.1600-0838.2010.01156.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Neuromuscular and muscle-tendon system adaptations to isotonic and isokinetic eccentric exercise. Ann Phys Rehabil Med 2010; 53:319-41. [DOI: 10.1016/j.rehab.2010.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 04/16/2010] [Indexed: 10/19/2022]
|
34
|
Abstract
Achilles tendinopathy is a painful condition that occurs commonly in both active and inactive individuals. It seems that this condition is painful as a result of ingrowth of neural structures and neovessels leading to poor healing, rather than from inflammatory mediators. Traditional conservative measures are often successful. There is a subset of patients who fail to respond to these measures, however, and this has led to the investigation of newer conservative techniques. This article provides a review of many of the emerging techniques in the treatment of Achilles tendinopathy.
Collapse
Affiliation(s)
- Jason E Lake
- Campbell Clinic, University of Tennessee, 1211 Union Avenue, Suite 510, Memphis, TN 38104, USA
| | | |
Collapse
|
35
|
Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls--an observational study. ACTA ACUST UNITED AC 2009; 15:37-42. [PMID: 19643657 DOI: 10.1016/j.math.2009.05.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 04/20/2009] [Accepted: 05/15/2009] [Indexed: 11/20/2022]
Abstract
There are no published data on the prevalence of Achilles tendinopathy in gymnasts. 40 elite gymnasts and 41 controls of mean (SD) age 16.3 (2.1) years had bilateral AT thickness (at 3 points along the tendon in longitudinal and transverse views) and abnormality measured using ultrasound (US). Data on a history of AT symptoms were gathered using a questionnaire. Among female gymnasts there were 17.5% of Achilles tendons (ATs) with current symptoms, compared with none of the controls (chi(2)=6.2, p<0.05). Similarly, among male gymnasts 12.5% of ATs were currently symptomatic, compared with none of the controls (chi(2)=6.62, p<0.01). US scanning showed gymnasts had significantly (p<0.001 to p<0.05) thicker ATs for 5 out of 6 measures, and had more irregular longitudinal AT thickness (p<0.05). 32.5% of female gymnast ATs had US abnormalities, compared with 6.2% of female control ATs (chi(2)=7.43, p<0.01). Similarly, 35% of male gymnast ATs had US abnormalities, compared with 4% of male control ATs (chi(2)=7.43, p=0<01). There was no relationship between AT symptoms and US-detected abnormalities in the gymnasts. Achilles tendinopathy is a common problem in gymnasts. The poor correlation between signs and symptoms suggests pathology is not always symptomatic.
Collapse
|
36
|
Meyer A, Tumilty S, Baxter GD. Eccentric exercise protocols for chronic non-insertional Achilles tendinopathy: how much is enough? Scand J Med Sci Sports 2009; 19:609-15. [PMID: 19602185 DOI: 10.1111/j.1600-0838.2009.00981.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Eccentric exercises for the calf muscles have been shown to be effective for chronic non-insertional Achilles tendinopathy (AT). However, the relative effectiveness of various dosages is unknown. A systematic review of randomized-controlled trials (RCTs) was designed to determine whether an optimum dose of eccentric exercises could be recommended. Three selected RCTs showed positive effects of very similar eccentric exercise protocols for chronic non-insertional AT. Owing to insufficient reported compliance data, a conclusion on the relative effectiveness of various compliances was not feasible. According to our review, the relative effectiveness of various dosages of eccentric exercises for AT is still unclear. However, it appears that highly variable compliance rates result in similar positive outcomes; these findings, therefore, highlight the need for further investigations.
Collapse
Affiliation(s)
- A Meyer
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | | | | |
Collapse
|
37
|
Rompe JD, Furia JP, Maffulli N. Mid-portion Achilles tendinopathy--current options for treatment. Disabil Rehabil 2009; 30:1666-76. [PMID: 18608388 DOI: 10.1080/09638280701785825] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To report on the present option for management of tendinopathy of the main body of the Achilles tendon. BACKGROUND Tendinopathy of the main body of tendo Achillis affects athletic and sedentary patients. Mechanical loading is thought to be a major causative factor. However, the exact mechanical loading conditions which cause tendinopathy are poorly defined. Repetitive mechanical loading induces a non-inflammatory pathology, and repetitive microtrauma ultimately exceeds the healing response. The management of Achilles tendinopathy is primarily conservative. Although many non-operative options are available, few have been tested under controlled conditions. This review article specifically focuses on eccentric training, and on shock wave therapy. Surgical intervention can be successful in refractory cases. However, surgery does not usually completely eliminate symptoms and complications are not rare. CONCLUSIONS Further studies are needed to discern the optimal non-operative and surgical management of midsubstance Achilles tendinopathy.
Collapse
Affiliation(s)
- Jan D Rompe
- OrthoTrauma Evaluation Center, Mainz, Germany
| | | | | |
Collapse
|
38
|
Rees JD, Lichtwark GA, Wolman RL, Wilson AM. Comment on: The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans: reply. Rheumatology (Oxford) 2008. [DOI: 10.1093/rheumatology/ken423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Knobloch K. Comment on: The mechanism for efficacy of eccentric loading in Achilles tendon injury: an in vivo study in humans. Rheumatology (Oxford) 2008; 48:202-3; author reply 203. [DOI: 10.1093/rheumatology/ken387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
40
|
Affiliation(s)
- Aaron T Scott
- Division of Orthopaedic Surgery, Duke University Medical Center, Duke University, Durham, NC 27704, USA
| | | | | |
Collapse
|
41
|
Knobloch K. The role of tendon microcirculation in Achilles and patellar tendinopathy. J Orthop Surg Res 2008; 3:18. [PMID: 18447938 PMCID: PMC2397381 DOI: 10.1186/1749-799x-3-18] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 04/30/2008] [Indexed: 12/11/2022] Open
Abstract
Tendinopathy is of distinct interest as it describes a painful tendon disease with local tenderness, swelling and pain associated with sonographic features such as hypoechogenic texture and diameter enlargement. Recent research elucidated microcirculatory changes in tendinopathy using laser Doppler flowmetry and spectrophotometry such as at the Achilles tendon, the patellar tendon as well as at the elbow and the wrist level. Tendon capillary blood flow is increased at the point of pain. Tendon oxygen saturation as well as tendon postcapillary venous filling pressures, determined non-invasively using combined Laser Doppler flowmetry and spectrophotometry, can quantify, in real-time, how tendon microcirculation changes over with pathology or in response to a given therapy. Tendon oxygen saturation can be increased by repetitive, intermittent short-term ice applications in Achilles tendons; this corresponds to 'ischemic preconditioning', a method used to train tissue to sustain ischemic damage. On the other hand, decreasing tendon oxygenation may reflect local acidosis and deteriorating tendon metabolism. Painful eccentric training, a common therapy for Achilles, patellar, supraspinatus and wrist tendinopathy decreases abnormal capillary tendon flow without compromising local tendon oxygenation. Combining an Achilles pneumatic wrap with eccentric training changes tendon microcirculation in a different way than does eccentric training alone; both approaches reduce pain in Achilles tendinopathy. The microcirculatory effects of measures such as extracorporeal shock wave therapy as well as topical nitroglycerine application are to be studied in tendinopathy as well as the critical question of dosage and maintenance. Interestingly it seems that injection therapy using color Doppler for targeting the area of neovascularisation yields to good clinical results with polidocanol sclerosing therapy, but also with a combination of epinephrine and lidocaine.
Collapse
Affiliation(s)
- Karsten Knobloch
- Plastic, Hand and Reconstructive surgery, Hannover Medical School, Germany.
| |
Collapse
|
42
|
Abstract
Achilles and patellar tendinopathies affect a broad range of the population and are difficult conditions to manage clinically. The pathology is persistent in the chronic tendon and can be considered to be failed healing. The exact cause of tendinopathy pain is unclear but may be related to changes in neurovascular structures. Rehabilitation for Achilles and patellar tendinopathies is based on an exercise programme that aims to improve muscle-tendon function and normalise the pelvic/lower limb kinetic chain. This incorporates a programme for restoring and improving muscle strength, endurance and power and retraining sport-specific function. Rehabilitation may take a prolonged period of time, both the athlete and clinician must be patient and persistent to maximise results from an exercise-based treatment.
Collapse
Affiliation(s)
- Alex Kountouris
- Musculoskeletal Research Centre, La Trobe University, Victoria 3086, Australia.
| | | |
Collapse
|
43
|
Knobloch K. Re: Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med 2007; 35:1208; author reply 1208-9. [PMID: 17581977 DOI: 10.1177/0363546507303564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
44
|
Knobloch K, Kraemer R, Jagodzinski M, Zeichen J, Meller R, Vogt PM. Eccentric training decreases paratendon capillary blood flow and preserves paratendon oxygen saturation in chronic achilles tendinopathy. J Orthop Sports Phys Ther 2007; 37:269-76. [PMID: 17549956 DOI: 10.2519/jospt.2007.2296] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A controlled, randomized, prospective study, OBJECTIVE To assess the changes in paratendon microcirculation after 12 weeks of daily painful eccentric training in individuals with chronic Achilles tendinopathy. BACKGROUND Changes in tendon and paratendon microcirculation are evident in insertional and midportion Achilles tendinopathy. Whether the paratendon is involved in eccentric training response is not known. METHODS Twenty patients with chronic Achilles tendinopathy were recruited for a prospective, controlled trial using eccentric exercise. A laser Doppler system assessed capillary blood flow (flow), tissue oxygen saturation (SO2), and postcapillary venous filling pressure (rHb) at 8 paratendon locations at depths of 2 and 8 mm. RESULTS Pain in the eccentric-training group was reduced by 48% (from a mean of 4.1 +/- 2.9 to 2.1 +/- 2.2, P<.05). Deep paratendon blood flow decreased at the midportion paratendon location (P<.05). Superficial blood flow at the medial distal midportion position (by 31%, P = .008) and the lateral proximal midportion location (by 45%, P = .016) were significantly decreased postintervention, No significant change of superficial or deep paratendon oxygenation was found after intervention as compared to baseline. Deep paratendon postcapillary venous filling pressures were significantly reduced following eccentric training (P<.05). CONCLUSION An eccentric-training program performed daily over 12 weeks reduced the increased paratendinous capillary blood flow in Achilles tendinopathy by as much as 45% and decreased pain level based on a visual analog scale. Local paratendon oxygenation was preserved while paratendinous postcapillary venous filling pressures were reduced after 12 weeks of eccentric training, which appears to be beneficial from the perspective of microcirculation.
Collapse
Affiliation(s)
- Karsten Knobloch
- Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | |
Collapse
|
45
|
Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med 2007; 41:211-6. [PMID: 17311806 PMCID: PMC2658946 DOI: 10.1136/bjsm.2007.035543] [Citation(s) in RCA: 172] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery relieves pain in the majority of cases. Directing a patient through the algorithm presented here will maximise positive treatment outcomes.
Collapse
Affiliation(s)
- Håkan Alfredson
- Sports Medicine Unit, Department of Surgical and Perioperative Science, Umeå University, Umeå, Sweden
| | | |
Collapse
|
46
|
Visnes H, Bahr R. The evolution of eccentric training as treatment for patellar tendinopathy (jumper's knee): a critical review of exercise programmes. Br J Sports Med 2007; 41:217-23. [PMID: 17261559 PMCID: PMC2658948 DOI: 10.1136/bjsm.2006.032417] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIM Eccentric training has become a popular treatment for patellar tendinopathy. Our purpose was to review the evolution of eccentric strength training programmes for patellar tendinopathy with a focus on the exercise prescriptions used, to help clinicians make appropriate choices and identify areas needing further research. METHODS A computerised search of the entire MEDLINE database was performed on 1 September 2006 to identify prospective and randomised clinical trials with a focus on clinical outcome of eccentric training for patellar tendinopathy. RESULTS 7 articles with a total of 162 patients and in which eccentric training was one of the interventions, all published after 2000, were included. The results were positive, but study quality was variable, with small numbers or short follow-up periods. The content of the different training programmes varied, but most were home-based programmes with twice daily training for 12 weeks. A number of potentially significant differences were identified in the eccentric programmes used: drop squats or slow eccentric movement, squatting on a decline board or level ground, exercising into tendon pain or short of pain, loading the eccentric phase only or both phases, and progressing with speed then loading or simply loading. CONCLUSION Most studies suggest that eccentric training may have a positive effect, but our ability to recommend a specific protocol is limited. The studies available indicate that the treatment programme should include a decline board and should be performed with some level of discomfort, and that athletes should be removed from sports activity. However, these aspects need further study.
Collapse
Affiliation(s)
- Håvard Visnes
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | |
Collapse
|
47
|
Boesen MI, Koenig MJ, Torp-Pedersen S, Bliddal H, Langberg H. Tendinopathy and Doppler activity: the vascular response of the achilles tendon to exercise. Scand J Med Sci Sports 2006; 16:463-9. [PMID: 17121650 DOI: 10.1111/j.1600-0838.2005.00512.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intratendinous Doppler activity has been interpreted as an equivalent of neovessels in the Achilles tendon and as a sign of tendinosis (AT). AIM To evaluate the vascular response as indicated by color Doppler activity after repeated loading of both symptomatic and non-symptomatic Achilles tendons. MATERIAL AND METHODS Ten non-trained, healthy subjects ran 5 km. Ultrasound (US) Doppler activity was determined before and after the exercise. Eleven patients with chronic AT performed 3 x 15 heavy-load eccentric exercise. The Achilles tendons were scanned before and immediately after the exercise. RESULTS Non-symptomatic: six Achilles tendons in five subjects had intratendinous Doppler activity before the exercise. All but two subjects (80%) had intratendinous Doppler activity after running. Symptomatic: all patients had Doppler activity in the tendons, with a median color fraction before eccentric exercise of 0.05 (range 0.01-0.33). The Doppler activity did not disappear after exercise. Tendons with a color fraction below the median at baseline increased significantly after the exercise (P=0.02). CONCLUSION The mere presence of Doppler in the Achilles tendon does not per se indicate disease. Eccentric exercise does not extinguish the flow during or after one training session in patients with chronic AT.
Collapse
Affiliation(s)
- M I Boesen
- The Parker Institute, Frederiksberg Hospital, Frederiksberg, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
48
|
Woodley BL, Newsham-West RJ, Baxter GD. Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med 2006; 41:188-98; discussion 199. [PMID: 17062655 PMCID: PMC2658941 DOI: 10.1136/bjsm.2006.029769] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the effectiveness of eccentric exercise (EE) programmes in the treatment of common tendinopathies. DATA SOURCES Relevant randomised controlled trials (RCTs) were sourced using the OVID website databases: MEDLINE (1966-Jan 2006), CINAHL (1982-Jan 2006), AMED (1985-Jan 2006), EMBASE (1988-Jan 2006), and all EBM reviews--Cochrane DSR, ACP Journal Club, DARE, and CCTR (Jan 2006). The Physiotherapy Evidence Database (PEDro) was also searched using the keyword: eccentric. REVIEW METHODS The PEDro and van Tulder scales were employed to assess methodological quality. Levels of evidence were then obtained according to predefined thresholds: Strong--consistent findings among multiple high-quality RCTs. Moderate--consistent findings among multiple low-quality RCTs and/or clinically controlled trials (CCTs) and/or one high-quality RCT. Limited--one low-quality RCT and/or CCT. Conflicting--inconsistent findings among multiple trials (RCTs and/or CCTs). No evidence-no RCTs or CCTs. RESULTS Twenty relevant studies were sourced, 11 of which met the inclusion criteria. These included studies of Achilles tendinopathy (AT), patella tendinopathy (PT) and tendinopathy of the common wrist extensor tendon of the lateral elbow (LET). Limited levels of evidence exist to suggest that EE has a positive effect on clinical outcomes such as pain, function and patient satisfaction/return to work when compared to various control interventions such as concentric exercise (CE), stretching, splinting, frictions and ultrasound. Levels of evidence were found to be variable across the tendinopathies investigated. CONCLUSIONS This review demonstrates the dearth of high-quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies. Further adequately powered studies that include appropriate randomisation procedures, standardised outcome measures and long-term follow-up are required.
Collapse
Affiliation(s)
- Brett L Woodley
- Centre for Physiotherapy Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand.
| | | | | |
Collapse
|
49
|
Alfredson H, Ohberg L. Increased intratendinous vascularity in the early period after sclerosing injection treatment in Achilles tendinosis : a healing response? Knee Surg Sports Traumatol Arthrosc 2006; 14:399-401. [PMID: 16538518 DOI: 10.1007/s00167-006-0720-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Accepted: 01/11/2006] [Indexed: 11/27/2022]
|
50
|
Abstract
Achilles tendon ruptures are common, and their incidence is increasing. The evidence for best management is controversial, and, in selected patients, conservative management and early mobilization achieves excellent results. Surgery is associated with an increased risk of superficial skin breakdown; however, modern techniques of percutaneous repair that are performed under local anesthesia and followed by early functional rehabilitation are becoming increasingly common, and should be considered when managing such patients.
Collapse
Affiliation(s)
- Tomas Movin
- Department of Orthopaedics, Huddinge Hospital, Karolinska Institute, S-14186 Stockholm, Sweden
| | | | | | | |
Collapse
|