Sorry the blog is late this month, been busy, but no excuses
This month won’t disappoint – interesting stuff from pain mechanisms, to PRP, to load response and hysteresis – and lot’s in there that can be applied clinically
Littlewood et al. has written review on the role of the CNS in rotator cuff pain. Obviously still important to consider and manage local factors (e.g. strength, tissue quality) but pain desensitization via progressive load is key
Peltonen et al. show only 5% hysteresis in Achilles tendon during maximal isometric contractions – hysteresis is energy lost during tendon function. Less hysteresis means the AT is more efficient – ie more energy is returned, so acts more like a spring. But hysteresis may be good for dampening in tasks involving landing and stopping – ie energy absorption without return
Kubo et al. are the first to show a link between genetic polymorphism, ie a specific genotype of the COL1A5 gene, and tissue properties, in this case strain.
Pingel et al. show increased AT microcirculation after 1 hr treadmill run – more so in tendinopathy patients vs controls. More blood flow but is it functional? Ie is it leading to healing or adaptation?
Stephenson et al. have reviewed the literature relating to fluiroquinolones and found an increased risk of AT ruptured is associated with their use – nothing new but it helps that it is a systematic review and they have included only studies they deemed to be high quality
Kesikburun et al found no difference between exercise + PRP or exercise + placebo saline groups for rotator cuff tendinopathy – adds to evidence in Achilles that PRP is not a magic potion. Cannot rule out mechanical effect of saline
In contracts, Mishra et al have published a large multicenter RCT supporting the use of PRP in the elbow. About 30% of PRP group and 50% of placebo local aneasthetic group still had pain at the end of the study. There was no rehab component from what I can see – so main question is how would rehab alone compare and does PRP add anything to rehab?
Ackermann et al. great review of neuronal factors in tendinopathy – looking at both healing from acute injury and tendinopathy. Highlight immune, blood flow, trophic, healing, nociception potential functions in both normal and abnormal tendons – a very complex business !
Ooi et al have reviewed the use of elastography in assessing tendon pathology – as with all imaging relationship to pain is unclear but some indications that improves on conventional US in detecting early pathology
Tsai 2013 –glucose upregulates matrix degradation signaling (i.e. matrix metalloproteinases) in cell model – may provide insight into diabetic tendinopathy
Docking et al. review mechanotransduction in relation to tenocyte compression. Fluid flow (water loss) may occur with high strain load so aggrecan accumulation may be attempt to improve energy absorption capabilities and protect tenocytes
Johanssen et al. report a series of Haglund’s deformity resection and show good outcomes in 69%. My clinic impression would be greater poor/failed outcomes++ but I get a biased group – ie non responders