Here is the latest tendinopathy research – on time! Interesting month – see what you think…
All the best
Dellaurdiere et al inject an anti angiogenesis agent (bevacizumab) into rat AT and PT and show better healing after collagenase induced tendinopathy. Add it to the list of injection hopefuls in tendinopathy – aprotonin, steroid, saline, growth factors, stem cells, sclerosants, irritants (prolotherapy). Please can we spend half as much time thinking about rehab?
Horstmann et al investigate Achilles eccentrics vs vibration training v wait and see. Suggest vibration training may be an alternative but most significant findings favour eccentrics over wait and see. Vibration may be ok for older Achilles patients – mean age in study – 46 years
Bagge et al PhD thesis showed tenocyte immunoreactions for TNFa and its receptors, in normal and abnormal tendon, but receptors upregulated in tendinosis – may have role in tenocyte proliferation and apoptosis
Willberg et al PhD thesis on Alfredson’s mini invasive surgery for Achilles and patellar – based on publications that are already out there
Lichtwark et al. investigate tendon fatigue after a 5km run (fatigue=greater strain associated with reduced stiffness) and find a small increase in strain but no change in stiffness. Suggests tendon stiffness relatively stable with running…therefore, change of material properties probably secondary rather than cause of injury/rupture
Rio et al – captivating review of tendon pain – review current tenocyte, biochemical theories (involving neuropeptides, glutamate, etc) and suggest new theory of sensitised ion channels that may better fit the on/off nature and then post activity flare. Jury out on extent of central involvement due to lack of classic features, ie long term potentiation, secondary hyperalgesia.
Grigg has produced some great work over the last few years. Recently Grigg et al 2013 showed that the Achilles experiences higher peak power and increased frequency vibrations with more repetitions of eccentrics – ie four sets of 15.
In Achilles tendinopathy there are lower frequency vibrations – possibly because of retained fluid / greater energy absorption (Grigg 2012b). Eccentrics reduces AP diameter more so than concentric (Grigg 2009), and Ap diameter also reduces following eccentrics in pathology (Grigg 2012). But there is less AP strain response in pathology – probably due to less fluid movement (Grigg 2012). Take home message, fluid flow is affected in pathology and this likely affects mechanotransduction. Greater repetitions / fatiguing load and eccentrics (I think because more time spent in end range) more likely to improve fluid flow? Implications for mechanotransduction and rehab?
Solchaga et al. rat model showing that platelet derived GF and PRP stimulate tenocytes and steroid does the opposite. Supports use of each in reactive-degenerative model.
Ram et al. show that following typical home-based eccentrics for AT only 2/15 (13%) of patients were satisfied – very sensibly suggest that we need other evidence based rehab options !
McEvoy et al found in their case series that CSI is more effective in the greater troch versus the subgluteus medius bursa
McMahon et al show it is the degree of tendon strain, regardless of training range of motion, that determines tendon adaptation. So isometrics with high load and long enough duration to reach max strain eg 10 sec is ideal for tendon adaptation. Obviously may not be ideal for muscle and function but high load isos definitely has a role in tendon rehab pathway. This is in contrast to low load isos that are now popular but have a different goal – ie hypoalgesia, treating pain