Talking Tendons

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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We all understand providing education for people with rotator cuff tendinopathy (and other conditions) is really important but we have very few resources or guidance regarding what should be delivered and how. In this episode I discuss two qualitative studies exploring the views of patients and expert clinicians about what needs to be included in education for rotator cuff tendinopathy. We the findings to develop an education resource which is embedded in one of the papers (Cridland et al). Some interesting insights - I hope you enjoy. 

Here are links to the papers:

White, J., Mc Auliffe, S., Jepson, M., Burstein, F., Hopman, R., Morrissey, D., Haines, T. and Malliaras, P., 2020. ‘There is a very distinct need for education’among people with rotator cuff tendinopathy: An exploration of health professionals' attitudes. Musculoskeletal Science and Practice, 45, p.102103.

https://pubmed.ncbi.nlm.nih.gov/32056827/

Cridland, K., Pritchard, S., Rathi, S. and Malliaras, P., 2021. ‘He explains it in a way that I have confidence he knows what he is doing’: A qualitative study of patients' experiences and perspectives of rotator‐cuff‐related shoulder pain education. Musculoskeletal Care, 19(2), pp.217-231.Vancouver

https://pubmed.ncbi.nlm.nih.gov/33258225/ 

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Here is my recent chat with Dr Ruth Chimenti about Achilles tendinopathy

We touched on some interesting topics, including

• Kinesiophobia and whether it changes with treatment
• Pain education for tendinopathy - what should it involve? does it work?
• Patient centred rehabilitation

Here is a link to some brand new trial data from Ruth's lab - she tested efficacy of pain education which is novel for Achilles tendinopathy.

https://clinicaltrials.gov/ct2/show/study/NCT04059146

And here is a link to the protocol paper:

https://pubmed.ncbi.nlm.nih.gov/33141102/

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Enjoyable chat with Colin Griffin who is undertaking an exercise trial for Achilles tendinopathy. We touched on so many important rehab considerations, including:

• Strength profiling for Achilles tendinopathy
• Assessing endurance, maximal dynamic and isometric calf capacity, and plyometric function and reactivity
• Home vs gym based rehab
• Why some people may have poorer outcomes

Here is a link to his open access trial protocol: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04553-6

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In this episode I talk about a new systematic review on plantarflexor muscle impairments in Achilles tendinopathy. It is clear that the relationship is not as clear as what you might think, and there are also some very interesting insights to how plantarflexor dysfunctions may change following rehabilitation.

Link to paper

Are Plantarflexor Muscle Impairments Present Among Individuals with Achilles Tendinopathy and Do They Change with Exercise? A Systematic Review with Meta-analysis

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This high quality trial provides further evidence to shift us away from eccentric training for Patelar Tendinoapthy.

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In this episode I talk about a relatively new trial investigating pressure massage versus eccentric exercise for Achilles tendinopathy in a randomised trial. I hope you enjoy! 

Also, if you have some time on your hands during this time of isolation and need to catch up on CPD head on over to www.tendinoapthyrehab.com. I am offering my online Mastering Lower Limb Tendinopathy course for $295.

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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).

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Hi All,

In this episode of Talking Tendons I have an enjoyable chat with PhD student and Spanish physio, Igor Sancho. He has recently published a study that assessed the feasibility of using jumping and hopping as rehabilitation for people with Achilles tendinopathy. We discuss the study and how to apply these findings in clinic.

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Isometric exercise for tendinopathy has exploded onto the scene over the last few years. Unfortunately, the certainty of evidence surrounding their use is far less certain and compelling than what we are told about them but some people. They may work, but the reality is we don't fully understand how and for whom. This episode delves into this uncertainty and provides lots of top tips for how to use isometrics and when they are useful. Enjoy!

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