Limb Tendinopathy Research Articles

Incidence of lower limb tendinopathy: A 3-year prospective study of a youth elite athletes in a Brazilian sport club

IntroductionThe purpose of this study was to investigate lower limb tendinopathy incidence over 3 seasons in Brazilian youth elite athletes. DesignProspective epidemiological study. MethodsA prospective study was performed during 2015, 2016 and 2017 seasons, with a total of 1553 Brazilian youth athletes (1.195 male and 358 female) out of 6 sports (volleyball, basketball, judo, gymnastics, tennis and futsal). The mean age was 14.1 (11.2; 17.0) years, mean height was 1.75 (1.55; 1.95) meters and mean body mass was 59.4 (42.0; 76.4) kilograms. The diagnosis of lower limb tendinopathy (LLT) was made by an experienced sports physician based on a detailed history and clinical exam. The incidence of LLT was determined by number of injuries/total exposure hours x 1000. ResultsIn total, 100 LLT were recorded during the 3 seasons. The most frequent type of LLT was patellar (79%), adductor (12%) and Achilles (9%). The frequency of patellar tendinopathy was higher in male's volleyball, basketball and female volleyball (41%, 25%, 13%, respectively) and the frequency of Achilles tendinopathy was higher in basketball and female volleyball (33%,22%). The LLT incidence was 2.5/1000h in 2015, 4.2/1000h in 2016 and 2.1/1000h in 2017. ConclusionLower limb tendinopathies are relatively common in youth elite athletes. In 3-season, the most frequent type was patellar tendinopathy. A higher LLT incidence was observed in male volleyball athletes when compared to female volleyball athletes. Basketball athletes presented a higher frequency of patellar, adductor and Achilles tendinopathies in 3-seasons when compared to other sports.

Does the ultrasound imaging predict lower limb tendinopathy in athletes: a systematic review

BackgroundTo conduct a systematic review looking into the possibility of US imaging to anticipate and identify future patellar or Achilles tendinopathy symptoms.MethodsThe studies that were taken into consideration for this review were prospective studies that employed baseline US imaging of the patellar OR Achilles tendons in asymptomatic patients and follow-up measures of pain and/or function. Two impartial reviewers evaluated the study’s quality using the Critical Appraisal Skills Programme instrument.ResultsParticipants in the included studies in this review came from various sports. The systematic review revealed a link between baseline tendon abnormalities in the US and a higher chance of developing both patellar and Achilles tendinopathy as well as their future occurrence. Nine of the included studies examined the patellar tendon alone, eight the patellar and Achilles tendon together, and four the Achilles tendon exclusively. For both tendons, US administration is done in a largely consistent manner. The tendon abnormalities of tendon thickness, hypoechogenicity and vascularity at baseline were associated with an increased risk of both Achilles and patellar tendinopathy.ConclusionsThis systematic review shows that abnormal tendon structures seen by US in asymptomatic persons can predict the development of tendinopathy.

Ultrasound Measurement of Local Deformation in the Human Free Achilles Tendon Produced by Dynamic Muscle-Induced Loading: A Systematic Review

Achilles tendinopathy is the most prevalent lower limb tendinopathy, yet it remains poorly understood, with mismatches between observed structure and reported function. Recent studies have hypothesised that Achilles tendon (AT) healthy function is associated with variable deformation across the tendon width during use, focusing on quantifying sub-tendon deformation. Here, the aim of this work was to synthesise recent advances exploring human free AT tissue-level deformation during use. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, Scopus and Web of Science were systematically searched. Study quality and risk of bias were assessed. Thirteen articles were retained, yielding data on free AT deformation patterns. Seven were categorised as high-quality and six as medium-quality studies. Evidence consistently reports that healthy and young tendons deform non-uniformly, with the deeper layer displacing 18%-80% more than the superficial layer. Non-uniformity decreased by 12%-85% with increasing age and by 42%-91% in the presence of injury. There is limited evidence of large effect that AT deformation patterns during dynamic loading are non-uniform and may act as a biomarker of tendon health, risk of injury and rehabilitation impact. Better considered participant recruitment and improved measurement procedures would particularly improve study quality, to explore links between tendon structure, function, aging and disease in distinct populations.

Factors associated with lower limb tendinopathy in a large cohort of runners: a survey with a particular focus on nutrition

ObjectivesLower limb tendinopathy (LLT) is highly prevalent in runners. Treatment can be challenging, and knowledge of risk factors may be valuable to develop preventive or treatment interventions for LLT. The...

The use of physical function capacity measures in the management of lower limb tendinopathy: A scoping review of expert recommendations

Introduction: hysical function capacity measures are recommended as outcomes in people with lower limb tendinopathy, however, a recent systematic review reported that they are rarely used. The purpose of this scoping review was to explore the measures of physical function capacity and the context in which they were used as recommended by experts in lower limb tendinopathy.

Assessment of the reporting quality of resistance training interventions in randomised controlled trials for lower limb tendinopathy: A systematic review

Objectives 1. To describe what exercises and intervention variables are used in resistance training interventions in randomised controlled trials for lower limb tendinopathy 2. To assess completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework. 3. To assess the implementation of scientific resistance training principles. 4. To assess therapeutic quality of exercise interventions with the i-CONTENT tool. Data sources We searched MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, and the Cochrane library databases. Review methods Systematic review of randomised controlled trials that reported using resistance exercises for lower limb tendinopathies. Results We included 109 RCTs. Eccentric heel drops were the most common exercise (43 studies), followed by isotonic heel raises (21), and single leg eccentric decline squats (18). Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0–13, with an average score of 9/13, and only 7 studies achieved a full 13/13. Reporting of items from the CERT ranged from 0–18, with an average score of 14/19. No study achieved a full 19/19, however 5 achieved 18/19. Scoring for resistance training principles ranged from 1–10, with only 11 studies achieving 10/10. Reporting across studies for the i-CONTENT tool ranged from 2–7, with an average score of 5 across included studies. A total of 19 studies achieved a full 7/7 score. Less than 50% of studies achieved an overall low risk of bias, highlighting the methodological concerns throughout studies. Conclusion The reporting of exercise descriptors and intervention content was generally high across RCTs for lower limb tendinopathy, with most allowing exercise replication. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.

Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation.

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.

Assessment of the reporting quality of resistance training interventions in randomised controlled trials for lower limb tendinopathy: A systematic review protocol

Review objectives: (1). To describe what exercises and intervention variables are used in resistance training interventions in randomised controlled trials for lower limb tendinopathy. (2). To assess completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework. (3). To assess the implementation of scientific resistance training principles. (4). To assess therapeutic quality of exercise interventions with the i-CONTENT tool. Design: Systematic review. Elligibility criteria: Randomized controlled trials only, that have reported using resistance exercises for common lower limb tendinopathies including Achilles, patellar, gluteal, and plantar heel pain. Methods: The authors will search for a wide range of sources to find both published and unpublished studies via EBSCOhost, including, but not limited to, MEDLINE, SPORTDiscus, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), and Allied and Complementary Medicine Database (AMED). Studies published in a language other than English will only be considered if a translation is available. Data synthesis will be presented in tabular form with an accompanying narrative synthesis. Completeness of reporting will be presented as the number of items reported for each of the tools used: the CERT, Toigo and Boutellier framework, i-CONTENT tool, and resistance training principles. Dissemination of the reporting findings of efficacious resistance training interventions used for lower limb tendinopathies, will allow for translation into clinical practice.

Reporting of exercise descriptors and variables in resistance training interventions for lower limb tendinopathy: Protocol for a scoping review applying the consensus on exercise reporting template and Toigo and Boutellier framework

Introduction: Musculoskeletal disorders have a significant global burden, with tendinopathies of the lower limb having a high prevalence. Although the use of resistance training interventions as treatment for tendinopathies has become widespread, the reporting and description of these interventions is often poor, preventing translation to clinical practice. Specific exercise description and intervention variables must be reported in order to translate research findings into clinical practice. This scoping review aims to summarise reporting of current resistance training interventions as assessed by the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework. Methods and analysis: The recommended methodological framework described by the Joanna Briggs Institute will be used to structure this review, with reporting in accordance with the PRISMA-ScR. Databases to be searched include MEDLINE, CINAHL, AMED, EMBase, SPORT Discus, Cochrane library (Controlled trials, Systematic reviews), JBI Evidence Synthesis, and five trial registries. Two independent reviewers will screen studies at title/abstract and full text. Following screening, data will be extracted and charted, then presented as figures and table alongside a narrative synthesis. Dissemination: This scoping review will evaluate current resistance training exercise descriptors and program variables in lower limb tendinopathy using recommended frameworks for the first time in the literature. The results will allow dissemination of the parameters of research exercise interventions to clinical practitioners through peer-reviewed publication and social media outlets, allowing implementation in clinical practice. The review will also outline future research and exercise reporting needs within tendinopathy resistance training interventions. Keywords: tendinopathy; resistance training; exercise; physiotherapy

Reporting of exercise descriptors and variables in resistance training interventions for lower limb tendinopathy: Protocol for a scoping review applying the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework

Reporting of exercise descriptors and variables in resistance training interventions for lower limb tendinopathy: Protocol for a scoping review applying the Consensus on Exercise Reporting Template and Toigo and Boutellier Framework

Autoregulation in Resistance Training for Lower Limb Tendinopathy: A Potential Method for Addressing Individual Factors, Intervention Issues, and Inadequate Outcomes.

Musculoskeletal disorders, such as tendinopathy, are placing an increasing burden on society and health systems. Tendinopathy accounts for up to 30% of musculoskeletal disorders, with a high incidence in athletes and the general population. Although resistance training has shown short-term effectiveness in the treatment of lower limb tendinopathy, more comprehensive exercise protocols and progression methods are required due to poor long-term outcomes. The most common resistance training protocols are predetermined and standardized, which presents significant limitations. Current standardized protocols do not adhere to scientific resistance training principles, consider individual factors, or take the importance of individualized training into account. Resistance training programs in case of tendinopathy are currently not achieving the required intensity and dosage, leading to high recurrence rates. Therefore, better methods for individualizing and progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress training at their own rate, taking individual factors into account. Despite the finding of their effectiveness in increasing the strength of healthy athletes, autoregulation methods have not been investigated in case of tendinopathy. The purpose of this narrative review was 3-fold: firstly, to give an overview and a critical analysis of the individual factors involved in tendinopathy and current resistance training protocols and their limitations. Secondly, to give an overview of the history, methods, and application of autoregulation strategies both in sports performance and physiotherapy. Finally, a theoretical adaptation of a current tendinopathy resistance training protocol using autoregulation methods is presented, providing an example of how the method could be implemented in clinical practice or future research.

Treatment of Gluteal Tendinopathy: A Systematic Review and Stage-Adjusted Treatment Recommendation

Background:Gluteal tendinopathy is the most common lower limb tendinopathy. It presents with varying severity but may cause debilitating lateral hip pain.Purpose:To review the therapeutic options for different stages of gluteal tendinopathy, to highlight gaps within the existing evidence, and to provide guidelines for a stage-adjusted therapy for gluteal tendinopathy.Study Design:Systematic review; Level of evidence, 4.Methods:We screened Scopus, Embase, Web of Science, PubMed, PubMed Central, Ovid MEDLINE, CINAHL, UpToDate, and Google Scholar databases and databases for grey literature. Patient selection, diagnostic criteria, type and effect of a therapeutic intervention, details regarding aftercare, outcome assessments, complications of the treatment, follow-up, and conclusion of the authors were recorded. An assessment of study methodological quality (type of study, level of evidence) was also performed. Statistical analysis was descriptive. Data from multiple studies were combined if they were obtained from a single patient population. Weighted mean and range calculations were performed.Results:A total of 27 studies (6 randomized controlled trials) with 1103 patients (1106 hips) were included. The mean age was 53.7 years (range, 17-88 years), and the mean body mass index was 28.3. The ratio of female to male patients was 7:1. Radiological confirmation of the diagnosis was most commonly obtained using magnetic resonance imaging. Reported treatment methods were physical therapy/exercise; injections (corticosteroids, platelet-rich plasma, autologous tenocytes) with or without needle tenotomy/tendon fenestration; shockwave therapy; therapeutic ultrasound; and surgical procedures such as bursectomy, iliotibial band release, and endoscopic or open tendon repair (with or without tendon augmentation).Conclusion:There was good evidence for using platelet-rich plasma in grades 1 and 2 tendinopathy. Shockwave therapy, exercise, and corticosteroids showed good outcomes, but the effect of corticosteroids was short term. Bursectomy with or without iliotibial band release was a valuable treatment option in grades 1 and 2 tendinopathy. Insufficient evidence was available to provide guidelines for the treatment of partial-thickness tears. There was low-level evidence to support surgical repair for grades 3 (partial-thickness tears) and 4 (full-thickness tears) tendinopathy. Fatty degeneration, atrophy, and retraction can impair surgical repair, while their effect on patient outcomes remains controversial.

Contribution of Imaging to the Diagnosis of Non-Traumatic Tendinopathies of the Thoracic Limb in a Resource-Constrained Country

Introduction: Tendinopathy of the thoracic limb (TMT) is frequent, and is responsible for an important socio-professional handicap. Medical imaging, in particular, ultrasound has a major role in contributing to the diagnosis. As the use of ultrasound is recent in osteoarticular pathology, especially in Africa, we proposed to determine the contribution of imaging in the diagnosis of tendinopathy of the thoracic limbs in a country with limited resources. Patients and Method: A descriptive and analytical cross-sectional study of patients with tendinopathy of the thoracic limb who consulted the rheumatology department of the CNHU-HKM of Cotonou from August 6, 2019 to October 6, 2019. We evaluated the concordance of thoracic limb tendinopathy between imaging (radiography and ultrasound) and the clinic on the one hand and then between radiography and ultrasound on the other hand. The analysis of the collected data was carried out with the Epi-info software version 7.2.1.0. Then the concordance was evaluated by the kappa coefficient. Results: Fifty- two (52) patients with 104 joints were evaluated. The average age was 54.92 ± 3.40 years. Clinically, rotator cuff tendinopathy was the most frequent abarticular pathology (45.19%). The clinical-ultrasound agreement was strong (k = 0.7527) for the shoulders, very strong (k = 0.9360) for the elbows and moderate for the wrists (k = 0.6695). The clinical-radiographic agreement was weak (k = 0.2316) at the shoulder level and very weak (k = 0.2087) at the elbow level. The radio-ultrasound agreement was very low in the shoulders (k = 0.1522), elbows (k = 0.1859) and wrists (k = 0.0001). Conclusion: The contribution of imaging in the diagnosis of TMT remains certain even in a country with limited resources like ours. Ultrasound is a reliable examination for the diagnosis of non-traumatic tendinopathy of the thoracic limb with a good clinical-ultra- sound concordance and a weak radio-clinical and radio-ultrasound concordance.

The Prevalence of Self Reported Psychological Characteristics of Adults with Lower Limb Tendinopathy

Purpose. There is an emerging body of literature describing psychological associations with lower limb tendinopathies. The literature suggests that those experiencing a lower limb tendinopathy are likely to experience varying degrees of kinesiophobia, depression and catastrophisation. These studies have typically been confined to one lower limb tendinopathy. The current study sought to explore whether these psychological influences were experienced across a range of lower limb tendinopathies in a clinical practice setting. Materials and methods. The current study utilised a cross-sectional cohort design to explore associations between those presenting with any lower limb tendinopathy and psychological factors. Consecutive patients attending a private physiotherapy practice in Melbourne (Australia) were invited to participate. Those who chose to participate were invited to complete a health questionnaire along with the Hospital Anxiety & Depression Scale (HADS), Tampa Scale of Kinesiophobia and the Life Orientation Test – Revised. Results. Ninety-one patients were recruited, with just over half identifying as male, and more than half experiencing a tendinopathy for more than twelve months. Nearly two-thirds (63.7%) of the cohort demonstrated kinesiophobia (n=58, 63.7%). Patients were classified as depressed in 13% of cases while 21% were classified as anxious. Conclusions. Routine screening for kinesiophobia may be valuable for patients presenting with any lower limb tendinopathy. The results also support the potential value of screening patients for the presence of anxiety and/or depression. The extent to which these psychological influences are associated with individual patient’s experience of lower limb tendinopathy, requires further exploration, as does the development of these influences over the duration of the tendinopathy.

Load progression criteria in exercise programmes in lower limb tendinopathy: a systematic review

ObjectiveThe objective of this study is to summarise and analyse the current literature about what progression criteria are applied in loading exercise programmes in lower limb tendinopathies and their evidence...

Conservative management of acute lower limb tendinopathies: A systematic review.

Most knowledge regarding conservative management for lower limb tendinopathy (LLT) is for persistent symptoms, with less known about conservative management of acute LLT. Sub-optimal management of acute LLT is detrimental in many regards, not least the likely conversion to persistent symptoms. To synthesise existing literature on conservative management of acute LLTs. Systematic review of relevant literature (PROSPERO [ID: CRD42018117882]). A search was made of multiple databases (MEDLINE, CINAHL and EMBASE) using relevant search terms. Titles, abstracts and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction and quality assessment, using the Grading of Recommendations Assessment, Development and Evaluation, were done independently by two authors. To understand how the interventions impacted the duration of reported symptoms, results were split into three time points: short-term (<4 weeks), medium-term (4-12 weeks) and long-term (>12 weeks). Thirteen studies (n = 534) met the criteria for inclusion. There was very low level of certainty for the effectiveness of interventions at short-term, medium-term and long-term follow ups. However, there were large effects seen across a number of different treatments on pain intensity and disability in LLTs. This review demonstrates that limited evidence currently exists to guide the management of acute LLT, and the quality of the existing evidence is collectively low. These findings inform the discussion of different treatment options with patients in a shared decision-making process to empower and enable the patient.

Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review.

Tendinopathy is a common disease that affects athletes, causing pain and dysfunction to the afflicted tendon. A clinical diagnose is usually combined with imaging and, among all the existing techniques, ultrasound is widely adopted. The aim of this review is to sum up the existing evidence on ultrasound as an imaging tool and guide for treatments in lower limbs tendinopathy. Using three different databases—PubMed, MEDLINE and CENTRAL—a literature search has been performed in May 2020 combining MeSH terms and free terms with Boolean operators. Authors independently selected studies, conducted quality assessment, and extracted results. Ultrasound imaging has a good reliability in the differentiation between healthy and abnormal tendon tissue, while there are difficulties in the identification of tendinopathy stages. The main parameters considered by ultrasound imaging are tendon thickness, hypoechogenicity of tendon structure and neovascularization of the tendon bound tissue. Ultrasound-guide is also used in many tendinopathy treatments and the available studies gave encouraging results, even if further studies are needed in this field.

Progression criteria in loading exercise programmes in lower limb tendinopathy: a protocol for a systematic review and meta-analysis

IntroductionLower limb tendinopathies have high rates of incidence and prevalence. Their symptomatology affects the functional capacity of people to exercise and work, being an important cause of economic and social...

Diagnosis and management of lower limb tendinopathy

This workshop will discuss the issues around accurate diagnosis and how this affects the management for both recreational and more competitive athletes. Understanding the complexity of tendon presentations and realising that the management has to be targeted to each person, tendon and sport is essential to being better at managing tendons.

The melbourne hip MRI score (MHIP score): reliability of a novel scoring system for MRI assessment of severity in gluteal tendinopathy

Introduction: Gluteal tendinopathy is a common cause of lateral hip pain and is the most common lower limb tendinopathy. The condition is most prevalent in middle aged women. The diagnosis of gluteal tendinopathy is based on the history of localized lateral hip pain, clinical signs and medical imaging. Magnetic Resonance Imaging (MRI) is used to identify gluteal tendinopathy but there has been no accepted validated scoring system to determine severity. The aim of this project was to validate a new scoring system; the MHIP score for gluteal tendinopathy.