Hi All,
On this talking tendons episode, I dive into the very murky world of isometric exercise and their effect on tendon pain. A new study by Sinead Holden and team brings some (just a little) light to the evidence. I argue that isometrics are useful for managing tendinopathy, but using them for short term pain reduction is just the tip of the iceberg.
Also if you're wanting to earn some extra CPD before Christmas check out my two upcoming workshops in December in Sydney and Melbourne (bookings). See omnystudio.com/listener for privacy information.

Isometric exercise and their effect on tendon pain

This podcast will delve deep into the best and most clinically relevant new studies on tendinopathy. The focus is what questions the researchers tried to answer and why, how they did it, what they found, and very importantly, the so what factor. That is, how can it be applied to the clinic and to individual tendinopathy patients.

Medicine

Science & Medicine

Science

Health & Fitness

This week I talk about a feasibility cohort study which sought to determine whether a larger cohort study addressing this question would be feasible. Listen to hear some interesting preliminary findings. 

Merza, E.Y., Pearson, S.J., Mallows, A.J. and Malliaras, P., 2023. The relationship between psychological, cognitive, and contextual factors and rehabilitation outcomes in Achilles tendinopathy: A prospective feasibility cohort study. Physical Therapy in Sport.

Mallows, A., Jackson, J., Littlewood, C. and Debenham, J., 2020. The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study). Musculoskeletal Care, 18(2), pp.169-176. See omnystudio.com/listener for privacy information.

Do psychological, cognitive, and contextual factors influence rehab outcomes in Achilles tendinopathy?

We have known for a while that type of exercise intervention (e.g. intensity, frequency, etc) does not seem to influence self-reported outcomes such as pain. Maybe all the benefits from exercise are explained by non-specific effects, or maybe exercise has benefits that do not depend on the type of exercise.
In this episode, I discuss 3 studies that look into (at least partly) other benefits that we may see at the level of the muscle and tendon from higher-load exercise interventions. 

References:
Radovanović, G., Kunz, J., Bohm, S., Arampatzis, A. and Legerlotz, K., 2021. Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function. Journal of Sports Sciences, 39(24), pp.2786-2795.

Radovanović, G., Bohm, S., Peper, K.K., Arampatzis, A. and Legerlotz, K., 2022. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Medicine-Open, 8(1), pp.1-19.

Radovanović, G., Bohm, S., Arampatzis, A. and Legerlotz, K., 2023. In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial. Journal of Clinical Medicine, 12(3), See omnystudio.com/listener for privacy information.

Does high load and high strain exercise have any benefit for Achilles tendinopathy?

This week, I had an engaging conversation with Anthony Nasser, an up-and-coming researcher on tendinopathy who recently completed his PhD on proximal hamstring tendinopathy. Our discussion covered the reasons for the lack of research attention towards this condition, the current state of evidence, and insights from his doctoral studies. You can find the full conversation here.

Here are Anthony's related publications:
Nasser, A.M., Pizzari, T., Grimaldi, A., Vicenzino, B., Rio, E. and Semciw, A.I., 2021. Proximal hamstring tendinopathy; expert physiotherapists’ perspectives on diagnosis, management and prevention. Physical Therapy in Sport, 48, pp.67-75.

Nasser, A.M., Vicenzino, B., Grimaldi, A., Anderson, J. and Semciw, A.I., 2021. Proximal hamstring tendinopathy: a systematic review of interventions. International journal of sports physical therapy, 16(2), p.288.

Nasser, A., Semciw, A., Grimaldi, A., Rio, E., Pizzari, T. and Vicenzino, B., 2022. Core outcome set development for proximal hamstring tendinopathy (COS-PHT): a study protocol. Physical Therapy Reviews, 27(4), pp.313-319.
 
  See omnystudio.com/listener for privacy information.

Proximal Hamstring Tendinopathy - the forgotten tendinopathy

Palpation can be useful for the diagnosis and assessment of tendinopathy, but there are limits. This is because non-painful tendons can be tender, and tenderness in painful tendons seems to be very slow to get better. 
Link to Evidence for Improvement in Local but not Diffuse Pressure Pain Thresholds Following Physical Therapist Interventions for Tendinopathy: A Systematic Review
Link to  Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players See omnystudio.com/listener for privacy information.

How useful is palpation for diagnosis and assessment?

Interesting perspective paper from Arampatzis et al talking about how we should consider tuning of muscle tendon unit in terms of muscle strength and tendon stiffness when considering training for specific groups.  See omnystudio.com/listener for privacy information.

Isometric exercise and their effect on tendon pain

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