Abstract

The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy, (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.

Highlights

  • Tendinopathy represents a spectrum of potential changes to healthy tendons, leading to tendon damage and disease, with changes characterised by abnormal tendon composition and cellularity, leading to altered tendon microstructure [1]

  • As the aim of this review was to evaluate reporting across all study designs implementing resistance training for lower limb tendinopathies, rather than evaluate effectiveness, a scoping review was more appropriate than a systematic review. is scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews [34]. e scoping review was reported in accordance with the Preferred Reporting Items for Systematic reviews and MetaAnalysis extension for Scoping Reviews (PRISMA-ScR) [34]

  • Plantar heel pain was included as it is considered to have a similar pathophysiology to tendinopathy and should be treated in accordance with other lower limb tendinopathies according to recent literature [19]. e concept of interest was resistance training for the treatment of lower limb tendinopathies, including any type or format of resistance training. e resistance training may be used as a first- or second-line intervention and may be delivered in isolation or combined with other treatments

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Summary

Introduction

Tendinopathy represents a spectrum of potential changes to healthy tendons, leading to tendon damage and disease, with changes characterised by abnormal tendon composition and cellularity, leading to altered tendon microstructure [1]. The normal arrangement of collagen fibres and organisation of tenocytes become altered by mechanical overuse, which leads to tendinopathy symptoms of pain, inflammation, swelling, and impaired physical function and performance [2]. Despite all healthy tendons having the capability to progress to tendinopathy, tendons of the lower limb may have an increased risk for mechanical overload which causes tendon changes, such as disruption to the normal collagen matrix structure [3]. E higher prevalence of patellar and Achilles tendinopathy found in athletes may be related to repetitive tendon microtrauma from repeated athletic. Prevalence of Achilles and patellar tendinopathy have been reported to be as high as 23% and 45% in runners and jumping athletes, respectively. Plantar heel pain was reported to be found in up to 18% of running athletes in one cohort [8–10]

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