Auscast Wellbeing

This is a new and lovely to read randomised trial comparing pain science education (including lots of good biopsychosocial info) versus placebo education for Achilles tendinopathy. Some interesting findings and potential avenues for further study. Definitely worth a listen and read. 

Here is a link to the actual paper: 

https://journals.lww.com/pain/Abstract/9900/The_effects_of_pain_science_education_plus.122.aspx

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This is a new study from my PhD student, Igor Sancho. He looks at strength, psychological and other factors that may be different between health runners and runners with Achilles tendinopathy. Seated calf raise 6RM seems to be the strongest predictor of having Achilles tendinopathy. Some interesting other findings and clinical implications. 

Here is a link to this paper, and Igor's other PhD papers:

• Sancho, I., Morrissey, D., Willy, R.W., Tayfur, A., Lascurain-Aguirrebeña, I., Barton, C. and Malliaras, P., 2022. Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study. Physical Therapy in Sport, 55, pp.241-247.
• Sancho, I., Malliaras, P., Barton, C., Willy, R.W. and Morrissey, D., 2019. Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis. Gait & posture, 73, pp.189-201.
• Sancho, I., Morrissey, D., Willy, R.W., Barton, C. and Malliaras, P., 2019. Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: a single cohort feasibility study. Physical Therapy in Sport, 40, pp.107-116.

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On this episode I focus on a new study from my PhD student Eman Merza. It is a cross-over randomised trial testing the effect of high and low contraction time and high and low intensity isometric contractions on acute changes to tendon volume and stiffness. Some very interesting potential insights for tendon adaptation. Good work, Eman!

Hope you enjoy. 

Peter

Here is a link to the study (open access for a few weeks): 

https://journals.biologists.com/jeb/article/225/10/jeb243741/275395

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Had a lovely chat with Shawn Hanlon who is a PhD candidate about his relatively new paper exploring patient features and clinical characteristics and how they may define certain subgroups of Achilles tendinopathy . Lots more to learn in this field and this is early work, but we discuss some of the juicy potential clinical implications.

Hope you enjoy!

And here is the link to the paper and also the 

1/ Hanlon, S.L., Pohlig, R.T. and Silbernagel, K.G., 2021. Beyond the diagnosis: Using patient characteristics and domains of tendon health to identify latent subgroups of Achilles tendinopathy. journal of orthopaedic & sports physical therapy, 51(9), pp.440-448.

2/ And this is the bumper issue of JOSPT from 2015 that is all about tendinopathy: journal of orthopaedic & sports physical therapy, 45(11) 

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Had an enjoyable chat with Shawn Hanlon a PhD candidate who has recently published a study that investigated a subgroup model for Achilles tendinopathy based on clinical and patient characteristics. Although the model needs to be investigated further there are some useful and interesting clinical implications that we discuss. 

I hope you enjoy!

And here is the link to the paper:

Hanlon, S.L., Pohlig, R.T. and Silbernagel, K.G., 2021. Beyond the diagnosis: Using patient characteristics and domains of tendon health to identify latent subgroups of Achilles tendinopathy. journal of orthopaedic & sports physical therapy, 51(9), pp.440-448.

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There is lots of debate about the pain mechanisms, particularly if there are central changes, in Achilles and other tendinopathies. Most studies in the literature use proxy measures of central sensitisation like pressure pain threshold away from the painful site, Other measures like conditioned pain modulation have been investigated less frequently. In this episode of talking tendons I discuss a huge new study investigating CPM in Achilles tendinopathy with some interesting findings and implications.

Hope you enjoy!

Here is the link to the study:

Mkumbuzi, N.S., Mafu, T.S., September, A.V., Posthumus, M. and Collins, M., 2021. Conditioned pain modulation is not altered in recreational athletes with Achilles tendinopathy. Translational Sports Medicine, 4(1), pp.147-153.

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This is one of my favourite narrative expert reviews that discusses the benefits of human biologic springs like the Achilles tendon. These benefits can be summarised as follows: 

• Metabolic energy conservation
• Amplification of muscle power output
• Attenuation of muscle power input

Some really interesting mechanisms and insights for rehabilitation . I hope you enjoy!

Here is the link to the study:

Roberts, T.J. and Azizi, E., 2011. Flexible mechanisms: the diverse roles of biological springs in vertebrate movement. Journal of experimental biology, 214(3), pp.353-361.

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I had a great time talking Gluteal tendinopathy with Chris Clifford. Chris is an experienced clinician from Glasgow who is in the throws of completing his PhD on this condition. We chatted about rehab, the use of isometrics, difficult patient groups and how to navigate them, and much more. 

I hope you enjoy!

Here is 2 related publications from Chris' PhD: 

1/ Clifford, C., Paul, L., Syme, G. and Millar, N.L., 2019. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ open sport & exercise medicine, 5(1), p.e000558.

2/ Clifford, C., Challoumas, D., Paul, L., Syme, G. and Millar, N.L., 2020. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ open sport & exercise medicine, 6(1), p.e000760.

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Patients often ask about dietary supplements and if they may be helpful in recovering from a tendinopathy problem. There is a new systematic review out which has attempted to answer this question and it is the subject of this episode of talking tendons.

I hope you enjoy. 

 

Here is the reference

Qiu, F., Li, J. and Legerlotz, K., 2022. Does Additional Dietary Supplementation Improve Physiotherapeutic Treatment Outcome in Tendinopathy? A Systematic Review and Meta-Analysis. Journal of clinical medicine, 11(6), p.1666.

 

And links to upcoming Mastering Lower Limb Tendinopathy course in Australia

https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-live-australia-211689

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Will midportion Achilles pain improve if you wait and see? This is often a really important question to discuss with patients. Luckily we have some evidence to answer it which I explore in this short podcast (9 minutes). Hope you enjoy. 

Here are the related studies

1/ Horstmann, T., Jud, H.M., Fröhlich, V., Mündermann, A. and Grau, S., 2013. Whole-body vibration versus eccentric training or a wait-and-see approach for chronic Achilles tendinopathy: a randomized clinical trial. journal of orthopaedic & sports physical therapy, 43(11), pp.794-803.

2/ Rompe, J.D., Nafe, B., Furia, J.P. and Maffulli, N., 2007. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. The American journal of sports medicine, 35(3), pp.374-383.

3/ de Vos, R.J., van der Vlist, A.C., Zwerver, J., Meuffels, D.E., Smithuis, F., van Ingen, R., van der Giesen, F., Visser, E., Balemans, A., Pols, M. and Veen, N., 2021. Dutch multidisciplinary guideline on Achilles tendinopathy. British journal of sports medicine, 55(20), pp.1125-1134.

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