Dissertations / Theses on the topic 'Achilles tendinopathy (AT)'
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1
Costa, Matthew. "Achilles tendinopathy and rupture." Thesis, University of East Anglia, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.426770.
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Grävare, Silbernagel Karin. "Achilles tendinopathy : evaluation and treatment /." Göteborg : Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at Göteborg University, 2006. http://hdl.handle.net/2077/504.
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Åström, Mats. "On the nature and etiology of chronic achilles tendinopathy." Lund : Dept. of Orthopaedics, Malmö University Hospital, Lund University, 1997. http://catalog.hathitrust.org/api/volumes/oclc/39705581.html.
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Shalabi, Adel. "Magnetic resonance imaging in chronic achilles tendinopathy /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-811-4/.
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O'Neill, Seth. "A biomechanical approach to Achilles tendinopathy management." Thesis, University of Leicester, 2017. http://hdl.handle.net/2381/40134.
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Achilles tendinopathy (AT) is a debilitating condition affecting active and inactive subjects. The aetiology of AT is contentious but most theoretical models are underpinned by the same core elements: increased tendon stress that exceeds the ability of the tendon to repair, eventually leading to tissue degradation. Proposed risk factors affect tissue load or the ability of the tendon to repair, unfortunately many proposed risk factors lack biological plausibility. This thesis reports a mixed methods approach to analyse risk factors for AT development. A Delphi study (using world tendon experts) was used to develop a consensus on risk factors for AT which were then used in an epidemiological study of UK runners – a high risk group for tendinopathy who have not previously been examined. Plantarflexor strength was identified as a potential contributor in AT development and this led to the development of a theory on why current treatment modalities work. This was further examined using a systematic review to determine whether changes occur in the muscle or tendon with the most common rehabilitation method (eccentric exercise). This review highlighted evidence for changes in plantaflexor power, amongst other factors. These findings were used to inform two studies examining how plantarflexor power was affected by AT and ultimately how rehabilitation altered these elements. The thesis reports multiple novel findings related to risk factors, the mechanism by which eccentric exercise may work, the effect of AT on plantarflexor function and how rehabilitation affects these deficits. The experimental studies contained in this thesis are some of the largest studies in the area, these studies identify significant torque and endurance deficits of the plantarflexors highlighting that Soleus appears to be most affected, whilst the later study reported how an eccentric rehabilitation regime improved these deficits but failed to fully resolve them. This offers an important clinical target but also highlights that rehabilitation needs to be for a longer duration with further modifications to resolve these identified plantarflexor deficits.
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Crouzier, Marion. "Muscle coordination and musculoskeletal disorders : investigation of Achilles tendinopathy." Thesis, Nantes, 2020. http://www.theses.fr/2020NANT2013.
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Le tendon d'Achille est composé de trois sous-tendons qui proviennent chacun d'un chef du triceps surae: gastrocnemius medialis, gastrocnemius lateralis, et soleus. Une distribution non optimale de la contrainte imposée au tendon d'Achille contribuerait au développement de la tendinopathie d'Achille. D’autre part, la distribution des contraintes sur le tendon d'Achille est en partie déterminée par la distribution de la force entre les chefs des triceps surae. L'objectif général de cette thèse était d’étudier le rôle de la coordination musculaire (définie comme la distribution de force entre les muscles) dans le développement d’une tendinopathie d'Achille. Les forces musculaires de chaque muscle ont été estimées à partir de l'activation, du volume et de l'architecture musculaires. Les résultats ont montré que (i) la distribution de l’activation musculaire dans le triceps surae est robuste dans le temps, et varie considérablement d'un individu à l'autre; (ii) il existe une corrélation positive significative entre la distribution de la surface de section transversale physiologique et la distribution de l'activation au sein des gastrocnemii; (iii) le gastrocnemius lateralis contribue significativement moins à la force totale produite par le triceps sural chez les personnes atteintes de tendinopathie d'Achille par rapport aux contrôles. L’altération de la coordination musculaire pourrait être une cause, comme elle pourrait être une conséquence de la tendinopathie d’AchilleThe Achilles tendon is made of three subtendons that each arises from a different head of the triceps surae: gastrocnemius medialis, gastrocnemius lateralis and soleus. Non-optimal distribution of load within Achilles tendon would contribute to the development of Achilles tendinopathy. Moreover, there is evidence that the distribution of load or strain within the Achilles tendon is partly determined by the distribution of force among the heads of the triceps surae. The overall aim of this thesis was to provide a deeper understanding of the role of muscle coordination (i.e. the distribution of force among muscles) on the development of Achilles tendinopathy. Individual muscle forces were estimated from muscle activation, volume and architecture. Results showed that (i) the distribution of activation among triceps surae is robust between days, and varies greatly between individuals; (ii) there is a significant positive correlation between the distribution of physiological cross-sectional area and the distribution of activation among gastrocnemii; (iii) muscle coordination among the triceps surae differs in people with Achilles tendinopathy compared with controls, with the gastrocnemius lateralis contributing significantly less to total triceps surae force in people with Achilles tendinopathy. Whether this altered strategy is a cause or a consequence of Achilles tendinopathy should be further explored
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Saunders, Colleen Jayne. "Extracellular matrix gene sequence variant analyses and Achilles tendinopathy." Doctoral thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/3199.
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Includes abstract.Includes bibliographical references)
The primary aim of this thesis was to identify additional genetic elements predisposing individuals to risk of AT using a candidate gene, case-control genetic association approach, and to propose the biological mechanisms underlying this genetic risk. Candidate genes (COMP, THBS2, COL27A1, TNC, COL3A1, COL5A2 and COL5A3) were selected based on their chromosomal location and/or the biological function of their encoded proteins within the extracellular matrix (ECM) of the tendon.
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Hutchison, Anne-Marie. "The treatment and management of patients with a chronic mid body achilles tendinopathy." Thesis, Swansea University, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678301.
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Azevedo, Liane. "Risk factors for Achilles tendinopathy in runners - an investigation of selected intrinsic, kinematic, kinetic and muscle activity factors that are associated with Achilles tendinopathy." Doctoral thesis, University of Cape Town, 2008. http://hdl.handle.net/11427/2772.
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The overarching purpose of this study was to investigate the multifactorial aetiology of Achilles tendinopathy. Variables such as training and injury history, lower limb alignment, running biomechanics and movement variability were investigated. This study also aims to understand how different sensory inputs, such as shoe or pain may affect biomechanics. Thirty four uninjured runners (UN) and twenty one runners with Achilles tendinopathy (AT) composed the population sample for this study. Questionnaire and lower limb measurements were used to investigate the multifactorial aetiology of the injury. Selected kinetic, kinematic and muscle activity parameters were employed to analyse the biomechanics aetiology of the injury. Runners performed 10 running trials at a self-selected speed in two running shoes with different hardness. Additionally, the UN runners ran for 10 min on the treadmill while the AT runners ran on the treadmill until they developed pain in the Achilles tendon. The results of the study showed that AT runners have a higher incidence of previous injury, run for more years, have reduced hamstring flexibility, and are heavier and taller than uninjured runners. The study also showed a reduced integrated electromyography activity (IEMG) of tibialis anterior and rectus femoris in the AT group during the running cycle. Stride to stride variability was similar between UN and AT runners but the biomechanics variability between participants were lower for the AT runners. No specific biomechanical adaptations were found between the two different shoe conditions (soft vs. hard). Similarly, biomechanics parameters were not altered at the onset of pain, but the reduced IEMG activity of tibialis anterior and rectus femoris were presented before and during the pain condition. It can, therefore, be concluded that runners with Achilles tendinopathy present reduced muscle activity during running which may be either a novel aetiological factor, or an adaptive response to the injury. The lower variability between runners with AT may indicate that these runners are less able to adjust their biomechanics according to their different functional behaviour or external input signals but this may require further investigation. Finally, it can also be concluded that the sensory inputs such as shoes and pain do not change this muscle activity pattern.
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Bjur, Dennis. "The human Achilles tendon : innervation and intratendinous production of nerve signal substances - of importance in understanding the processes of Achilles tendinosis." Doctoral thesis, Umeå universitet, Idrottsmedicin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-30284.
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Tendinopathies are painful tendon conditions of presumably multifactorial genesis. In tendinosis, as in Achilles tendinosis, there is apart from pain also morphological changes which are described as degenerative with no signs of inflammation. The exact mechanisms behind these conditions are still, to a large extent, unknown. Pain, being the foremost impairing symptom, leads us to the hypothesis that nerves are deeply involved in the symptoms and processes of Achilles tendinosis. Locally produced nerve signal substances may also be involved in the processes. Knowledge of the innervation patterns within the tendon and knowledge on a possible local nerve signal substance production are therefore of utmost importance. There is a lack of information on these aspects. The specific aims of this thesis were 1) to investigate the innervation patterns regarding general, sensory, cholinergic and sympathetic innervations, and 2) to examine for the possible occurrence of a production of nerve signal substances and a presence of receptors related to these in the tendon cells, the tenocytes. Painfree normal and tendinosis Achilles tendons were examined. Immunohistochemistry, using antibodies against the general nerve marker PGP9.5, the synthesizing enzymes for acetylcholine (choline acetyltransferase; ChAT), and catecholamines (tyrosine hydroxylase; TH), the vesicular acetylcholine transporter (VAChT), neuropeptide Y (NPY), substance P and calcitonin gene-related peptide, was applied. Immunohistochemistry was also used for the delineation of muscarinic (M2R), adrenergic (α1-AR) and NPY-ergic (Y1 and Y2) receptors. To detect mRNA for TH and ChAT, in situ hybridization was used. In normal Achilles tendons, as well as in the tendinosis tendons, there was a very scanty innervation within the tendon tissue proper, the main general, sensory and sympathetic innervations being found in the paratendinous loose connective tissue. Interestingly, the tenocytes showed immunoreactions for ChAT, VAChT, TH, M2R, α1-AR and Y1R. The reactions were clearly more observable in tendons of tendinosis patients than in those of controls. The tenocytes of tendinosis patients also displayed mRNA reactions for ChAT and TH. Nevertheless, all tenocytes in the tendinosis specimens did not show these reactions. Immunoreactions for α1-AR, M2R and Y1R were also seen for blood vessel walls. The present thesis shows that there is a very limited innervation within tendon tissue proper, whilst there is a substantial innervation in the paratendinous loose connective tissue. It also gives evidence for an occurrence of production of catecholamines and acetylcholine in tenocytes, especially for tendinosis tendons. Furthermore, that ACh, catecholamines and NPY can have effects on these, as well as on blood vessels, via the receptors observed. The observations suggest that Achilles tendon tissue, whilst containing a very scarce innervation, exhibits autocrine/paracrine cholinergic/catecholaminergic/NPY-ergic effects that are upregulated in tendinosis. These findings are of great importance as the results of such effects may mimic processes that are known to occur in tendinosis. That includes effects related to proliferation and angiogenesis, and blood vessel and collagen regulating effects. In conclusion, within the Achilles tendon there is a very scarce innervation, whilst there appears to be a marked local production of nerve signal substances in Achilles tendinosis, namely in the tenocytes, the cells also harbouring receptors for these substances. The observations give a new insight into how the tendon tissue of the Achilles tendon is influenced by signal substances and may give options for new treatments of Achilles tendinosis.
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Miranda, Ana Areias Marques. "O efeito dos exercícios excêntricos na tendinopatia do tendão de Aquiles em adultos saudáveis: revisão sistemática." Bachelor's thesis, [s.n.], 2016. http://hdl.handle.net/10284/5674.
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Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em FisioterapiaObjetivo: A presente revisão pretende compreender os efeitos da implementação de exercícios excêntricos na tendinopatia do tendão de aquiles independentemente da amostra utilizada. Metodologia: Pesquisa computorizada através das palavras-chaves elegidas, em bases de dados como Science Direct, EBSCO e Pubmed para selecionar artigos experimentais que colocassem em questão a eficiência dos exercícios excêntricos na tendinopatia do tendão de aquiles. Resultados: Foram incluídos 12 artigos, com um total de 465 indivíduos. Obtendo uma média de 8,8 na escala CASP. 3 artigos compararam o uso de exercícios excêntricos com o uso de uma ortótese noturna, outros 3 compararam com outras técnicas terapêuticas e os restantes aplicaram apenas exercícios excêntricos. Conclusão: Após a analise dos resultados é possível observar a eficácia dos exercícios excêntricos na tendinopatia do tendão de aquiles, no entanto, muitas vezes não são diferenças que corresponderiam ao expectável. A aplicação de ortóteses e aprendizagem do método não potencia o efeito positivo, contudo associado a outras técnicas terapêuticas (ultrassom e massagem transversal profunda) promove a sua eficácia.
Objective: The present revision pretends to comprehend the effects of the implementation of eccentric exercises in the Achilles tendinopathy regardless the sample used. Methodology: Computer research through elected keywords, in data bases such as Science Direct, EBSCO and Pubmed to select experimental articles that would question the effectiveness of eccentric exercises in the Achilles tendinopathy. Results: Twelve articles were selected, with a total of 465 individuals. Obtaining an average of 8,8 in the CASP scale. 3 articles compared the use of eccentric exercises with the use of a night orthosis, other 3 compared with other therapeutic techniques and the rest only applied eccentric exercises. Conclusion: After the analysis of the results it is possible to observe the effectiveness of the eccentric exercises of the Achilles tendinopathy, however, many times the differences would not correspond to the expectable. The application of orthosis and the learning method do not enhance the positive effect, however in association with other therapeutic techniques (ultrasound and deep transversal massage) promotes its effectiveness.
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D'Costa, Lois Fatima. "Effectiveness of eccentric training in chronic Achilles tendinopathy : systematic critical review." Thesis, Manchester Metropolitan University, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.647443.
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Willberg, Lotta. "Patellar and Achilles tendinopathy : sclerosing injections and ultrasound guided arthroscopic shaving." Doctoral thesis, Umeå universitet, Idrottsmedicin, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-80194.
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Chronic painful tendinopathy is a common cause for elite- and recreational athletes to stop or decrease the level of their sports activity. Recent research on innervation patterns, histopathology and possible pain mechanisms in tendons has led to an increased knowledge about the chronic painful tendon. Ultrasound (US) and colourDoppler (CD) examination showing localized high blood flow, inside and outside regions with structural tendon abnormalities, has been shown to be of importance for tendon pain. Immuno-histochemical analyses of biopsies have shown sensory and sympathetic nerves in close relation to the high blood flow outside the tendon. These findings have led to new ideas about development of new treatment methods for chronic painful tendinopathy. In study I, we evaluated the already in use, US-guided sclerosing polidocanol injection treatment of midportion Achilles tendinopathy, using two different concentrations of the substance. This study aimed to find out if there was a faster return to pain-free activity by using the concentration 10 mg/ml compared to the formerly used 5 mg/ml. There were no significant differences in the clinical results between the groups. In study II - Technical note, we aimed to develop a new one-stage surgical treatment method for patellar tendinopathy. This method was based on research concerning the innervation patterns and US and CD findings in patellar tendinopathy/ “jumper’s knee”. Technically we added ultrasound guidance to knee arthroscopy to identify and visualize the region of interest during a surgical shaving procedure. In study III, we tested the newly invented US and CD-guided arthroscopic shaving technique in a pilot study. The short-term clinical results were promising and the majority of the patients returned to pain-free activity after a short rehabilitation period. In study IV, we compared the US and CD-guided artrhroscopic shaving method with the already in use sclerosing polidocanol injection treatment in a randomized study. At short-term follow-up, the patients treated with US and CD-guided arthroscopic shaving had significantly less pain during rest and activity, were significantly more satisfied with the treatment, and had a faster return to sports, compared to the patients in the sclerosing injection group. There were no complications. In study V, at longer-term followup (endpoint 46 months) there was a significant decrease in pain during activity in both groups. There were no remaining significant differences in the pain levels during activity between the groups. The tendon structure had improved significantly in both groups. There was a significant decrease in the antero-posterior thickness of the proximal patellar tendon in patients treated with US and CD-guided arthroscopic shaving, but not in the sclerosing injection group. The CD flow had diminished significantly in both groups, and there was a correlation between low CD flow and high patient satisfaction in both groups, The CD flow decreased faster in the surgical group than in the injection group. In conclusion, this newly invented US and CD-guided arthroscopic shaving treatment, focusing on treatment outside the tendon, has shown good clinical results with pain relief and a fast return to sports activity, in patients with patellar tendinopathy.
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Rezvani, Sabah Nader. "Novel Preclinical Approaches to the Understanding and Treatment of Achilles Tendinopathy." Diss., Virginia Tech, 2021. http://hdl.handle.net/10919/103637.
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Achilles tendinopathy is a debilitating condition affecting the entire spectrum of society and a
condition that increases the risk of tendon rupture. Effective therapies remain elusive, as anti-inflammatory drugs and surgical interventions show poor long-term outcomes. Eccentric loading
of the Achilles muscle-tendon unit is an effective physical therapy for treatment of symptomatic
human tendinopathy. Post-injury analgesia is often achieved with non-steroidal anti-inflammatory
drugs such as ibuprofen; however, there is increasing evidence that NSAID usage may interfere
with the healing process. The deposition of aggrecan/hyaluronan (HA)-rich matrix within the
tendon body and surrounding peritenon impede tendon healing and result in compromised
biomechanical properties. Herein, we present work investigating chemical, biological, and
mechanical loading approaches to treating Achilles tendinopathy in a murine model.
Our previously established TGF-ß1-induced murine model of Achilles tendinopathy was used to
investigate the cellular mechanism by which ibuprofen (chemical) therapy might lead to a
worsening of tendon pathology, potentially by interfering with the native inflammation phase of
tendon healing. We conclude that the use of ibuprofen for pain relief during inflammatory phases
of tendinopathy has detrimental effects on the turnover of a pro-inflammatory HA matrix produced
ain response to soft-tissue injury, thus preventing the switch to cellular responses associated with
functional matrix remodeling and eventual healing.
We examined the therapeutic potential of a recombinant human hyaluronidase, rHuPH20
(biologic, FDA approved for reducing HA accumulation in tumors) in a novel Achilles
tendinopathy and retrocalcaneal bursitis injury model. The potential of rHuPH20 to effectively
clear the pro-inflammatory, HA-rich matrix within the retrocalcaneal bursa (RCB) and tendon
strongly supports the future refinement of injectable glycosidase preparations as potential
treatments to protect or regenerate tendon tissue by reducing inflammation and scarring in the
presence of bursitis or other inducers of damage such as mechanical overuse.
Finally, we developed a novel mouse model of hind limb muscle loading (mechanical) designed
to achieve a tissue-targeted therapeutic exercise. When applied to a murine Achilles tendinopathy
model, muscle loading led to a significant improvement in Achilles tendon biomechanical outcome
measures, with a decrease in cross-sectional area and an increase in material properties, compared
to untreated animals. Our model facilitates the future investigation of mechanisms whereby
rehabilitative muscle loading promotes healing of Achilles tendon injuries. Overall, these findings
enhance our understanding of the mechanisms of injury and treatment in Achilles tendinopathy
injuries.Doctor of Philosophy
Achilles tendinopathy is a chronic, overuse condition affecting the entire spectrum of society and a condition that increases the risk of tendon rupture. Therapies are limited, as anti-inflammatory drugs and surgical interventions show poor long-term outcomes. Drugs such as ibuprofen are commonly prescribed at the onset of injury to treat pain. Eccentric loading of the Achilles muscle-tendon unit is an effective physical therapy for treatment of human tendinopathy; however, the reasons driving the healing are not well understood. Characteristics of the disease include pain, increased tendon size, and disorganization of tendon fiber structure. Here, we present work investigating chemical, biological, and mechanical loading approaches to treating Achilles tendinopathy in a mouse model. Our mouse model of Achilles tendinopathy was used to investigate how ibuprofen (chemical) therapy might lead to a worsening of tendon by potentially interfering with the inflammation phase of tendon healing. We conclude that the use of ibuprofen for pain relief during inflammatory phases of tendinopathy has negative effects on the turnover of matrix produced in response to injury, affecting the transition to the next phase in the tendon healing response. We examined the potential of a recombinant human hyaluronidase, rHuPH20 (biologic, FDA approved for reducing HA accumulation in tumors) in a novel Achilles tendinopathy and retrocalcaneal bursitis injury model. The potential of rHuPH20 to effectively clear the proinflammatory, HA-rich matrix within the retrocalcaneal bursa (RCB) and tendon strongly supports the future refinement of injectable treatments as a potential to protect or regenerate tendon tissue by reducing inflammation and scarring in the presence of bursitis or other inducers of damage such as mechanical overuse. Finally, we developed a mouse model of hind limb muscle loading (mechanical) based on physical therapy exercises. This model led to an improvement in biomechanical measures compared to untreated animals. The model allows for investigation of the underlying mechanisms in which physical therapy promotes healing of Achilles tendon injuries. Overall, these findings enhance our understanding of the mechanisms of injury and treatment in Achilles tendinopathy injuries.
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Dixon, Claire, Laureen Holloway, Teresa Lee, Nick Lo, Janice Meier, and Darlene Reid. "Pain-enduring Eccentric Exercise for the Treatment of Chronic Achilles Tendinopathy." Irving K. Barber Learning Centre, 2006. http://hdl.handle.net/2429/89.
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Recorded by Eugene Barsky, Physiotherapy Outreach Librarian, UBCThis is a Systematic Review Presentation titled - "Pain-enduring Eccentric Exercise for the Treatment of Chronic Achilles Tendinopathy", created by Master of Physical Therapy Graduating Students, University of British Columbia - 2006, Presented on September 14-15, 2006 , Vancouver, BC, Canada
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Spang, Christoph. "The plantaris tendon in relation to the Achilles tendon in midportion Achilles tendinopathy : studies on morphology, innervation and signalling substances." Doctoral thesis, Umeå universitet, Institutionen för integrativ medicinsk biologi (IMB), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-103292.
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Midportion Achilles tendinopathy (tendinosis) is a troublesome painful condition, often characterised by pain, local swelling, tenderness and functional disability. Despite extensive research, the pathogenesis is poorly understood and treatment remains challenging. Features related to the peritendinous connective tissue can be of importance. Recently it has been suggested that the plantaris tendon might be involved in this condition. Furthermore, it has been hypothesised that tendon pain and the tendinosis-related tissue changes in tendinopathy might be mediated by signalling substances such as glutamate and acetylcholine. A clinical observation, not scientifically evaluated, has been that unilateral treatment for bilateral Achilles tendinosis can lead to an effect on the contralateral side. The aim of this work was to examine the morphology and innervation patterns in the plantaris tendon and the peritendinous connective tissue in between the Achillles and plantaris tendons in midportion Achilles tendinopathy, and to evaluate if plantaris tendon removal has an effect on Achilles tendon structure. Another aim was to determine if unilateral treatment for Achilles tendinopathy targeting the peritendinous connective tissue can result in bilateral recovery. Furthermore the presence of non-neuronal cholinergic and glutamate systems was examined. Sections of plantaris tendons with adjacent peritendinous connective tissue from patients with midportion Achilles tendinopathy were stained for morphology (H&E), and innervation patterns were evaluated using antibodies against general nerve marker (PGP9.5), sensory (CGRP) and sympathetic (TH) nerve fibres and Schwann cells (S-100β). Furthermore immunostainings against non-neuronal aceylcholine (ChAT) and glutamate signalling components (glutamate, VGluT2, NMDAR1) were performed. Plantaris tendon cells were cultured and also stained for glutamate signalling components, and were stimulated with glutamate and glutamate receptor agonist NMDA. Furthermore, Ultrasound Tissue Characterisation (UTC) was used to monitor the integrity of the Achilles tendon collagen structure after plantaris tendon removal. Plantaris tendons exhibited tendinosis-like tissue patterns such as hypercellularity, collagen disorganisation and large numbers of blood vessels. The peritendinous connective tissue between the plantaris and Achilles tendons contained large numbers of fibroblasts and blood vessels and to some extent macrophages and mast cells. A marked innervation was found in the peritendinous connective tissue and there were also nerve fibres in the loose connective tissue spaces within the tendon tissue proper. Most nerve fibres were identified as sensory fibres. Some nerve fascicles in the peritendinous connective tissue showed absence of axons but homogenous reactions for Schwann cell marker. Tenocytes and cells in the peritendinous connective tissue expressed ChAT, glutamate, VGluT2 and NMDAR1. Tendon cells in vitro expressed VGluT2, NMDAR1 and glutamate. UTC showed significant improvement of Achilles tendon integrity 6 months after surgical plantaris tendon removal and scraping procedure. Eleven out of thirteen patients reported of a bilateral recovery after unilateral surgical treatment. The results of this work show that plantaris tendons exhibit tendinosis-like tissue changes, internal innervation and features that suggest occurrence of glutamate and acetylcholine production and signalling. Plantaris removal improves Achilles tendon structure suggesting possible compressive/shearing interference between the Achilles and plantaris tendons in tendinopathy. The peritendinous connective tissue shows marked innervation, which thus might transmit pain when being compressed. The partial absence of axons indicates a possible nerve degeneration. On the whole, the study gives new evidence favouring that the plantaris tendon and the peritendinous connective tissue might be of importance for pain and the tendinopathy process in midportion Achilles tendinopathy.
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Weinert-Aplin, Robert. "Development of a foot and ankle musculoskeletal model : implications for achilles tendinopathy." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/25519.
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This thesis investigates the mechanics behind Achilles tendinopathies and their respective treatments using a musculoskeletal modelling approach. Specifically, the eccentric heel-drop exercise used to treat Achilles tendinosis and orthotic heel wedges used to treat Achilles tendonitis were investigated, as the mechanics which drive tendon healing are not currently understood, but are believed to work by directly altering the mechanical loading of the Achilles tendon. An inverse dynamics model of the lower limb including the hip, knee ankle and MTP joints was developed to include a musculoskeletal foot and ankle model. An existing muscle geometry dataset was used, but a new algorithm to account for soft tissue and bony constraints at the ankle to ensure physiological musculo-tendon paths around the foot and ankle was developed. Optical motion, forceplate and instrumented pressure insole data was used to derive independent 3D ground reaction vectors necessary for the data inputs for each of the two foot segments modelled. In addition to the moments of the hip and knee, foot and ankle muscle forces and ankle joint reaction forces were also estimated. A cohort of 19 healthy individuals performed the eccentric heel-drop exercise used to treat Achilles tendinosis and walked on a level and up and down an inclined (10°) surface barefoot and in running shoes with and without prefabricated orthotic heel wedges used to treat Achilles tendonitis. Clinical questions regarding changes in lower limb mechanics due to variants of the eccentric heel-drop exercise and orthotic heel wedges were considered as well as model sensitivity to foot models and sources of centre of pressure (CoP) data. CoP data source and number of foot segments modelled did not consistently change the model outputs, with greater or worse similarity between sources depending on the specific phase of stance considered. An example of this are the reduced knee and hip extension moments and increased ankle dorsiflexion moments at heel-strike, but consistent peak ankle joint reaction and Achilles tendon forces due to different CoP inputs. Across all walking conditions, heel wedges were found to have minimal impact on Achilles tendon force, but had a significant impact on knee moments and secondary plantarflexors such as Tibialis Posterior and the toe flexor muscles. The ability of heel wedges to reduce Achilles tendon load during walking was not supported by this thesis. Key observations regarding the eccentric heel-drop exercise were the reductions in peak Achilles tendon force achieved when performing the exercise in running shoes compared to barefoot and with a flexed compared to extended knee. Given the increased difficulty in performing the flexed knee exercise, this questioned the efficacy of the flexed knee version of the task and possible changes to the rehabilitation protocol, incorporating the effect of shoes on peak Achilles tendon force were suggested.
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Jonsson, Per. "Eccentric training in the treatment of tendinopathy." Doctoral thesis, Umeå : Sports Medicine, Umeå university, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-25856.
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Payne, Catherine. "Clinical applications of shear wave elastography to achilles tendon imaging and the monitoring of a rehabilitation protocol for achilles tendinopathy." Thesis, University of Brighton, 2018. https://research.brighton.ac.uk/en/studentTheses/7e9deb5d-b2af-4f85-90b7-d7613811035c.
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Udeze-Jyambere, Chineye Princess. "The effect of loading frequency on tenocyte metabolism." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/25982.
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Achilles tendinopathy is a prevalent, highly debilitating condition. It is believed to result from repetitive overuse, which creates micro-damage tendon, and initiates a catabolic cell response. The aetiology of tendinopathy remains poorly understood, therefore appropriate treatment remains unclear. Current data support the use of shock wave therapy and eccentric exercise as some of the more effective treatment options for tendinopathy. Studies have shown that these treatments generate perturbations within tendon at a frequency of approximately 8-12Hz. Consequently, it is hypothesised that 10Hz loading initiates increased anabolic tenocyte behaviour promoting tendon repair. The primary aim of this thesis is to investigate the effects of 10Hz perturbations on tenocyte metabolism, comparing tenocyte gene expression in response to a 10Hz and 1Hz loading profile. A variety of in vitro models for mechanically stimulating cells were explored, comparing tissue explants with isolated cells on a 2D or within a 3D collagen gel. The mechanical environment of each model was investigated, in addition to cell viability and gene stabilisation following strain, as needed for future cell studies. 3D collagen gels arose as the most suitable model. Human tenocytes from healthy semitendinosus and tendinopathic Achilles tendons were seeded into 3D collagen gels and subjected to cyclic strain at 10Hz and 1Hz to establish cell response. Tenocyte gene expression was characterised using qRT-PCR. Healthy tenocytes showed increased expression of all analysed genes in response to loading. Furthermore, the increase was significantly larger in the 10Hz loading group. Tendinopathic tenocytes showed a more varied response, possibly indicative of an early healing response. Nevertheless, the response to 10Hz loading was consistently greater than seen with 1Hz loading. Analysis of the signalling pathways involved suggested that the IL1 signalling pathway may be involved in the strain response reported. This study has demonstrated for the first time that loading at a frequency of 10Hz may enhance metabolic response in healthy tenocytes.
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Bagge, Johan. "TNF-α and neurotrophins in Achilles tendinosis." Doctoral thesis, Umeå universitet, Anatomi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-63660.
Full textAbstract:
Tenocytes are the principal cells of the human Achilles tendon. In tendinosis, changes in the metabolism and morphology of these cells occur. Neurotrophins are growth factors essential for the development of the nervous system. Tumour necrosis factor alpha (TNF-α) has been found to kill sarcomas but has destructive effects in several major diseases. The two systems have interaction effects and are associated with apoptosis, proliferation, and pain signalling in various diseases. Whether these systems are present in the Achilles tendon and in Achilles tendinosis is unknown. The hypothesis is that the tenocytes produce substances belonging to these systems. In Studies I–III, we show that the potent effects of these substances are also likely to occur in the Achilles tendon. We found tenocyte immunoreactions for the neurotrophins brain-derived neurotrophic factor (BDNF), the nerve growth factor (NGF), the neurotrophin receptor p75, and for TNF-α and both of its receptors, TNFR1 and TNFR2. This occurred in both subjects with painful mid-portion Achilles tendinosis, and in controls. Furthermore, we found mRNA expression for BDNF and TNF-α in tenocytes, which proves that these cells produce these substances. TNFR1 mRNA was also detected for the tenocytes, and TNFR1 immunoreactions were upregulated in tendinosis tendons. This might explain why tenocytes in tendinosis undergo apoptosis more often than in normal tendons. Total physical activity (TPA) level and blood concentration of both soluble TNFR1 and BDNF were measured in Study IV. The results showed that the blood concentration of both factors were similar in subjects with tendinosis and in controls. Nevertheless, the TPA level was related to the blood concentration of sTNFR1 in tendinosis, but not in controls. This relationship should be studied further. The findings of this doctoral thesis show that neurotrophin and TNF-α systems are expressed in the Achilles tendon. We believe that the functions include tissue remodelling, proliferation and apoptosis.
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Hammar, Clausen Adrian. "Follow-up of Patients Treated with Sclerosing Therapy and/or Surgery for Achilles Tendinopathy." Thesis, Örebro universitet, Institutionen för medicinska vetenskaper, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-72993.
Full textAbstract:
Introduction: Achilles tendinopathy can be a chronic disabling condition. Sclerosing injections under ultrasonographic guidance is one method to treat Achilles tendinopathy. Initially good results have later been questioned. Surgery is another treatment option that has been questioned because of varying reported success rate. Aim: We aimed to assess patient- reported outcome in patients suffering from Achilles tendinopathy, treated with sclerosing injections and/or surgery during a 6 ½ year- period. Method: After review of patient records, the Self-reported foot and ankle score (SEFAS) together with an in-house satisfaction questionnaire were mailed to the patients. A SEFAS score of 48 represents normal foot/ankle function. Results: 97 patients (53 women, 44 men, 104 tendons) were included. 69 patients (41 women, 28 men, 75 tendons) returned the questionnaires. The SEFAS values (median and range) were 37.5 (13-48) in patients treated with sclerosing therapy, 42 (15-48) in patients treated surgically and 47 (19-48) in patients that received both treatments. A greater proportion of surgically treated patients were satisfied (90% vs 50%), experienced symptom improvement and were able to return to the previous level of activity. Complications following surgery were wound infections (n=3) and deep vein thrombosis (n=3), two with pulmonary embolism. Following sclerosing injection, there was one complete Achilles tendon rupture. Conclusion: Sclerosing injections seems to be a safe treatment and a positive outcome in 50% of patients might be sufficient to use this therapy in selected patients with Achilles tendinopathy. However, surgical treatments seem more effective but are associated with more severe complications.
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Andersson, Gustav. "Influences of paratendinous innervation and non-neuronal substance P in tendinopathy : studies on human tendon tissue and an experimental model of Achilles tendinopathy." Doctoral thesis, Umeå universitet, Anatomi, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-35917.
Full textAbstract:
Pain of the musculoskeletal system is one of the most common reasons for people seeking medical attention, and is also one of the major factors that prevent patients from working. Chronic tendon pain, tendinopathy, affects millions of workers world-wide, and the Achilles tendon is an important structure often afflicted by this condition. The pathogenesis of tendinopathy is poorly understood, but it is thought to be of multifactoral aetiology. It is known that tendon pain is often accompanied not only by impaired function but also by structural tissue changes, like vascular proliferation, irregular collagen organisation, and hypercellularity, whereby the condition is called tendinosis. In light of the poor knowledge of tendinosis pathophysiology and recent findings of a non-neuronal signalling system in tendon tissue, the contributory role of neuropeptides such as substance P (SP) has gained increased interest. SP, known for afferent pain signalling in the nervous system, also has multiple efferent functions and has been described to be expressed by non-neuronal cells. As pain is the most prominent symptom of tendinopathy, the focus of the studies in this thesis was the innervation patterns of the tissue ventral to the Achilles tendon (i.e. the tissue targeted in many contemporary treatment methods) as well as the distribution of SP and its preferred receptor, the neurokinin-1 receptor (NK-1R), in the tendon tissue itself. It was hereby hypothesised that the source of SP affecting the Achilles tendon might be the main cells of the tendon tissue (the tenocytes) as well as paratendinous nerves, and that SP might be involved in tendinosis- development. The studies were conducted, via morphological staining methods including immunohistochemistry and in situ hybridisation, on tendon biopsies from patients suffering from Achilles tendinosis and on those from healthy volunteers. The hypothesis of the thesis was furthermore tested using an experimental animal model (rabbit) of Achilles tendinopathy, which was first validated. The model was based on a previously established overuse protocol of repetitive exercise. In the human biopsies of the tissue ventral to the Achilles tendon, there was a marked occurrence of sympathetic innervation, but also sensory, SP-containing, nerve fibres. NK-1R was expressed on blood vessels and nerve fascicles of the paratendinous tissue, but also on the tenocytes of the tendon tissue proper itself, and notably more so in patients suffering from tendinosis. Furthermore, the human tenocytes displayed not only NK-1R mRNA but also mRNA for SP. The animal model was shown to produce objectively verified tendinosis-like changes, such as hypercellularity and increased vascularity, in the rabbit Achilles tendons, after a minimum of three weeks of the exercise protocol. The contralateral leg of the animals in the model was found to be an unreliable control, as bilateral changes occured. The model furthermore demonstrated that exogenously administered SP triggers an inflammatory response in the paratendinous tissue and accelerates the intratendinous tendinosis-like changes such that they now occur after only one week of the protocol. Injections of saline as a control showed similar results as SP concerning hypercellularity, but did not lead to vascular changes or pronounced paratendinous inflammation. In summary, this thesis concludes that interactions between the peripheral sympathetic and sensory nervous systems may occur in Achilles tendinosis at the level of the ventral paratendinous tissue, a region thought to be of great importance in chronic tendon pain since many successful treatments are directed toward it. Furthermore, the distribution of NK-1R:s in the Achilles tendon described in these studies gives a basis for SP, whether produced by nerves mainly outside the tendon or by tenocytes within the tendon, to affect blood vessels, nerve structures, and/or tendon cells, especially in tendinosis patients. In light of this and of previously known SP-effects, such as stimulation of angiogenesis, pain signalling, and cell proliferation, the proposed involvement of SP in tendinosis development seems likely. Indeed, the animal model of Achilles tendon overuse confirms that SP does induce vascular proliferation and hypercellularity in tendon tissue, thus strengthening theories of SP playing a role in tendinosis pathology.
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Becker, James N. M. 1979. "Towards an Understanding of Prolonged Pronation: Implications for Medial Tibial Stress Syndrome and Achilles Tendinopathy." Thesis, University of Oregon, 2013. http://hdl.handle.net/1794/13257.
Full textAbstract:
Epidemiologic data suggest 25% to 75% of all runners experience an overuse injury each year. Commonly cited biomechanical factors related to overuse injuries such as Achilles tendinopathy or medial tibial stress syndrome include excessive amounts or velocities of foot pronation. However, there is conflicting evidence in the literature supporting this theory. An alternative hypothesis suggests it is not necessarily the amount or velocity of pronation which is important for injury development; rather it is the duration the foot remains in a pronated position throughout stance that is the important variable.
This project examined this hypothesis by first identifying biomechanical markers of prolonged pronation. Second, it assessed whether individuals currently symptomatic with injuries typically attributed to excessive pronation instead demonstrate the biomechanical markers of prolonged pronation. Finally, musculoskeletal modeling techniques were used to examine musculotendinous kinematics in injured and healthy runners, as well as healthy runners with prolonged pronation.
The results suggest the two most robust measures for identifying individuals with prolonged pronation are the period of pronation and the eversion of the rear foot at heel off. Individuals with prolonged pronation can also be identified with a set of clinically feasible measures including higher standing tibia varus angles, reduced static hip internal rotation range of motion, and increased hip internal rotation during stance phase. Finally, individuals with prolonged pronation display a more medially located center of pressure trajectory during stance. Compared to healthy controls, individuals currently symptomatic with Achilles tendinopathy or medial tibial stress syndrome did not differ in the amount or velocity of pronation. However, they did demonstrate the biomechanical markers of prolonged pronation. Injured individuals also demonstrated greater average musculotendinous percent elongation than healthy controls, especially through mid and late stance. Currently healthy individuals demonstrating prolonged pronation exhibited musculotendinous percent elongations intermediate to the healthy and injured groups.
As a whole, the results from this study suggest prolonged pronation may play a role in the development of common overuse running injuries. It is suggested future studies on injury mechanisms consider pronation duration as an important variable to examine.
This dissertation includes unpublished co-authored material.
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Netto, Cesar de Cesar. "Estudo histológico e biomecânico da tendinopatia induzida por injeções seriadas de colagenase: novo modelo experimental no tendão do calcâneo de coelho." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5140/tde-09082017-132050/.
Full textAbstract:
INTRODUÇÃO: Este estudo tem como objetivo comparar os achados biomecânicos e anatomopatológicos de um modelo animal inédito de tendinopatia do tendão do calcâneo, induzido por injeções seriadas de baixa dose da enzima colagenase bacteriana, com o modelo mais comumente utilizado na literatura, induzido por injeção única de maior dose da enzima, e com os controles. A hipótese é que a utilização de injeções seriadas resultaria em alterações tendíneas mais progressivas e duradouras, similar à doença nos humanos. MÉTODOS: Quarenta e cinco (N=45) coelhos foram randomizados em três diferentes grupos de estudo (A, B e Controles). Animais do Grupo A (n=18) foram submetidos a três injeções seriadas de baixa dose de colagenase (0,1mg), em ambos os tendões do calcâneo, separadas por intervalo de duas semanas. Animais do Grupo B (n=18) foram injetados com dose única de maior dose (0,3mg). Já no Grupo Controle, animais (n=9) foram injetados bilateralmente com três doses seriadas de solução fisiológica 0,9%. Após a última injeção, foi realizada eutanásia do mesmo número de animais dos Grupos A e B (n=6), com 10 semanas (Subgrupos A1 e B1), 12 semanas (Subgrupos A2 e B2) e 16 semanas (Subgrupos A3 e B3). Todos os animais do Grupo controle foram eutanasiados após 16 semanas. Alterações anatomopatológicas, pelo escore de Bonar, e biomecânicas foram comparadas entre os grupos e dentro de cada grupo, para os diferentes momentos de eutanásia. Valores de p < 0,05 foram considerados estatisticamente significativos. RESULTADOS: Após 16 semanas, o escore anatomopatológico de Bonar foi significativamente maior para ambos os Grupos A (11,8±2,28) e B (5,6±2,51), quando comparados aos controles (2±0,76). Os valores para o grupo A também diferiram do Grupo B (p < 0,001). Para os desfechos biomecânicos, os grupos diferiram quanto à área de secção transversa do tendão (p=0,003), módulo de elasticidade (p=0,024), e tensões no limite da elasticidade (p=0,020) e na resistência máxima (p=0,022), com piores resultados encontrados nos animais do Grupo A. Na semana 12, também houve diferença entre os Grupos A e B para o escore anatomopatológico de Bonar (p=0,028) e para a tensão no limite da elasticidade(p=0,013), novamente com piores resultados no Grupo A. Já na 10a semana, foram os coelhos do Grupo B que demonstraram alterações mais pronunciadas quando comparados aos do Grupo A, com diferença significativa no Escore de Bonar (p=0,033), área de secção transversa do tendão (p=0,038), rigidez (p=0,048), módulo de elasticidade (p=0,024), força, tensão, energia e densidade de energia no limite da elasticidade (p=0,008, p=0,020, p=0,047 e p=0,0015, respectivamente) além de força e tensão no limite da resistência máxima (p=0,004 e p=0,008, respectivamente). A comparação dos desfechos dentro de cada grupo, entre os diferentes subgrupos, apresentou diferenças significativas no escore de Bonar em ambos os grupos A (p=0,012) e B (p < 0,001). Parâmetros biomecânicos não diferiram entre os subgrupos do Grupo A. Já os subgrupos do grupo B apresentaram diferenças na área de secção transversa do tendão (p=0,011), módulo de elasticidade (p=0,024), tensão no limite da elasticidade (p=0,023) e da resistência máxima (p=0,031), assim como na a densidade de energia no limite da elasticidade (p=0,017), com resultados mais pronunciados no subgrupo B1. CONCLUSÃO: O modelo animal de tendinopatia do tendão calcâneo induzida por injeções seriadas de colagenase apresentou alterações anatomopatológicas e biomecânicas mais avançadas na 16a semana, de caráter progressivo e duradouro, similar à doença dos humanos. Tal modelo experimental pode representar uma melhor opção na indução da tendinopatia do tendão do calcâneo, possibilitando a realização de estudos promissores no futuroINTRODUCTION: This study aims to compare the biomechanical and histological findings of a new animal model of Achilles tendinopathy induced by serial low-dose injections of bacterial collagenase with the most commonly used high-dose single injection and to controls. The hypothesis of the study is that consecutive low-dose injections of collagenase would result in more progressive and long-lasting tendinopathic findings, reproducing better the disease in humans. METHODS: Forty-five (N=45) rabbits were randomly divided into three groups (A, B and Control). Animals in Group A (n=18) underwent three serial low-dose (0,1mg) injections of bacterial type I collagenase in both Achilles tendons, separated by a two-week interval. Animals in Group B (n=18) underwent bilateral single high dose injection (0,3mg) of the same enzyme. In the Control Group, animals (n=9) were injected bilaterally with three consecutive doses of saline solution, separated by a two-week interval. Following the last injection, the same number of rabbits from Groups A and B (n=6) were euthanized after 10 weeks (Subgroups A1 and B1), 12 weeks (Subgroups A2 and B2), and 16 weeks (Subgroups A3 and B3). Animals in the Control Group were all euthanized after 16 weeks. Histological findings, using the Bonar tendinopathy score, and biomechanical properties of the Achilles tendons were compared between the groups and inside each the group, in the different time-points of euthanasia. Findings at 16 weeks were considered primary outcomes. P-values < 0,05 were considered significant. RESULTS: After 16 weeks, the Bonar score was significantly increased for both Groups A (11,8±2,28) and B (5,6±2,51), when compared to controls (2±0,76). Group A has also differed from Group B (p < 0,001). Regarding biomechanical findings, groups differed in cross-sectional area of the Achilles tendon (p=0,003), Young\'s modulus (p=0,024), Yield stress (p=0,020) and ultimate tensile strength (p=0,022), with the worst results in animals from Group A. At 12 weeks, comparison between Groups A and B have shown significant differences for Bonar score (p=0,028) and Yield stress (p=0,013), again with worse results in Group A. Conversely, at 10 weeks, rabbits in Group B showed worse results when compared to Group A, with significant differences in the Bonar score (p=0,033), cross sectional area of the tendon (p=0,038), stiffness (p=0,048), Young\'s modulus (p=0,024), Yield tension (0,008), Yield stress (p=0,020), energy Yield (p=0,047), ultimate tension (p=0,004), ultimate stress (p=0,008) and yield strain energy density (p=0,015). The comparison of outcomes inside each group, in the different time-points of follow-up, demonstrated significant differences in the Bonar score for Group A (p=0,012) and Group B (p < 0,001). Regarding biomechanical properties, Group A showed no differences between the subgroups for any of the parameters evaluated. Subgroups in Group B differed for cross-sectional area of the tendon (p=0,011), Young\'s modulus (p=0,024), Yield stress (p=0,023), ultimate stress (p=0,031) and yield strain energy density (p=0,017), with worst results in the earliest follow-up (Subgroup B1). CONCLUSIONS: The animal model of Achilles tendinopathy induced by consecutive injections of collagenase showed worse histological and biomechanical properties after 16 weeks, demonstrating more progressive and long lasting tendinopathic findings, reproducing better the disease in humans. This novel experimental model can represent a better option to induce Achilles tendinopathy, allowing promising future research on the subject
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Müller, Steffen. "Die belastungsspezifische neuromuskuläre Antwort bei Athleten mit Tendinopathie der Achilles- oder Patellarsehne : Analysen der funktionalen und therapeutischen Effekte eines sensomotorischen Trainings." Phd thesis, Universität Potsdam, 2008. http://opus.kobv.de/ubp/volltexte/2008/1645/.
Full textAbstract:
Tendinopathien der Achilles- oder Patellarsehne sind häufig in Sportarten mit zahlreichen repetitiven Belastungen im Dehnungs-Verkürzungs-Zyklus der unteren Extremität zu finden. Sowohl eine möglicherweise alterierte belastungsspezifische neuromuskuläre Antwort (NMA), als auch funktional begründete Therapiemaßnahmen mit möglichen positiven Effekten sind aktuell ungeklärt. Ziel der Arbeit war deshalb die Untersuchung der belastungsspezifischen neuromuskulären Antwort bei Athleten mit Tendinopathie der Achilles- oder Patellarsehne im Vergleich zu beschwerdefreien Athleten. Zusätzlich sollten mögliche funktionale und therapeutische Effekte eines sensomotorischen Trainings im randomisierten, kontrollierten und prospektiven Studiendesign überprüft werden.
51 Sportler mit unilateraler Tendinopathie (Achilles-/Patellarsehne n = 35/16) und 33 gesunde Sportler wurden zur Beurteilung der belastungsspezifischen neuromuskulären Antwort eingeschlossen. Zur Klärung der Effekte eines sensomotorischen Trainings im Längsschnitt konnten 26 Sportler mit Tendinopathie randomisiert zu einer Kontrollgruppe (n = 14) und einer Therapiegruppe mit sensomotorischem Training (n = 12) zugeordnet werden. Nach einer ersten biomechanischen Messung M1 (Belastungssituationen: Lauf-, Stabilisations-, Kraftbelastung) und der Erhebung der subjektiven Schmerzsymptomatik folgte eine 8-wöchige Therapiephase mit einer abschließenden Re-Test-Messung M2 identisch zu M1. Das sensomotorische Training war auf die gesamte untere Extremität ausgerichtet und wurde nach Einweisung regelmäßig kontrolliert. Die Erfassung der NMA erfolgte über die Quantifizierung der muskulären Aktivität (EMG). Zusätzlich wurde die Kinetik (z.B. Maximalkraft) belastungsspezifisch erfasst.
Eine reduzierte NMA konnte für die Sportler mit Tendinopathie über veränderte EMG-Zeit- und Amplitudenmessgrößen, eine reduzierte aktive Stabilisationsfähigkeit und Maximalkraft (p < 0,05) nachgewiesen werden. In Abhängigkeit der Lokalisation (Achilles-/Patellarsehen) bzw. der Seite (Beschwerdeseite/gesunde Seite) ergaben sich keine relevanten Differenzen. Das sensomotorische Training zeigte eine Optimierung der NMA (z.B. erhöhte Maximalkraft) bei Tendinopathie der Achilles- oder Patellarsehne. Die Überprüfung der Beschwerdesymptomatik wies in allen Schmerz-Scores nach der Therapie reduzierte Werte und damit einen positiven therapeutischen Effekt gegenüber der Kontrollgruppe auf.
Zusammenfassend kann eine systematisch reduzierte NMA bei Lauf-, Stabilisations- und Kraftbelastung der Sportler mit Tendinopathie nachgewiesen werden. Das sensomotorische Training ist funktional und therapeutisch als effiziente Therapiemaßnahme zu erachten.Tendinopathies of the achilles- or patellartendon are common overuse unjuries in sports including high numbers of repetitive stretch-shortening-cycles of the lower limb. Possible alterations of the neuromuscular response (NMR) to physical stress and functionally justified therapies with potential positive effects are currently unknown. The aim of the study was therefore the analysis of the neuromuscular response in situations with physical stress in athletes with tendinopathie of the achilles or patellartendon compared to symptom free athletes. In addition, possible functional and therapeutic effects of a sensorimotor training were studied in a prospective, randomized and controlled study. 51 athletes with unilateral tendinopathy (achilles-/patellartendon n = 35/16) and 33 healthy athletes were included to assess the stress related neuromuscular response (NMR). To clarify the effects of a sensorimotor training 26 athletes with tendinopathy were randomized to a control group (n = 14) and a therapy group with sensorimotor training (n = 12). After initial biomechanical measurements M1 (situations: running, active postural stability and maximum strength test) and the collection of subjective complaints (pain) an 8-week treatment phase followed with a final re-test M2 measure identical to M1. The sensorimotor training was arranged for the entire lower extremity, and was checked after an initial briefing on a regular basis. The assessment of the NMR was quantified by muscle activity (EMG). In addition, the kinetics (e.g. maximum force) was acquired in the stabilization and maximum strength test. A reduced NMR could be proven for athletes with tendinopathy with changed EMG time and amplitude measurements, a reduced active postural stabilization ability and reduced maximum strength (p <0.05). No relevant differences could be observed in comparing localization (achilles-/patellartendon) and side (leg with complains/healthy leg). The sensorimotor training showed an optimization of NMR (e.g. increased maximum strength) for patient with tendinopathy of the achilles- or patellartendon. The examination of the complaints showed reduced values in all pain scores after therapy. The treatment had therefore positive therapeutic effects compared to the control group. In summary, a systematically reduced NMR in running, stabilization and strength tests are evident for athletes with tendinopathy. The sensorimotor training can be considered as an efficient treatment with functional and therapeutic effects.
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Della, Pasqua Alberto. "L'esercizio terapeutico nel trattamento della tendinopatia Achillea: revisione sistematica della letteratura." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2019. http://amslaurea.unibo.it/19320/.
Full textAbstract:
Background:
La tendinopatia Achillea è una condizione che causa dolore, rigidità e alterazione della funzione del tendine d’Achille. La patogenesi è degenerativa. Il trattamento conservativo verte soprattutto sulla ricerca di stimoli che promuovano la sintesi di collagene e incrementino la forza tensile del tendine d’Achille. Per questo motivo, l’esercizio è una delle modalità più studiate.
Obiettivi:
Valutare l’efficacia dell’esercizio terapeutico, in termini di miglioramento dei sintomi di dolore e funzione, nel trattamento della tendinopatia achillea cronica della porzione media.
Disegno dello studio:
Revisione sistematica seguendo la checklist del PRISMA statement.
Criteri di eleggibilità:
Studi Trial Clinici Randomizzati e non, che indagano il cambiamento di dolore e funzione in pazienti affetti da tendinopatia achillea cronica della porzione media trattati con esercizio terapeutico.
Fonti di ricerca:
PUBMED, PEDro, CINAHL complete, PsycARTICLES, Psychology and Behavioral Sciences Collection, PsycINFO, SPORTDiscus, Cochrane Central Register of Controlled Trial.
Risultati:
13 studi inclusi. In tutti, l’esercizio terapeutico produce miglioramenti significativi di dolore e funzione. Il protocollo di esercizio eccentrico di Alfredson (HECT) è più efficace della guarigione spontanea, dell’esercizio concentrico isolato, e del programma di Stanish. Inoltre, unito a massaggio trasverso profondo ed ultrasuoni provoca miglioramenti statisticamente significativi rispetto a queste terapie isolate. Non ci sono differenze significative fra l’HECT e: l’AirHeel brace, le onde d’urto, gli ultrasuoni, il PRP, il “pressure massage”, e l’esercizio isotonico in palestra (HSR). L’HECT ridotto di volume e frequenza produce gli stessi miglioramenti.
Conclusioni:
L’esercizio è un trattamento efficace per la tendinopatia achillea cronica della porzione media. Il suo utilizzo consente di scegliere programmi di lavoro ugualmente validi come l’HECT (classico o ridotto) e l’HSR.
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Nell, Erica-Mari. "A pathway-based approach investigating DNA sequence variants to implicate the inflammatory pathway in the predisposition to Achilles tendinopathy." Master's thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/10807.
Full textAbstract:
Includes abstract.Includes bibliographical references (leaves 159-179).
The aims of this dissertation were therefore (i) to follow a pathway-based approach investigating genes encoding proteins involved in the ECM degradation and apoptosis signalling cascade for associations with AT and (ii) to identify a polygenic risk model, comprised of several genetic markers within genes encoding proteins involved in the inflammatory pathway, to predict risk of AT.
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Trogen, Josefin, and Clara Ringmar. "Är excentrisk träning den bästa behandlingen för akillestendinopati? : En systematisk litteraturstudie." Thesis, Uppsala universitet, Åsenlöf: Fysioterapi, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-443583.
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Bakgrund: Besvär från akillessenan är ett vanligt problem hos såväl motionärer som elitidrottare och kan leda till båda smärta och funktionsförlust. Excentrisk träning är en vanlig behandlingsmetod i klinik, trots att evidensen är begränsad och motstridig. Syfte: Att kartlägga vilken evidens som finns för excentrisk träning som behandling av akillestendinopati. Metod: Systematisk litteraturstudie. Sökningen genomfördes i databasen PubMed. Studierna granskades med PEDro-skalan och den sammanlagda evidensen graderades enligt GRADEstud. Resultat: Litteratursökningen resulterade i att 7 studier med totalt 448 deltagare inkluderades. Studierna fick medelhög-hög kvalitet enligt PEDro. Evidensen för excentrisk träning vid 8-16 veckor var måttligt hög (+++) och vid 52 veckor mycket låg (+). Excentrisk träning hade en lägre effekt än hälinlägg och akupunktur mätt med VISA-A vid 8-16 veckor. Effekten av excentrisk träning mätt med VISA-A hade en likvärdig effekt som passiv stretch och tung långsam styrketräning vid 8-16 veckor. Vid 52 veckor var effekten mätt med VISA-A densamma av excentrisk träning som proloterapiinjektioner och tung långsam styrketräning. Konklusion: Excentrisk träning kan ha en effekt vid achillestendinopati. Effekten är densamma som eller lägre sett till poäng på VISA-A än andra behandlingsmetoder och skulle kunna bero på naturlig läkning över tid eller deltagandet i en studie. Evidensen för excentrisk träning graderades vid 8-16 respektive 52 veckor till måttligt hög (+++) och mycket låg (+). Detta grundar sig på studier av medelgod till hög kvalitet.Background: Achilles tendon issues is a common problem among athletes on all levels. The problem can cause pain and loss of function. Eccentric exercise is a somewhat gold standard and often used in the clinical setting although the level of evidence is limited and conflicting. Objective: Map the evidence of eccentric exercise as a treatment for achilles tendinopathy. Method: A systematic review. The search was conducted in the Pubmed database. The included studies were analyzed using the PEDro scale and the evidence was graded using the GRADEstud. Results: The literature search identified 7 studies that were included with a total of 448 participants. The studies received a moderate-high quality on PEDro. The level of evidence at 8-16 weeks was moderate (+++) and at 52 weeks very low (+). Eccentric exercise had a lower effect than heel lifts and acupuncture measured with VISA-A. Eccentric exercise had a similar effect on VISA-A as passive stretch and heavy slow resistance. At 52 weeks the effect of eccentric exercise was the same as prolotherapy injections and heavy slow resistance. Conclusion: Eccentric exercise might have an effect as treatment for achilles tendinopathy, but the effect is the same or lower than other treatment options measured with VISA-A and might depend on the natural healing process or the participation in a study. The level of evidence for eccentric exercise was graded at 8-16 and 52 weeks respectively, as moderate (+++) and very low (+). This is based on studies of moderate to high quality.
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Backman, Ludvig. "Neuropeptide and catecholamine effects on tenocytes in tendinosis development : studies on two model systems with focus on proliferation and apoptosis." Doctoral thesis, Umeå universitet, Anatomi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-70193.
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Background: Achilles tendinopathy is a common clinical syndrome of chronic Achilles tendon pain combined with thickening of the tendon and impaired tendon function. Tendinopathy is often, but not always, induced by mechanical overload, and is frequently accompanied by abnormalities at the tissue level, such as hypercellularity and angiogenesis, in which case the condition is called tendinosis. In tendinosis, there are no signs of intratendinous inflammation, but occasionally increased apoptosis is observed. Tendinosis is often hard to treat and its pathogenesis is still not clear. Recently, a new hypothesis has gained support, suggesting a biochemical model based on the presence of a non-neuronal production of classically neuronal signal substances by the primary tendon cells (tenocytes) in tendinosis. The possible functional importance of these signal substances in tendons is unknown and needs to be studied. In particular, the neuropeptide substance P (SP) and catecholamines are of interest in this regard, since these substances have been found to be up-regulated in tendinosis. As both SP and catecholamines are known to exert effects in other tissues resulting in changes similar to those characteristic of tendinosis, it is possible that they have a role in tendinosis development. It is furthermore unknown what elicits the increased intratendinous neuropeptide production in tendinosis, but given that tendon overload is a prominent riskfactor, it is possible that mechanical stimuli are involved. The hypothesis of this thesis work was that intratendinous production of SP is up-regulated in response to load of Achilles tendons/tenocytes, and thatstimulation of the preferred SP receptor, the neurokinin-1 receptor (NK-1 R), aswell as stimulation of the catecholamine α2 adrenoreceptors, contribute to the hypercellularity seen in tendinosis, via increased proliferation and/or decreased apoptosis, and that SP stimulates tendon angiogenesis. The purpose of the studies was to test this hypothesis. To achieve this, two model systems were used: One in vivo (rabbit Achilles tendon overload model of tendinosis) and one in vitro (human primary Achilles tendon cell culture model). Results: In the rabbit Achilles tendon tissue, SP and NK-1 R expression was extensive in the blood vessel walls, but also to some extent seen in the tenocytes. Quantification of endogenously produced SP in vivo confirmed intratendinous production of the peptide. The production of SP by human tendon cells in vitro was furthermore demonstrated. The catecholamine synthesizing enzyme tyrosine hydroxylase (TH), as well as the α2A adrenoreceptor (α2A AR), were detected in the tenocytes, both in vivo in the rabbit tissue and in vitro in the human tendon cells. As a response to mechanical loading in the in vivo model, the intratendinous levels of SP increased, and this elevation was found to precede distinct tendinosis changes. The in vitro model demonstrated the same response to load, i.e. an increased SP expression, but in this case also a decrease in the NK-1 R expression. In the in vivo model, exogenously administered SP, as well as clonidine (an α2 AR agonist), accelerated tenocyte hypercellularity, an effect that was not seen when administrating a specific α2A AR antagonist. Exogenous administration of SP also resulted in intratendinous angiogenesis and paratendinous inflammation. In the in vitro model, both SP and clonidine had proliferative effects on the human tenocytes, specifically mediated via NK-1R and α2A AR, respectively; both of which in turn involved activation/phosphorylation of the extracellular signal-regulated kinases 1 and 2 (ERK1/2). Exogenously administered SP, in Anti-Fas induced apoptosis of the tenocytes in vitro, confirmed SP to have an anti-apoptotic effect on these cells. This effect was specifically mediated via NK-1 R and the known anti-apoptotic Akt pathway. Conclusions: In summary, this thesis concludes that stimulation of NK-1 R and α2A AR on tenocytes, both in vitro and in vivo, mediates significant cell signalling effects leading to processes known to occur in tendinosis, including hypercellularity. The pathological role of the hypercellularity in tendinosis is still unclear, but it is likely to affect collagen metabolism/turnover and arrangement, and thereby indirectly tendon biomechanical function. Additional evidence is here provided showing that SP not only causes tenocyte proliferation, but also contributes to anti-apoptotic events. Furthermore, it was concluded that SP may be involved in the development of tendinosis, since its production is increased in response to load, preceding tendinosis, and since SP accelerates tendinosis changes, through some mechanistic pathways here delineated. These findings suggest that inhibition of SP, and possibly also catecholamines, could be beneficial in the reconstitution/normalization of tendon structure in tendinosis.
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Bussin, Erin Rebecca. "Randomized controlled trial to evaluate the effects of topical diclofenac on the pain associated with chronic Achilles tendinopathy : a pilot study." Thesis, University of British Columbia, 2016. http://hdl.handle.net/2429/59289.
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Background:
Exercise-based rehabilitation for chronic Achilles tendinopathy (CAT) has proven to be effective, but it can be a painful process. The purpose of this research is to see if a topically applied non-steroidal anti-inflammatory drug, diclofenac, will be able to relieve the pain associated with chronic tendinopathy. The effects of diclofenac on subjects’ pain and mechanical hyperalgesia will be evaluated at rest and during simple calf exercises. It is expected that diclofenac will reduce pain among subjects with Achilles tendinopathy.
Methods:
19 subjects (22 Achilles) with CAT were randomly assigned to a crossover treatment order (active gel containing 10% diclofenac, or placebo). The primary outcome measure was pain level during tendon loading (hopping) and at rest. The secondary outcome measures evaluated tendon loading characteristics, and mechanical hyperalgesia over the lesion, and over the bilateral trapezius muscles.
Results:
Pain was significantly reduced from baseline with the use of diclofenac during tendon loading (p=0.0003) and rest (p=0.0313). At baseline the average resting pain was 3.05 (+/-1.43), with the use of diclofenac the pain was 2.32 (+/- 1.52), and with the use of placebo the pain was 2.68 (+/- 2.03). At baseline the average hopping pain was 4.82 (+/-2.1), with the use of diclofenac the average hopping pain was 3.05 (+/-1.81), and with the use of placebo the average pain was 3.77 (+/-2.76). During the hopping test, subjects were able to generate significantly more force when experiencing less pain (p<0.0001). The pressure pain threshold at the Achilles tendon was significantly increased from baseline with diclofenac treatment (p = 0.0275). There was no statistically significant difference between the diclofenac and placebo treatment in all cases.
Conclusion:
Diclofenac was able to improve symptoms and reduce pain during tendon loading and rest in subjects with CAT. Future studies can look at using topical diclofenac with loading exercises to build a more effective and tolerable rehabilitation program while determining the potential clinical significance of diclofenac vs placebo treatment. The pressure pain threshold at the Achilles tendon and distant regions should be further investigated to gain a better understanding of the pain mechanisms involved with this disorder.Medicine, Faculty of
Graduate
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Koszalinski, Alex Michael. "Trigger Point Dry Needling, Manual Therapy and Exercise versus Manual Therapy and Exercise for the Management of Achilles Tendinopathy| A Feasibility Study." Thesis, Nova Southeastern University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13423731.
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Background: The effect of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy are unknown. Objectives: To determine the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to exercise in a patient population with Achilles tendinopathy. Methods: This single-factor, pretest-posttest control group design included 22 subjects between the ages of 24 and 65 years with Achilles tendinopathy. Subjects were randomly assigned to either a control group (MT+Ex) or experimental group (TDN+MT+Ex). Subjects in both groups completed 8 physical therapy treatment sessions over 4 weeks. The intervention for the TDN+MT+Ex group included TDN to MTPs in the gastrocnemius, soleus or tibialis posterior each session while the same soft tissue mobilization and exercise program was conducted in both groups. Results: Within group analysis was performed for each group at 4 week and 90 day follow up. Significant improvement (p < .05) was achieved for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 90 days. The GROC was significant for MT + Ex at 90 days. The MCID for the FAAM, GROC were surpassed in both groups at 4 weeks and 90 days. NPRS surpassed the MCID for the MT + Ex group at 4 weeks. Conclusion: A large RCT to investigate the effects of TDN on MTP in Achilles tendinopathy is feasible with modifications. Recommendations: Special considerations for data collection sites should be given to the health care system, insurance payor, and financial burden to subjects.
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Abrahams, Yoonus. "The regulation of the COL5A1 gene via the 3' - UTR and its impact on Achilles Tendinopathy and other exercise-related phenotypes Yoonus Abrahams." Master's thesis, University of Cape Town, 2013. http://hdl.handle.net/11427/4234.
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Vieira, Cristiano Pedrozo 1986. "Efeito da nutrição terapêutica a base de Camellia sinensis (chá verde) e ração rica em glicina sobre a tendinite do tendão calcanear de rato = Effect of therapeutic nutrition on the basis of Camellia sinensis (green tea) and glycine-diet on the tendinitis of Achilles tendon of rats." [s.n.], 2015. http://repositorio.unicamp.br/jspui/handle/REPOSIP/317356.
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Orientador: Edson Rosa PimentelTese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: Nutrição terapêutica é a administração de alguns nutrientes, em doses maiores que as necessidades alimentares diárias que podem prevenir deficiências orgânicas e atuar como agentes farmacológicos. A glicina apresenta amplos efeitos benéficos em processos inflamatórios e tumorais. O Chá verde feito de folhas e brotos da planta Camellia sinensis, é a segunda bebida mais consumida em todo mundo. O interesse econômico e social tem ganhado espaço no mercado e atualmente seu consumo faz parte da rotina diária de muitas pessoas que utilizam essa bebida como uma finalidade terapêutica. O Chá verde possui propriedades antimutagênicas, antidiabéticos, antiinflamatórias, antioxidante, antimicrobial e hipocolesterolêmica. A tendinite é reconhecidamente um problema clínico que motiva a comunidade científica a buscar tratamentos que auxiliem no restabelecimento das propriedades funcionais dos tendões. O presente estudo investigou o efeito do chá verde e ou da ração rica em glicina após 7 e 21 dias da indução da tendinite com colagenase. Ensaios bioquímicos, moleculares, morfológicos e biomecânicos foram desenvolvidos. Além disso, tenócitos em cultura foram tratados com glicina após inflamação induzida por TNF-?. Nossos ensaios in vivo mostraram altas concentrações de hidroxiprolina e glicosaminoglicanos no grupo glicina e chá em 21 dias de tratamento. Nos ensaios biomecânicos os grupos chá verde e dieta de glicina em 21 dias suportaram maiores cargas biomecânicas antes da ruptura. Além disso, uma melhor organização das fibras de colágeno foi observada no grupo chá verde em 7 dias. Análises bioquímicas e moleculares da junção miotendínosa mostraram que a inflamação instalada na região osteotendinea pode provocar alterações significativas nesse local. Marcantes alterações foram notadas nas metaloproteínases (MMP) tais como MMP-2, MMP-8 e MMP-9 em animais com tendinite tratados ou não com chá verde e glicina. No estudo in vitro, tenócitos extraídos a partir de tendão de Aquiles foram tratados com TNF-?, seguindo ou não de tratamento com glicina em meio de cultura. Antes e após 24 horas da inflamação foi adicionado glicina. Tenócitos inflamados e tratados com glicina mostraram expressão de colágeno tipo I próxima aos grupos tratados com glicina previamente e depois da inflamação quando comparado ao grupo controle. Todos os grupos tratados com glicina mostraram menor expressão de MMP-2. A atividade da MMP-9 foi alta apenas no grupo tratado com glicina em 48 horas. A concentração de ácido urônico foi menor no grupo tratado com glicina 24 horas após a inflamação. No ensaio de migração celular, resultados em 24 horas de tratamento foram similares ao grupo controle. Em geral, tanto a glicina quanto o chá verde influenciam na síntese dos componentes do tendão, melhoram a organizaçao das fibras colagênicas, aumentam a resistência a cargas do tendão inflamado e consequentemente aceleram o processo de remodelamento após indução da tendinite. Além disso, o tratamento com glicina em cultura de tenócitos mostrou uma reorganização eficiente da matriz extracelular, corroborando com os resultados encontrados in vivo
Abstract: Therapeutic nutrition is the administration of some nutrients, in higher doses than those recommended for the daily food needs that can prevent dysfunctions and act as pharmacological agents. Glycine has large beneficial effects in inflammatory and tumor processes. Green tea made from leaves and buds of the Camellia sinensis plant, is the second most consumed beverage in the world. The economic and social interest has gained space in the market and currently its consumption is part of the daily routine of many people who use this drink as a therapeutic purpose. Green tea has antimutagenic, antidiabetic, anti-inflammatory, antioxidant, antimicrobial and hypocholesterolemic properties. Tendinitis is recognized as a clinical problem that motivates the scientific community to investigate treatments that help in restoring the functional properties of tendons. The present study investigated the effect of green tea and/or diet rich in glycine after 7 and 21 days of tendinitis collagenase-induced. Biochemical, molecular, morphological and biomechanical tests were developed. Furthermore, tenocytes in culture were treated with glycine after inflammation induced by TNF-?. Our tests in vivo showed high concentrations of hydroxyproline and glycosaminoglycans in glycine and green tea group in 21 days of treatment. In biomechanical assay, green tea and glycine diet groups in 21 days showed a high biomechanical loads bore before rupture. In addition, better organization of collagen fibers was observed in green tea group in 7 days. Biochemical and molecular analyzes of myotendinous junction showed that the inflammation installed in osteotendinious region can cause significant change in that region. Remarkable changes were noted in metalloproteinases (MMP) such as MMP-2, MMP-8 and MMP-9 in animals with tendinitis treated with or without glycine and green tea. In the in vitro study, tenocytes from Achilles tendon were treated with TNF-?, or not following treatment with glycine in the culture medium. Before and 24 hours after inflammation was added glycine. Tenocytes inflamed and treated with glycine showed expression of collagen type I close to the treated groups with glycine previously and after the inflammation when compared to the control group. All treated groups showed less glycine MMP-2 expression. The activity of MMP-9 was high only in the group treated with glycine for 48 hours. In the cell migration assay results in 24 hours of treatment were similar to the control group. In general, both glycine and green tea influenced the synthesis of the tendon components, improve the organization of the collagenous fibers, increase the load resistance of the inflamed tendon and consequently accelerate the remodeling process after inducing tendinitis. In addition, the treatment with glycine in tenocytes culture showed efficient reorganization of the extracellular matrix, confirming the results found in vivo
Doutorado
Biologia Celular
Doutor em Biologia Celular e Estrutural
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Grigg, Nicole Lorraine. "The acute adaptations of normal and pathological human Achilles tendons to eccentric and concentric exercise." Thesis, Queensland University of Technology, 2011. https://eprints.qut.edu.au/47048/1/Nicole_Grigg_Thesis.pdf.
Full textAbstract:
Eccentric exercise is the conservative treatment of choice for mid-portion Achilles tendinopathy. While there is a growing body of evidence supporting the medium to long term efficacy of eccentric exercise in Achilles tendinopathy treatment, very few studies have investigated the short term response of the tendon to eccentric exercise. Moreover, the mechanisms through which tendinopathy symptom resolution occurs remain to be established. The primary purpose of this thesis was to investigate the acute adaptations of the Achilles tendon to, and the biomechanical characteristics of, the eccentric exercise protocol used for Achilles tendinopathy rehabilitation and a concentric equivalent. The research was conducted with an orientation towards exploring potential mechanisms through which eccentric exercise may bring about a resolution of tendinopathy symptoms. Specifically, the morphology of tendinopathic and normal Achilles tendons was monitored using high resolution sonography prior to and following eccentric and concentric exercise, to facilitate comparison between the treatment of choice and a similar alternative. To date, the only proposed mechanism through which eccentric exercise is thought to result in symptom resolution is the increased variability in motor output force observed during eccentric exercise. This thesis expanded upon prior work by investigating the variability in motor output force recorded during eccentric and concentric exercises, when performed at two different knee joint angles, by limbs with and without symptomatic tendinopathy. The methodological phase of the research focused on establishing the reliability of measures of tendon thickness, tendon echogenicity, electromyography (EMG) of the Triceps Surae and the standard deviation (SD) and power spectral density (PSD) of the vertical ground reaction force (VGRF). These analyses facilitated comparison between the error in the measurements and experimental differences identified as statistically significant, so that the importance and meaning of the experimental differences could be established. One potential limitation of monitoring the morphological response of the Achilles tendon to exercise loading is that the Achilles tendon is continually exposed to additional loading as participants complete the walking required to carry out their necessary daily tasks. The specific purpose of the last experiment in the methodological phase was to evaluate the effect of incidental walking activity on Achilles tendon morphology. The results of this study indicated that walking activity could decrease Achilles tendon thickness (negative diametral strain) and that the decrease in thickness was dependent on both the amount of walking completed and the proximity of walking activity to the sonographic examination. Thus, incidental walking activity was identified as a potentially confounding factor for future experiments which endeavoured to monitor changes in tendon thickness with exercise loading. In the experimental phase of this thesis the thickness of Achilles tendons was monitored prior to and following isolated eccentric and concentric exercise. The initial pilot study demonstrated that eccentric exercise resulted in a greater acute decrease in Achilles tendon thickness (greater diametral strain) compared to an equivalent concentric exercise, in participants with no history of Achilles tendon pain. This experiment was then expanded to incorporate participants with unilateral Achilles tendinopathy. The major finding of this experiment was that the acute decrease in Achilles tendon thickness observed following eccentric exercise was modified by the presence of tendinopathy, with a smaller decrease (less diametral strain) noted for tendinopathic compared to healthy control tendon. Based on in vitro evidence a decrease in tendon thickness is believed to reflect extrusion of fluid from the tendon with loading. This process would appear to be limited by the presence of pathology and is hypothesised to be a result of the changes in tendon structure associated with tendinopathy. Load induced fluid movement may be important to the maintenance of tendon homeostasis and structure as it has the potential to enhance molecular movement and stimulate tendon remodelling. On this basis eccentric exercise may be more beneficial to the tendon than concentric exercise. Finally, EMG and motor output force variability (SD and PSD of VGRF) were investigated while participants with and without tendinopathy performed the eccentric and concentric exercises. Although between condition differences were identified as statistically significant for a number of force variability parameters, the differences were not greater than the limits of agreement for repeated measures. Consequently the meaning and importance of these findings were questioned. Interestingly, the EMG amplitude of all three Triceps Surae muscles did not vary with knee joint angle during the performance of eccentric exercise. This raises questions pertaining to the functional importance of performing the eccentric exercise protocol at each of the two knee joint angles as it is currently prescribed. EMG amplitude was significantly greater during concentric compared to eccentric muscle actions. Differences in the muscle activation patterns may result in different stress distributions within the tendon and be related to the different diametral strain responses observed for eccentric and concentric muscle actions.
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Andere, Nathalie Ferrari Bechara. "Fatores clínicos e biomecânicos associados com a tendinopatia de calcâneo em corredores fundistas." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-03052017-155858/.
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OBJETIVO: Avaliar características clínicas, componente vertical da força de reação do solo e função muscular de flexores plantares e dorsais do tornozelo em corredores com e sem tendinopatia de calcâneo, e em indivíduos não corredores. MÉTODOS: Setenta e dois indivíduos (42H: 30M, idade 37,3 ±9,9 anos) foram divididos em três grupos: grupo tendinopatia de calcâneo (GTC, n= 24), grupo de corredores controle (GCC, n=24), e grupo de não corredores (GNC, n=24), sendo que em cada grupo ambos os tornozelos foram avaliados. A AOFAS ankle-hindfoot score, parâmetros da força de reação do solo e dados isocinéticos foram avaliados usando plataformas de força e dinamômetro isocinético. RESULTADOS: A AOFAS ankle-hindfoot score foi significativamente menor no GTC. A FRS foi igual entre os grupos, porém o impulso vertical inicial foi maior no GTC que GCC e GNC. Não houve diferenças para o impulso total. O GTC demonstrou menor trabalho total na velocidade 120º/s que GCC. Não houve diferenças para as outras variáveis isocinéticas entre GTC e GCC, apenas em relação ao GNC. CONCLUSÃO: Os corredores com tendinopatia de calcâneo têm maior impacto no momento de aterrissagem, menor resistência muscular dos flexores plantares e maior comprometimento clínico e funcional. A associação do maior impulso e menor resistência pode ser um fator predisponente e mantenedor para lesão no tendão calcâneoOBJECTIVE: To evaluate the clinical characteristics, vertical component of the ground reaction force and muscle function of plantar flexors and dorsiflexors of the ankle in runners with and without Achilles tendinopathy and in non-runners. METHODS: Seventy-two subjects (42 M: 30W, 37.3±9.9 years old) were divided into three groups: Achilles Tendinopathy Group (GTC, n=24), Runners Control Group (GCC, n=24) and Non-Runners Group (GNC, n=24), in which both ankles were evaluated in each group. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, parameters of ground reaction force, and isokinetic data were evaluated by means of force platforms and isokinetic dynamometer. RESULTS: The AOFAS ankle-hindfoot score was significantly lower in the GTC. The GRF was similar between the groups; however, the initial vertical impulse was higher in the GTC than in the GCC and GNC. There were no differences regarding the total impulse. The GTC presented lower total work in the 120º/s speed than the GCC. There were no differences regarding the other isokinetic variables between the GTC and GCC, only regarding the GNC. CONCLUSION: Runners with Achilles tendinopathy show higher impact at the moment of landing, lower muscle endurance of plantar flexors and higher clinical and functional damage. The association between higher impulse and lower endurance could be a predisposing and maintaining factor for Achilles tendon
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Borella, Federica. "Tendon Neuroplastic Training, un nuovo approccio riabilitativo per la risoluzione del dolore e il ritorno allo sport nelle persone con tendinopatia achillea e patellare. Scoping review." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2020. http://amslaurea.unibo.it/21904/.
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Introduzione: le tendinopatie achillea e patellare sono le più frequenti a livello dell’arto inferiore e sono caratterizzate da sintomi persistenti quali dolore che si accentua col carico e compromissione della funzione. L’approccio riabilitativo tradizionale si basa su esercizi eccentrici isolati in carico, modalità che pare inefficace per circa il 45% dei pazienti. Stanno perciò emergendo nuove strategie riabilitative che includano altri tipi di contrazione muscolare. Si è ipotizzata una correlazione tra la persistenza dei sintomi e fenomeni di sensibilizzazione del SNC.
Obiettivo: analizzare le nuove strategie basate sul carico nel trattamento della TA e TP - in particolare l’HSR – e le componenti di sensibilizzazione del SNC che sembrano ostacolare la riabilitazione.
Materiali e metodi: consultazione delle principali banche dati. Si potevano includere studi primari e secondari. I soggetti dovevano presentare un quadro di TA o TP con eventuale associazione di alterazioni dell’elaborazione del dolore a livello centrale e dovevano essere sottoposti a un programma di esercizio eccentrico o ad HSR.
Risultati: 5 studi hanno soddisfatto i criteri di inclusione. Tre studi confermano l’efficacia dell’HSR per il raggiungimento degli outcome desiderati, ma non in maniera statisticamente significativa rispetto all’esercizio eccentrico. Due articoli analizzavano se fosse presente un quadro di sensibilizzazione del SNC nei soggetti con TA e TP. Entrambi affermano la presenza di un’alterazione della capacità di modulazione centrale del dolore.
Conclusioni: l’HSR risulta efficace per il trattamento della TA e TP in maniera sovrapponibile all’esercizio eccentrico tradizionale. L’alta percentuale di recidiva dei sintomi sembra causata da un’alterazione della capacità di modulare il dolore in questi pazienti. E’ necessario quindi ricercare nuove tipologie di trattamento - come il Tendon Neuroplastic Training - che tengano conto delle presenza di sensibilizzazione del SNC.
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Marques, Anna Cristina de Farias. "Efeito do laser de baixa intensidade no colágeno tipo I e III na metaloproteinase de matriz em modelo experimental de tendinopatia induzida por colagenase em tendão calcâneo de ratas idosas." Universidade Nove de Julho, 2015. http://bibliotecatede.uninove.br/handle/tede/1796.
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This study investigates the effect of low-level laser therapy (LLLT) on collagen type I and III, matrix metalloproteinase (MMP), and vascular endothelial growth factor (VEGF) in experimentally induced tendinopathy in female aged rats. Tendinopathy was induced by collagenase peritendinous of the Achilles tendon. Forty-two Wistar rats (Norvegicus albinus) were used; groups consisted of 36 aged animals (18 months old; mean body weight, 517.7 ± 27.54 g) and 6 adult animals (12 weeks old; mean body weight, 266 ± 19.30 g). The animals were randomlydivided in three groups: control, aged tendinopathy, and aged tendinopathy LLLT; the aged groups were subdivided according to experimental periods: 7, 14, and 21 days. LLLT involved a gallium-arsenide-aluminum laser (Theralaser, DMC®) with active medium operating at wavelength 830 ± 10 nm, 50 mW power, 0.028 cm2 laser beam, 107 J/cm2 energy density, 1.7 w/cm2 power density, and 6 J of energy, with a frequency of 3 times per week, until euthanasia. VEGF, MMP-3, and MMP-9 were analyzed by immunohistochemistry, and collagen type I and III by Sirius red. LLLT increased the deposition of collagen type I and III in a gradual manner, with significant differences relative to the group aged tendonitis (p<0.001), and in relation to VEGF (p<0.001); decreased expression of MMP-3 and 9 was observed in group aged tendinopathy (p<0.001). LLLT, therefore, increased the production of collagen type I and III, downregulated the expression of MMP-3 and MMP-9, and upregulated that of VEGF, with age and age-induced hormonal deficiency.
O objetivo deste estudo foi investigar O Efeito da terapia Laser de baixa intensidade no Colágeno tipo I e III, Metaloproteinase e VEGF em Modelo Experimental de Tendinopatia, em ratas fêmeas idosas. A colagenase foi induzida na região peritendínea no tendão Calcâneo dos animais. Quarenta e duas ratas Wistar (Norvegicus albinus) foram utilizadas no estudo, com grupos consistindo de 36 animais idosos (18 meses de idade; com média da massa, 517.7 ± 27.54 g) e 6 animais adultos (12 semanas de idade; média da massa, 266, 19:30 0 ± g). Os animais foram randomizados e divididos em três grupos, Controle, tendinopatia idoso e tendinopatia Laser idoso, e subdividido em três grupos experimentai, 7, 14 e 21 dias. O tratamento com Laser de baixa intensidade foi aplicado utilizando um Laser Arseneto de Galium e Alumínio (AsGaAl) (Theralaser, DMC®) operando no comprimento de onda de 830nm (±10nm), 50 mW de potência, saída do feixe de 0,028 cm2, densidade de energia de 107J /cm2, densidade de potência 1,7 w/cm2 e energia de 3 J, com uma frequência de 3 vezes por semana, até a data da eutanásia (7, 14 e 21 dias). Foram analisados VEGF e MMP 3 e 9 por meio de Imunohistoquímica e Colágeno tipo I e III por Sirius red. Os resultados sugerem que a Terapia a Lesar de Baixa Intensidade foi capaz de aumentar os níveis de Colágeno tipo I e III de maneira gradual e com significante diferença no grupo Tendinpatia Idoso (p<0,001), isso pode ser observado em relação ao VEGF (p<0.001), foi também observado diminuição da expressão de MMP 3 e MMP 9 em relação ao grupo tendinopatia Idoso, com diferença estatística (p<0,001). Nós concluímos que a terapia Laser de Baixa Intensidade foi capaz de diminuir a produção de Colágeno tipo I e III, reduzir a expressão de MMP 3 e 9, e aumentar a expressão de VEGF, mesmo nas ratas fêmeas idosas com deficiência hormonal causada pela idade.
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Alsousou, Joseph. "Platelet rich plasma in regenerative tendon repair mechanobiological interactions and clinical application." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:2692c00e-0c0d-4096-8daa-c00ad47fd03d.
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Tendon injury prevalence in both athletic and occupational settings is on the increase. Tendon healing properties are poor, despite the complex biological process triggered by the injury, which makes those injuries incapacitating for months. A significant proportion of these injuries remain difficult to treat, and many patients suffer from decreased performance and longstanding sequelae. While mechanical stabilization has been a hallmark of tendon surgical management, orthobiologics are playing an increasing role in optimizing tendon healing. Platelet rich Plasma (PRP), which is a volume of autologous plasma having platelet concentration above baseline, has been suggested as an accelerant orthobiological agent rich in supraphysiological concentration of growth factors. However, strong evidence of its mode of action and of its clinical efficacy is lacking. The purpose of this thesis is to identify the role of PRP in tendon regeneration in in-vitro and clinical studies. Firstly, the viability and biological components of clinically-prepared PRP were studied in novel experiments. This PRP was used in linked in-vitro studies to investigate the possible mechanism of PRP effect on the injured Achilles tendon cells and tissues. Cell count, viability, proliferation and DNA content were studied. The clinical application of PRP in Achilles tendon rupture was assessed in a randomised clinical pilot study using a combination of PROMs, objective outcome measures and a novel imaging modality called functional ultrasound elastography. This non-invasive technique was developed in a healthy-tendons volunteer study and its feasibility in ruptured tendons was assessed in the pilot trial. In another unique study, the immunohistochemical response to PRP was assessed in biopsies taken under US guidance at week 6 and compared to control to explore the possible mechanism of PRP effects. The findings confirmed that PRP is a viable activatable autologous blood product rich in growth factors. The results also confirmed that leukocytes and platelets are present in very high concentration with reversal of lymphocyte neutrophil ratio. Elastography volunteer study confirmed that FUSE is feasible using clinically applicable ultrasound scan. The improved algorithm allowed visualisation of localised strain within the studied tissues. The clinical application of PRP in Achilles tendon rupture revealed positive efficacy signal that PRP led to faster healing, improved pain and earlier restoration of function. However, the findings of this pilot trial were indicative and not confirmative. Immunohistochemistry analysis showed that PRP enhanced the maturity of the healing tendon tissues by promoting better collagen I deposition, improved Collagen III/Collagen I ratio, reduced cellularity, better vascular structure and higher GAGs content when compared with control. The finding may explain the clinical improvement observed in these patients at week 6 onwards. Linked in-vitro studies showed that autologous PRP with its cellular components, which include platelets, leukocytes and erythrocytes, has the ability to stimulate tendon cell migration to the injury site and stimulate proliferation in the injured human tendon. Additionally, it may maintain tissue viability in the hypoxic environment that follows tendon injury. Promoting migration and proliferation of cells and maintain tissue viability may play an important role to accelerate tendon healing. The findings of this project has informed the design of a phase II large multi-centre randomised controlled trial and helped secure major funding from the National Institute of Health Research (NIHR). This trial will set the scene for PRP use in tendon treatment.
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Vogel, Gunilla. "Dorsalflexion i första metatarsofalangealleden och naviculare position hos motionärer med Achilles tendinopati i mittportionen." Thesis, Gymnastik- och idrottshögskolan, GIH, Institutionen för idrotts- och hälsovetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:gih:diva-3811.
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Sammanfattning Syfte och frågeställningar: Syftet med denna studie var att a) undersöka om motionärer med Achilles tendinopati (AT) i mittportionen har nedsatt dorsalflexion i första metatarso- falangealleden (MTP 1-leden) på affekterad sida jämfört med frisk b) undersöka om det finns sidoskillnader i naviculare position samt c) undersöka vilken metod - goniometermätning (GM) eller visuell estimation (VE) - som är att föredra vid mätning av dorsalflexionen i MTP 1-leden. Frågeställningarna var följande: Hur förhåller det sig med skillnaden för dorsalflexion i MTP 1-leden då affekterad sida jämförs med frisk hos motionärer med AT? Hur förhåller det sig med sidoskillnaden för fotvalvets höjd ? Hur förhåller det sig med sidoskillnaden för den vertikala rörligheten i mellanfoten? Hur förhåller det sig med mätvärdet för dorsalflexion i MTP 1-leden då affekterad sida jämförs med frisk vid användandet av respektive mätmetod (GM och VE)? Hur förhåller det sig med den samtidiga validiteten mellan VE och GM vid mätning av dorsalflexionen i MTP 1-leden? Metod: 28 patienter med unilateral AT (medelålder 39 år, symtomtid median 12 veckor), rekryterades konsekutivt. Patienterna diagnosticerades kliniskt, nedre extremitet screenades för rörelseinskränkningar i sagittalplanet, naviculares höjd (NH) mättes i två positioner och naviculare drop (ND) beräknades. MTP 1-leden fotograferades tre gånger i standardiserad mätposition och dorsalflexionen mättes med GM på fotografierna som randomiserats. Fotografierna med det högsta mätvärdet för respektive fots dorsalflexion i MTP 1-leden användes randomiserat för VE som utfördes med protokoll för standardisering. Resultat: Motionärer med AT uppvisade signifikant lägre medelvärde (p=0,015) för dorsalflexionen i MTP 1-leden på affekterad sida jämfört med frisk. Ingen signifikant sidoskillnad på medelvärdena för fotvalvets höjd (NH) eller på medelvärdena för vertikal rörlighet i mellanfoten (ND) förelåg. GM uppvisade signifikant högre medelvärde (p=0,0009) för dorsalflexion i MTP 1-leden jämfört med VE. Oavsett mätmetod (GM och VE), visade resultatet även ett signifikant (p= 0,047) högre medelvärde för dorsalflexionen i MTP 1-leden på frisk sida jämfört med affekterad. Pearson korrelation test visade r= 0,90 på frisk respektive r=0,86 på affekterad sida då metoderna VE och GM undersöktes för samvarians. Konklusion: Motionärer med unilateral AT har nedsatt dorsalflexion i MTP 1-leden på den affekterade sidan jämfört med friska. Inga sidoskillnader verkar finnas beträffande naviculare position. GM är att föredra framför VE vid klinisk mätning av dorsalflexion i MTP 1-leden, eftersom rörligheten underestimerades vid VE.Abstract Aim: The aim of this study was to a) investigate if recreational athletes diagnosed with midportion Achilles tendinopathy (AT) have restricted dorsiflexion in the 1st metatarsophalangeal (MTP) joint on affected side, compared to non-affected, b) investigate whether there are side side differences in naviculare position and also c) investigate which method - goniometric measurement (GM) or visual estimation (VE) - is preferable in measurement for dorsiflexion in the 1st MTP joint. The questions were: Is there a difference for dorsiflexion in the 1st MTP joint when comparing the affected side with the unaffected? Is there a side difference for the height of the medial longitudinal arch? Is there a side difference for the size of midtarsal vertical movement? Are there differences between the values of dorsiflexion in the 1st MTP joint using the respective method (GM and VE) when comparing the affected side to the unaffected? Does the method VE exhibit concurrent validity with the method GM in measuring dorsiflexion for the 1st MTP joint? Method: 28 patients with unilateral AT (mean age 39 years, weeks of symptoms median =12) were consecutively recruted. The patients were diagnosed clinically, the lower extremity was screened for restrictions in the sagittal plane, naviculare height (NH) was measured in two positions and navicular drop (ND) was calculated. The 1st MTP joint was photographed three times in a standardized position, and the dorsiflexion was measured by GM in the photos, which were randomized. The highest value measured for dorsiflexion in the 1st MTP joint for each foot was used for VE, and a protocol was used to standardize. Results: There was a significantly restricted dorsiflexion (p=0.015) in the 1st MTP joint on the affected side for recreational athletes with AT. There was no significance between the height of the longitudinal arch (NH) or the size of midtarsal vertical movement (ND) when comparing the affected side to the unaffected. Using GM there was a significantly higher mean (p= 0.0009) for dorsiflexion in the 1st MTP joint compared to VE. The mean was also significantly higher for dorsiflexion in the 1st MTP joint, using GM as well as VE, on the unaffected side, compared to the affected. When the methods VE and GM were examined for covariance, Pearson's correlation test showed r = 0.90 to the unaffected side and r = 0.86 to the affected side. Conclusions: Recreational athletes with unilateral AT have a restriction of dorsiflexion in the 1st MTP joint on the affected side compared to the unaffected. There were no side differences found between naviculare position. GM is to be chosen over VE for clinical measurements of dorsiflexion in the 1st MTP joint, since VE underestimated the range of motion.
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Bignami, Stefano. "Quale efficacia dell’esercizio terapeutico nella Tendinopatia Achillea? Una Revisione della Letteratura esistente." Bachelor's thesis, Alma Mater Studiorum - Università di Bologna, 2022. http://amslaurea.unibo.it/25936/.
Full textAbstract:
Background: la tendinopatia Achillea è uno dei più frequenti infortuni da uso eccessivo del distretto caviglia-piede. Le fonti del dolore in questa patologia sono complesse e ancora non completamente comprese.
Obiettivo: lo scopo di questa revisione è di valutare l’efficacia dell’esercizio terapeutico nella gestione del dolore nei pazienti con tendinopatia Achillea quando comparato al decorso naturale della patologia, ad altre modalità di intervento di competenza fisioterapica o ad altre tipologie/modalità di esercizio terapeutico/stretching e, possibilmente, identificare quali di queste proposte, e secondo quali parametri, abbiano mostrato una validità superiore
Disegno dello studio: revisione sistematica della letteratura.
Metodi: è stata condotta una ricerca nelle banche dati PubMed e PEDro. Sono stati inclusi solo i Trial Clinici Randomizzati (RCT) mentre sono stati esclusi protocolli di studio e studi non randomizzati. Gli articoli utilizzati sono stati ricercati in full-text e in lingua inglese, senza limiti temporali.
Risultati: sono stati inclusi 19 studi, tutti RCT, con una qualità metodologica variabile. La maggior parte degli studi ha considerato pazienti con tendinopatia Achillea non inserzionale (79%). Sono state comparate diverse tipologie di trattamento, volte alla gestione e risoluzione della sintomatologia dolorosa legata alla tendinopatia Achillea. Diversi studi hanno sottolineato la superiorità dell’esercizio eccentrico rispetto al wait-and-see e ad altri approcci convenzionali. In altri studi, affiancare l’esercizio eccentrico con altre modalità terapeutiche ha prodotto risultati migliori rispetto al solo esercizio eccentrico.
Conclusioni: l’esercizio eccentrico sembra essere l’esercizio terapeutico più efficace nel trattamento della tendinopatia Achillea. Data la sua semplicità di esecuzione, i bassi costi e la relativa sicurezza, dovrebbe essere considerato alla base di un programma di riabilitazione della tendinopatia Achillea.
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Müller, Steffen. "Die belastungsspezifische neuromuskuläre Antwort bei Athleten mit Tendinopathie der Achilles- oder Patellarsehne : Analysen der funktionalen und therapeutischen Effekte eines sensomotorischen Trainings." Potsdam Univ.-Verl. Potsdam, 2008. http://deposit.d-nb.de/cgi-bin/dokserv?id=3095894&prov=M&dokv̲ar=1&doke̲xt=htm.
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Müller, Steffen. "Die belastungsspezifische neuromuskuläre Antwort bei Athleten mit Tendinopathie der Achilles- oder Patellarsehne Analysen der funktionalen und therapeutischen Effekte eines sensomotorischen Trainings." Potsdam Univ.-Verl, 2007. http://d-nb.info/988467984/04.
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Müller, Steffen [Verfasser]. "Die belastungsspezifische neuromuskuläre Antwort bei Athleten mit Tendinopathie der Achilles- oder Patellarsehne : Analysen der funktionalen und therapeutischen Effekte eines sensomotorischen Trainings / Steffen Müller." Potsdam : Univ.-Verl, 2008. http://d-nb.info/1000231453/34.
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Rossi, Rafael Paolo. "Avaliação do processo de reparo tecidual em tendão de Aquiles de ratos após indução de tendinopatia por colagenase: efeito do laser de baixa intensidade e de drogas anti-inflamatórias." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/42/42136/tde-23012012-131838/.
Full textAbstract:
Introdução: A tendinopatia de Aquiles caracteriza-se pela presença de sinais clássicos da resposta inflamatória, como o edema e a dor, além de alterações estruturais no tecido. Neste estudo avaliamos o processo de reparação e reorganização tecidual de tendões de ratos submetidos a tendinopatia por colagenase, sendo posteriormente tratados com laserterapia de baixa intensidade, anti-inflamatório esteroidal e anti-inflamatório não-esteroidal. Materiais e Método: Ratas Wistar fêmeas foram submetidas a injeção transcutânea de colagenase (100mg/tendão) na região peritendínea das patas e posteriormente divididas e tratadas nos seguintes grupos: laser (3J), diclofenaco potássico (1,1mg/kg) e dexametasona (0,02mg/kg). Foram realizadas análises histomorfológicas, incluindo o score de achados, quantidade de colágeno presente no tecido e nível de agregação/organização das fibras colágenas. Resultados e Discussão: A colagenase produziu o aumento de células inflamatórias, extravasamento plasmático e hemorragia. Entre os tratamentos testados, o laser mostrou-se a melhor opção, atenuando a resposta inflamatória, aumentando a concentração de colágeno e mantendo a organização das fibras colágenas.Introduction: Achilles tendinopathy is characterized by presence of classical signs of inflammatory response such as edema, pain, and structural changes in tissue. In this study we evaluated the repair process and tissue reorganization of rats tendons submitted to collagenase induced tendinopathy, being posteriorly treated with low-level laser therapy, steroidal anti-inflammatory and non-steroidal anti-inflammatory. Materials and Methods: Female Wistar rats were submitted to transcutaneous collagenase injection (100mg/tendon) at paws peritendinous site and posteriorly divided and treated in following groups: laser (3J), potassium diclofenac (1.1mg/kg), and dexamethason (0.02mg/kg). Histomorphological analyses were made including findings score, tissue collagen amount and collagen fibers aggregation/organization levels. Results and Discussion: Collagenase produced enhancement of inflammatory cells, edema and hemorrhage. Laser therapy showed be the better option between tested treatments, decreasing inflammatory response, increasing collagen concentration and mantaining collagen fibers organization.
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Yun-BinLiu and 劉允斌. "Effect of Rehabilitation Exercise on Achilles tendinopathy- a Rat Model." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/09937516324213648871.
Full textAbstract:
碩士國立成功大學
生物醫學工程學系
102
The Achilles tendon plays an important role in plantar flexion of ankle joint. The Achilles tendinopathy often occurs in athletes and it associates with tenderness, pain, and the long duration of conservative treatments. Strengthening and stretching exercises are commonly adapted to improve the pain score or activity level in clinical rehabilitation. The purpose of this study is to investigate the effects of different rehabilitation protocols on mechanical properties and sonographic assessments of the Achilles tendon with a rat model. The tendinopathy rat model was established by injecting collagenase in the Achilles tendon. After resting for 4 weeks, 12-week-old male Sprague-Dawley rats with a medium severity level of sonographic assessments were randomly assigned to 4 groups, eccentric group, concentric group, passive range of motion group, and control group. A self-designed rehabilitation system was developed and used to control the angular velocity, the range of motion of ankle joint and contraction types, as well as generate calf muscles contraction using electrical stimulation. After 6 weeks of training, the sonographic assessments were tested. Then the specimen, including parts of gastrocnemius, Achilles tendon and calcaneus, was collected for the following tensile testing. By Mann-Whitney analysis, there are significant differences between EE and CE groups in their maximum force (p=0.032) and maximum stress (p=0.032). However, neither maximum stress nor maximum force has correlation with integral torque. The results might explain why isolated eccentric exercise has better clinical effects on healing Achilles tendinopathy than isolated concentric exercise. The higher torque exerted from eccentric than concentric contraction may not be the dominant impact on why eccentric exercise is more effective than concentric exercise for healing Achilles tendon. In addition, correlating the results of mechanical testing with sonographic assessments, there are moderately negative correlation between Young’s modulus and echogenicity (r=-0.483), as well as moderate correlation between cross-sectional area and vascularity (p=0.469). These results provide the links from the non-invasive sonographic assessments to the mechanical properties of the tendon.
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Mostecká, Dagmar. "Tendinopatie achillovy šlachy jako důsledek funkčních poruch pohybového aparátu." Master's thesis, 2009. http://www.nusl.cz/ntk/nusl-274412.
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This diploma thesis deals with the Achilles tendinopathy, and particularly with its etiopatogenetics. The theoretical part includes information about the Achilles tendon, tendinopathy of Achilles tendon and a summary of dysfunctions of the locomotor system. We assumed that the dysfunction of the locomotor system is the main etiopatogenetic factor of the Achilles tendinopathy, and that it results in changes of its position and loading. In the practical part we tried to reveal these dysfunctions by examination of seven patients, and to prove its main etiopatogenetic influence by a successfull therapy. The aim of the thesis was to point out the importance of the examination as well as the therapy of the locomotor systems function. Powered by TCPDF (www.tcpdf.org)
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Robinson, Jennifer Mary. "Assessment of the Visa-A questionnaire for Achilles tendinopathy and its correlation with imaging." Thesis, 2000. http://hdl.handle.net/2429/10746.
Full textAbstract:
Background: Because Achilles tendon disorders, which are common, have a
significant morbidity among athletes, further research into efficacious treatments is
necessary. Yet there is a lack of objective or quantifiable outcome measurement tools.
Purpose: The purpose of this thesis was to investigate outcome measurement tools
used in Achilles tendinopathy research. In particular clinical measures that quantify the
severity of the patient's condition and ultrasound and magnetic resonance imaging
were examined.
Methods: A 3-month prospective study was done.
Participants: Forty five consecutive patients (27 men, 18 women; mean age 42 years,
range 20-66 years) with 57 symptomatic and 33 asymptomatic Achilles tendons (mean
duration 21 months, range 0.5 - 120 months) were admitted to the study.
Results: The VISA-A questionnaire had construct validity. The VISA-A scores of the
45 subjects correlated significantly (p<0.01) with their scores on two other clinical
severity grading systems. There was also a significant difference in scores among the
45 symptomatic subjects (mean 63.75 ± 16.81) compared to the VISA-A scores of 66
asymptomatic University students (mean 95.95 ± 7.41) (p<0.01). The test-retest
reliability was 0.930, the interrater reliability was 0.903, the intrarater reliability was
0.903 and the short term reliability was 0.805.
Ultrasound had a sensitivity of 0.65 and specificity of 0.67 and an overall accuracy of
0.66. The addition of colour and power doppler interrogation did not enhance the
accuracy of US. MRI had a sensitivity of 0.56, a specificity of 0.94 and an overall
accuracy of 0.68.
At 3 month follow up 7 of the 45 patients had improved, 37 remained the same and 1
had worsened. Only the baseline VISA-A score correlated with the 3 month results
(p<0.01) neither US nor MRI was able to differentiate between cases that would
improve and those that would worsen.
Conclusion: The VISA-A index of severity for Achilles tendon disorders offers a
valid, reliable and quantifiable outcome measurement tool useful clinically and in
research. Imaging lacked sensitivity and therefore not suitable as an outcome measure.
Neither imaging modality proved more accurate but because of the cost and
accessibility US would be preferred when imaging is required.
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Yun-PuTsai and 蔡雲圃. "Quantitative analyses of gait behavior and nociception of radiofrequency treated acute Achilles tendinopathy in rat." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/40284343435145043950.
Full textAbstract:
碩士國立成功大學
細胞生物及解剖學研究所
100
Achilles tendinopathy is caused by excessive use or loading of physical force of the tendon and it is commonly occurred among athletes. The patient is in general treated conservatively. Radiofrequency (RF) has been proven to be an effective method to relieve pain in those patients. Currently, the pathophysiology of tendinopathy is thought to be associated with a failed healing response. In this study, collagenolytic agent was injected to the Achilles tendon to generate tendinopathy in Sprague-Dawley (SD) rat. The effects of RF, specifically, on changes of pain-related neuropeptides release and gait behavior in acutely post RF treated SD rats were examined. Collagenase І (0.3mg/20ul) or Phosphate-Buffer Saline (PBS) was injected to the rat Achilles tendon as the experiment and sham control groups. SD rats underwent skin incision over the Achilles tendon were served as normal control. The experiment was following a time-course schedule to exam post collagenase I injection on 1,3,5,7,9,11,13,15 days to examine pathohistology and gait changes. RF treatment was on day 8 after collagenase injection. Substance P, Calcitonin gene related peptide(CGRP) and Galanin expressions were examined by immunohistochemical (IHC) staining to evaluate nociception. β III tubulin immunofluorescence (IF) staining was used to evaluated nerve fiber change. Masson trichrome staining of tendon was used to examine collagen change. The gait parameters recorded and analyzed in this study included gait pattern time (stance phase, double stance phase, walk speed), distance (step length, step width, stride length, print length, intermediary toe-spread), and range of motion (initial contact, mid‐stance, pre‐swing, mid‐swing, foot angle). Substance P and CGRP IHC staining showed that the nociception was increased on the days 1, 3, 5, 7, but Substance P (n=5, p〈0.001) and CGRP (n=5, p〈0.001) decrease after RF treatment. Galanin IHC staining showed that there was no significance change in rats underwent RF treatment. β III tubulin IF staining showed that the nerve fiber density and diameter increased on the days 1, 3, 5, 7 when compared to the normal controls. However, the nerve fibers diameter (n=5, p〈0.001) were decreased after RF treatment. Masson trichrome staining showed that the tension increased after chemical injury. In post-RF treated groups, the stance phase (n=7, p〈0.05), step length (n=8, p〈0.05), intermediary toe-spread (n=8, p〈0.01) and pre‐swing (n=8, p〈0.05), were significantly different from shame and normal controls. These changes suggest that RF treatment improves gait behavior in acute tendinopathy, which allows rat ambulate toward to the normal gait pattern. Nociception is different in different time intervals, which may cause differences in gait pattern. RF treatment decreases nociception neuropeptides release, decrease nerve fiber diameter in injured Achilles tendon, improves pain and makes rat walk better. In conclusion, this study provides the first detailed analysis of RF effects on acute Achilles tendinopathy in rat. Whether these data would apply to the patients with pain in early stage of Achilles tendinopathy might require further evaluation.
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Voleský, Kryštof. "Analýza rizikových faktorů pro vznik tendinopatií u běžců - literární rešerše." Master's thesis, 2021. http://www.nusl.cz/ntk/nusl-447443.
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Title: The analysis of risk factors for tendinopathy in runners Objectives: The aim of this thesis is to find out the most important risk factor for development of Achilles tendinopathy, detect the most relevant diagnostic approach with preventive monitoring for Achilles tendinopathy and evaluate the best treatment for Achilles tendinopathy in runners. Methods: The diploma thesis is in form of literary review. The Scopus, PubMed and Web of science databases were used to search for studie using a combination of keywords. A total of 1084 titles were identified. Due to duplicates 402 titles were excluded. On the basis of the name of the article 51 titles were included. On the basis of the availability 50 titles were included. On the basis of the abstract 46 titles were included. Finally 29 titles were included in this review. Results: The most important risk factor for development of Achilles tendinopathy was training intensity for distances 1500-3000 m, week running volume >65 km or being new to running. The most relevant diagnostic approach for Achilles tendinopaty was clinical examination assessing pain (Achilles tendon pain, positive palpation test) and function (pain during physical aktivity) of Achilles tendon. This approach serves as indication for sonographic assessment of Achilles tendon...