List of Titles

Clinical improvements are not explained by changes in tendon structure on ultrasound tissue characterization after an exercise program for patellar tendinopathy

- van Ark, Mathijs, Rio, Ebonie, Cook, Jill, van den Akker-Scheek, Inge, Gaida, James, Zwerver, Johannes, Docking, Sean

Authors: van Ark, Mathijs , Rio, Ebonie , Cook, Jill , van den Akker-Scheek, Inge , Gaida, James , Zwerver, Johannes , Docking, Sean
Date: 2018
Type: Text , Journal article
Relation: American Journal of Physical Medicine & Rehabilitation Vol. 97, no. 10 (2018), p. 708-714
Full Text: false
Reviewed:
Description: Objectives The aim of this study was to investigate the effects of a 4-wk in-season exercise program of isometric or isotonic exercises on tendon structure and dimensions as quantified by ultrasound tissue characterization (UTC). Design This was a randomized clinical trial. Volleyball and basketball players (16-31 yrs, n = 29) with clinically diagnosed patellar tendinopathy were randomized to a 4-wk isometric or isotonic exercise program. The programs were designed to decrease patellar tendon pain. A baseline and 4-wk UTC scan was used to evaluate change in tendon structure. Results No significant change in tendon structure or dimensions on UTC was detected after the exercise program despite patellar tendinopathy symptoms improving. The percentage and mean cross-sectional area of aligned fibrillar structure (echo types I + II) (Z = -0.414, P = 0.679) as well as disorganized structure (echo types III + IV) (Z = -0.370, P = 0.711) did not change over the 4-wk exercise program. Change in tendon structure and dimensions on UTC did not differ significantly between the groups. Conclusion Structural properties and dimensions of the patellar tendon on UTC did not change after a 4-wk isometric or isotonic exercise program for athletes with patellar tendinopathy in-season, despite an improvement in symptoms. It seems that structural improvements are not required for a positive clinical outcome.

Jump-landing mechanics in patellar tendinopathy in elite youth basketballers

- Harris, Meaghan, Schultz, Adrian, Drew, Michael, Rio, Ebonie, Charlton, Paula, Edwards, Suzi

Authors: Harris, Meaghan , Schultz, Adrian , Drew, Michael , Rio, Ebonie , Charlton, Paula , Edwards, Suzi
Date: 2020
Type: Text , Journal article
Relation: Scandinavian Journal of Medicine & Science in Sports Vol. 30, no. 3 (Mar 2020), p. 540-548
Full Text: false
Reviewed:
Description: Patellar tendinopathy (PT) is a leading cause of morbidity in jump-landing athletes. Landing mechanics are identified as a factor associated with PT and/or patellar tendon abnormality. This study aimed to identify key jump-landing variables associated with PT. Thirty-six junior elite basketball players (men n = 18, women n = 18) were recruited from a Basketball Australia development camp. Three-dimensional (3D) kinematic and ground reaction force (GRF) data during a stop-jump task were collected as well as ultrasound scans of the patellar tendons and recall history of training load data. Mixed-model factorial analyses of variance were used to determine any significant between-group differences. Of the 23 participants included for statistical analyses, 11 had normal bilateral patellar tendons (controls) and eight reported PT (currently symptomatic); however, the four participants categorized as asymptomatic with patellar tendon abnormality on diagnostic imaging were excluded from statistical analyses due to their small sample size. Athletes with PT displayed a similar knee flexion angle at initial foot-ground contact (IC) and hip extension strategy during a stop-jump horizontal landing. Despite a similar kinematic technique, athletes with PT utilized a strategy of a longer stance duration phase from IC to peak force. This strategy did not lead to those athletes with PT decreasing their peak vertical GRF nor patellar tendon force during landing but enabled these athletes to land with a lower rate of loading (control 59.2 +/- 39.3 vs. PT 29.4 +/- 33.7 BW.s-1). Athletes with PT still reported significantly reduced training volume (control 4.9 +/- 1.8 vs PT 1.8 +/- 1.1 sessions/wk; total training time/wk control 2.4 +/- 1.0 vs PT 1.4 +/- 1.1 h/wk).

Pain mapping of the anterior knee: Injured athletes know best

- Rio, Ebonie, Girdwood, Michael, Thomas, Jake, Garofalo, Christopher, Fortington, Lauren, Docking, Sean

Authors: Rio, Ebonie , Girdwood, Michael , Thomas, Jake , Garofalo, Christopher , Fortington, Lauren , Docking, Sean
Date: 2018
Type: Text , Journal article
Relation: Scandinavian Journal of Pain Vol. 18, no. 3 (2018), p. 409-416
Full Text: false
Reviewed:
Description: Research investigating differences in pain location and distribution across conditions is lacking. Mapping a patient's pain may be a useful way of understanding differences in presentations, however the use of pain mapping during a pain provocation task has not been investigated. The aim of this study was to assess the reliability of patient and clinician rated pain maps during a pain provocation task for the anterior knee. Participants were recruited from a larger study of professional Australian rules football players (n=17). Players were invited to participate if they reported a current or past history of patellar tendon pain. No clinical diagnosis was performed for this reliability study. Participants were asked to point on their own knee where they usually experienced pain, which was recorded by a clinician on a piloted photograph of the knee using an iPad. Participants then completed a single leg decline squat (SLDS), after which participants indicated where they experienced pain during the task with their finger, which was recorded by a clinician. Participants then recorded their own self-rated pain map. This process was repeated 10 min later. Pain maps were subjectively classified into categories of pain location and spread by two raters. Pain area was quantified by the number of pixels shaded. Intra- and inter-rater reliability (between participants and clinicians) were analysed for pain area, similarity of location as well as subjective classification. Test-retest reliability was good for participants (intraclass correlation coefficients [ICC]=0.81) but only fair for clinicians (ICC=0.47) for pain area. There was poor agreement between participants and clinicians for pain area (ICC=0.16) and similarity of location (Jaccard index=0.19). Clinicians had good inter- and intra-rater reliability of classification of pain spread (k=0.75 and 0.67). Participant completed pain maps were more reliable than clinician pain maps. Clinicians were reliable at classifying pain based on location and type of spread. Clinicians should ask patients to complete their own pain maps following a pain provocation test, to elicit the most reliable and consistent understanding of their pain perception. © 2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston.

Patellar tendinopathy : Clinical diagnosis, load management, and advice for challenging case presentations

- Malliaras, Peter, Cook, Jill, Purdam, Craig, Rio, Ebonie

Authors: Malliaras, Peter , Cook, Jill , Purdam, Craig , Rio, Ebonie
Date: 2015
Type: Text , Journal article
Relation: Journal of Orthopaedic & Sports Physical Therapy Vol. 45, no. 11 (2015), p. 887-898
Full Text: false
Reviewed:
Description: The hallmark features of patellar tendinopathy are (1) pain localized to the inferior pole of the patella and (2) load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon. While imaging may assist in differential diagnosis, the diagnosis of patellar tendinopathy remains clinical, as asymptomatic tendon pathology may exist in people who have pain from other anterior knee sources. A thorough examination is required to diagnose patellar tendinopathy and contributing factors. Management of patellar tendinopathy should focus on progressively developing load tolerance of the tendon, the musculoskeletal unit, and the kinetic chain, as well as addressing key biomechanical and other risk factors. Rehabilitation can be slow and sometimes frustrating. This review aims to assist clinicians with key concepts related to examination, diagnosis, and management of patellar tendinopathy. Difficult clinical presentations (eg, highly irritable tendon, systemic comorbidities) as well as common pitfalls, such as unrealistic rehabilitation time frames and overreliance on passive treatments, are also discussed.

Quantification of Achilles and patellar tendon structure on imaging does not enhance ability to predict self-reported symptoms beyond grey-scale ultrasound and previous history

- Docking, Sean, Rio, Ebonie, Cook, Jill, Carey, David, Fortington, Lauren

Authors: Docking, Sean , Rio, Ebonie , Cook, Jill , Carey, David , Fortington, Lauren
Date: 2019
Type: Text , Journal article
Relation: Journal of Science and Medicine in Sport Vol. 22, no. 2 (2019), p. 145-150
Full Text: false
Reviewed:
Description: Background: Tendon pathology on imaging has been associated with an increased risk of developing symptoms. This evidence is based on classifying the tendon as normal or pathological. It is unclear whether the extent of tendon pathology is associated with the development or severity of symptoms. Objectives: To investigate whether the presence and extent of tendon pathology on ultrasound tissue characterisation (UTC), or a previous history of symptoms, were associated with the development of symptoms over a football season. Methods: 179 male Australian football players underwent UTC imaging of their Achilles and/or patellar tendon at the start of the pre-season. Players completed monthly OSTRC overuse questionnaires to quantify the presence and severity of Achilles and/or patellar tendon symptoms. Risk factor analysis was performed to identify associations between imaging and the development of symptoms. Results: A pathological Achilles tendon increased the risk of developing symptoms (RR = 3.2, 95%CI 1.7–5.9). Conversely, a pathological patellar tendon was not significantly associated with the development of symptoms (RR = 1.8, 95%CI 0.9–3.7). Quantification of tendon structure using UTC did not enhance the ability to identify athletes who developed symptoms. Previous history of symptoms was the strongest predictor for the development of symptoms (Achilles RR = 3.0 95%CI 1.8–4.8; patellar RR = 3.7 95%CI 2.2–6.1). Conclusion: Tendon pathology was associated with the development of self-reported symptoms; however previous history of symptoms was a stronger risk factor. The extent of disorganisation quantified by UTC should not be used as a marker for the presence or severity of current and future symptoms.

Quick View

Tendon neuroplastic training : Changing the way we think about tendon rehabilitation : A narrative review

- Rio, Ebonie, Kidgell, Dawson, Lorimer Moseley, Graham, Gaida, Jamie, Docking, Sean, Purdam, Craig, Cook, Jill

Authors: Rio, Ebonie , Kidgell, Dawson , Lorimer Moseley, Graham , Gaida, Jamie , Docking, Sean , Purdam, Craig , Cook, Jill
Date: 2016
Type: Text , Journal article
Relation: British Journal of Sports Medicine Vol. 50, no. 4 (2016), p. 209-215
Full Text:
Reviewed:
Description: Tendinopathy can be resistant to treatment and often recurs, implying that current treatment approaches are suboptimal. Rehabilitation programmes that have been successful in terms of pain reduction and return to sport outcomes usually include strength training. Muscle activation can induce analgesia, improving self-efficacy associated with reducing one's own pain. Furthermore, strength training is beneficial for tendon matrix structure, muscle properties and limb biomechanics. However, current tendon rehabilitation may not adequately address the corticospinal control of the muscle, which may result in altered control of muscle recruitment and the consequent tendon load, and this may contribute to recalcitrance or symptom recurrence. Outcomes of interest include the effect of strength training on tendon pain, corticospinal excitability and short interval cortical inhibition. The aims of this concept paper are to: (1) review what is known about changes to the primary motor cortex and motor control in tendinopathy, (2) identify the parameters shown to induce neuroplasticity in strength training and (3) align these principles with tendon rehabilitation loading protocols to introduce a combination approach termed as tendon neuroplastic training. Strength training is a powerful modulator of the central nervous system. In particular, corticospinal inputs are essential for motor unit recruitment and activation; however, specific strength training parameters are important for neuroplasticity. Strength training that is externally paced and akin to a skilled movement task has been shown to not only reduce tendon pain, but modulate excitatory and inhibitory control of the muscle and therefore, potentially tendon load. An improved understanding of the methods that maximise the opportunity for neuroplasticity may be an important progression in how we prescribe exercise-based rehabilitation in tendinopathy for pain modulation and potentially restoration of the corticospinal control of the muscle-tendon complex.

The continuum of tendon pathology : Current view and clinical implications

- Cook, Jill, Rio, Ebonie, Purdam, Craig, Girdwood, Michael, Ortega-Cebrian, Silvia, Docking, Sean

Authors: Cook, Jill , Rio, Ebonie , Purdam, Craig , Girdwood, Michael , Ortega-Cebrian, Silvia , Docking, Sean
Date: 2017
Type: Text , Journal article
Relation: Apunts Medicina de l'Esport Vol. 52, no. 194 (2017), p. 61-69
Full Text: false
Reviewed:
Description: Cook and Purdam first proposed the Continuum model in 2009, with the aim of improving the understanding of the complexity of tendon pathologies. The Continuum is based on three states of tendon structure: reactive tendon, tendon disrepair and degenerative tendon. In contrast to other proposals, the Continuum model describes continuous changes in tendon structure. Each state of tendon structure represents a particular clinical presentation and requires a particular type of management. Evidence seen in histopathological studies, imaging and clinical studies all support the Continuum model for the analysis of tendon pathologies. © 2017 Consell Català de l'Esport. Generalitat de Catalunya

The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time-loss definition

- Docking, Sean, Rio, Ebonie, Cook, Jill, Orchard, John, Fortington, Lauren

Authors: Docking, Sean , Rio, Ebonie , Cook, Jill , Orchard, John , Fortington, Lauren
Date: 2018
Type: Text , Journal article
Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 28, no. 9 (2018), p. 2016-2022
Full Text: false
Reviewed:
Description: Little is known about the prevalence and associated of morbidity of tendon problems. With only severe cases of tendon problems missing games, players that have their training and performance impacted are not captured by traditional injury surveillance. The aim of this study was to report the prevalence of Achilles and patellar tendon problems in elite male Australian football players using the Oslo Sports Trauma Research Centre (OSTRC) overuse questionnaire, compared to a time-loss definition. Male athletes from 12 professional Australian football teams were invited to complete a monthly questionnaire over a 9-month period in the 2016 pre- and competitive season. The OSTRC overuse injury questionnaire was used to measure the prevalence and severity of Achilles and patellar tendon symptoms and was compared to traditional match-loss statistics. A total of 441 participants were included. Of all participants, 21.5% (95% CI: 17.9-25.6) and 25.2% (95% CI 21.3-29.4) reported Achilles or patellar tendon problems during the season, respectively. Based on the traditional match-loss definition, a combined 4.1% of participants missed games due to either Achilles or patellar tendon injury. A greater average monthly prevalence was observed during the pre-season compared to the competitive season. Achilles and patellar tendon problems are prevalent in elite male Australian football players. These injuries are not adequately captured using a traditional match-loss definition. Prevention of these injuries may be best targeted during the off- and pre-season due to higher prevalence of symptoms during the pre-season compared to during the competitive season.

Thirty-seven jump-landing biomechanical variables are associated with asymptomatic patellar tendon abnormality and patellar tendinopathy : A systematic review

- Harris, Meaghan, Schultz, Adrian, Drew, Michael, Rio, Ebonie, Adams, Stuart, Edwards, Suzi

Authors: Harris, Meaghan , Schultz, Adrian , Drew, Michael , Rio, Ebonie , Adams, Stuart , Edwards, Suzi
Date: 2020
Type: Text , Journal article , Review
Relation: Physical Therapy in Sport Vol. 45, no. (2020), p. 38-55
Full Text: false
Reviewed:
Description: Objective: To identify studies that report three-dimensional (3D) biomechanical analysis of jump-landing tasks in relation to athletes with current patellar tendinopathy (PT), and/or asymptomatic with history of PT or patellar tendon abnormality (PTA) on diagnostic imaging. Methods: Five electronic databases were searched. Included articles were required to: (1) investigate the 3D biomechanics of a jump-landing task; (2) be cross-sectional or longitudinal in design; and (3) include participants that had symptomatic PT, were asymptomatic with a history of PT, asymptomatic with PTA on diagnostic imaging and/or asymptomatic with an unknown pathology or PT history. Results: Thirty-seven statistically significant jump-landing variables were associated with PT, history of PT and/or PTA. The only consistent variable that could be replicated between studies was knee flexion angle at initial foot-ground contact (IC) and an altered hip flexion/extension strategy during a horizontal land phase of a vertical stop-jump. Conclusion: Isolated vertical landings or take-offs alone may not be sensitive enough to identify key jump-landing variables associated with PT, thus clinicians and researchers should incorporate a whole jump-landing task with a horizontal landing component. Sagital plane hip and knee kinematics in a horizontal landing phase appear to provide the most valuable information for evaluating those with PT. (C) 2020 Elsevier Ltd. All rights reserved.

Showing items 1 - 9 of 9