Dear all,

Please find a link below to the monthly tendinopathy research update. As always I have included all studies with a clinical focus but only laboratory studies with a direct clinical implications.

 

Here are some highlights:

Mann et al show that kinematic patterns around the hip and knee during jumping may predispose to patellar tendinopathy among young high level jumping athletes – in essence, greater knee flexion and less hip flexion seems to concentrate load at the knee and increase risk of patellar tendinopathy. Reduced quadriceps flexibility was also a significant predictor, supporting the Witvrouw et al 2001 paper

Wyndow et al found greater offset of soleus and lateral gastrocnemius timing (soleus is delayed) in Achilles tendinopathy patients during running compared with controls. Not clear if chicken or egg? Reinforces for me the importance of soleus in Achilles rehabilitation.

In a systematic review of insertional Achilles management, Wiegerinck et al. found some benefit from surgery, shockwave and eccentrics, but the literature is limited and includes many case series.

The quest to understand eccentric loading and if and when it has a place continues. Yu et al. compare eccentric and concentric loading in Achilles tendinopathy. This is good as in a recent review (in press) we found only 1 prior study had compared eccentric loading to any other form of loading in the Achilles (Mafi et al 2001). Unfortunately, the loading programs in both studies are almost identical and the issue is as well as contraction type differing, the load-intensity is also lower in the concentric group.

Grigg et al. show that the tendon effectively vibrates during eccentric but not concentric contractions. This may influence tendon adaptation and explain eccentric training response but maybe it is simply a quirk of motor control and tenocyte response is related more to other factors, such as load-intensity?

Drew et al show that actually tendon pathology is unlikely to improve following tendon loading – so this cannot explain improvements in pain

High volume injections are a great option for both reactively painful and tendons with stable pain, as they never cause the irritability often seen with blood-based injections. Maffulli et al. have published a large case series of 94 athletes showing positive results in Achilles tendinopathy – RCT needed now!

Here is a link to the abstracts: Tendon research update Nov 2012

Hope you enjoy

Peter

 

References

Witvrouw, E., Bellemans, J., Lysens, R., Danneels, L., & Cambier, D. (2001). Intrinsic risk factors for the development of patellar tendinitis in an athletic population. American Journal of Sports Medicine, 29(2), 190.

Mafi N, Lorentzon R, Alfredson H. (2001) Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc; 9: 42–7.