Talking Tendons

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.

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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),

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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.

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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

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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. 

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This talking tendons episode will discuss a study by Igor Sancho, PhD, assessing Achilles forces during common rehab exercises and habitual activities and how this relates to reported pain among runners. Some interesting implications for practice.

Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study

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In this episode, I am discussing kinesiophobia in the context of tendon rehab and how rehab can be conceptualised as graded exposure for some people. 

References

1) Physiotherapy management of Achilles tendinopathy

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In this episode, I talk about load test pain assessment and how this can also be used to assess kinesiophobia and movement apprehension. 

References

1) Physiotherapy management of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/36274038/

2) Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise: https://pubmed.ncbi.nlm.nih.gov/35295417/

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This is an interesting study from the Delaware tendinopathy group among others investigating a host of structural, tissue property, functional and pain factors that may persist among people with Achilles tendinopathy making a return to running. Provides guidance to clinicians about potential impairments to consider assessing. 

Here's the link to the study:

Corrigan, P., Hornsby, S., Pohlig, R.T., Willy, R.W., Cortes, D.H. and Silbernagel, K.G., 2022. Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return‐to‐sport. Scandinavian Journal of Medicine & Science in Sports.

Here's the link to my upcoming course series in the UK in Sept:

https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009

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In this episode I talk about three qualitative studies that aim to understand the patient perspective and patient motivations in Achilles tendinopathy. I find this work really helps clinicians to understand what patients are gong through so we are able to be empathic and help them. Hope you enjoy!

Here's a link to courses in the UK:

https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009

Here are the studies:

Turner, J., Malliaras, P., Goulis, J. and Mc Auliffe, S., 2020. “It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy. PloS one, 15(5), p.e0233459.

Mc Auliffe, S., Synott, A., Casey, H., Mc Creesh, K., Purtill, H. and O'Sullivan, K., 2017. Beyond the tendon: experiences and perceptions of people with persistent Achilles tendinopathy. Musculoskeletal Science and Practice, 29, pp.108-114.

Mallows, A., Head, J., Goom, T., Malliaras, P., O'Neill, S. and Smith, B., 2021. Patient perspectives on participation in exercise-based rehabilitation for Achilles tendinopathy: A qualitative study. Musculoskeletal Science and Practice, 56, p.102450.

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