ObjectivesTo establish quantitative values of stiffness for the gastrocnemius muscle in patients diagnosed with Achilles tendinopathy.DesignCase–control study with a single (cross sectional) time point of patients diagnosed with unilateral Achilles tendinopathy and an asymptomatic group.MethodsSample of 50 participants: 25 participants with symptomatic unilateral Achilles tendinopathy (symptomatic group) with the asymptomatic side of this group used as a control (control group 1). A third group of 25 participants with asymptomatic Achilles tendons (control group 2). Mechanical stiffness parameters, including natural oscillation frequency (F), dynamic stiffness (S), mechanical stress relaxation time (R), logarithmic decrement (D) and creep (C), were assessed using the MyotonPRO. Measurements at the medial and lateral gastrocnemii were taken as non-weight bearing (NWB) and weight bearing (WB).ResultsSignificant (p<0.05) differences were observed between the mean symptomatic group and control groups 1 and 2 in the WB and NWB conditions for natural oscillation frequency (F), dynamic stiffness (S), and creep (C). There was a significant reduction in S WB and conversely a significant increase in S of the symptomatic group NWB. Creep (C) and mechanical stress relaxation time (R) were significantly (p<0.05) less in the symptomatic group NWB. Significant differences were observed between the NWB and WB data sets for logarithmic decrement (D). NWB D demonstrated significantly (p<0.05) higher scores than the WB condition.ConclusionThis study demonstrated that there was a significant reduction in stiffness of the gastrocnemius muscle in participants with Achilles tendinopathy compared with the two control groups. The WB MyotonPRO measures for the symptomatic groups of F and S were significantly lower, indicating a decrease in the tonal properties (F) and dynamic stiffness (S) of the muscle. The application of MyotonPRO technology to measure changes in stiffness in the gastrocnemius muscle may be useful to measure as part of a rehabilitation programme where specific attention could be placed to increase the tonal properties of the muscle. Further studies are required to develop a robust clinical application of this technology, particularly with regard to Achilles tendinopathy.

Purpose: This study aims to investigate the benefits of Point of Care (POC) ultrasound and Scheduled Ultrasound Clinics using a Proof of Concept approach in the orthopaedic triage setting.Materials and Methods: The trial ran for a six week period sourcing all patients referred to the orthopaedic triage service. The trial collected three measurable outcomes i.e. two Patient Reported Outcome Measures: MSK-HQ and The Care Measure, and a Proof of Concept clinician survey via Survey Monkey. These were completed by the clinicians and patient cohort during the scheduled clinic and POC clinical contact.Results: A total of 135 patients received a diagnostic ultrasound scan over the six week trial period. 34 patients received a diagnostic ultrasound scan from the Extended Scope Practitioner  (ESP) Physiotherapist in a Scheduled Care setting. 101 patients received a diagnostic ultrasound scan from the ESP Podiatrist in orthopaedic triage over the six week period (74 in Scheduled care clinics and 27 at Point of Care). The outcome measure suggest that patients recieved a rapid diagnosis (n.135), implementation of appropriate treatment pathway (86.36%), a positive impact on Referral to Treatment (88.55%), appropriate implementation of conservative treatment (91.11%) and had excellent co-production during the trial with an 88% average CARE Measure Score.  The MSK-HQ results suggested a wide variety of muscuoskeletal conditions were asseessed during the trial with a mean MSK-HQ score of 27.6 with a Standard Deviation of 12.Conclusion: Results from clinician sourced Survey Monkey data, The CARE Measure and MSK HQ suggest that POC ultrasound and Scheduled care clinics offer a positive benefit for the patient’s care pathway, are beneficial clinically and suggest adequate demand for the service.

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Objectives. To establish quantitative values of stiffness for the Achilles tendon (AT) and Gastrocnemius muscle (GM) in participants weight bearing and non-weight bearing. Methods. Measurements of 25 participants taken bilaterally at 8 points along the AT, and 2 points at the GM included: Natural Oscillation frequency (F), dynamic stiffness (S), mechanical stress relaxation time (R), logarithmic decrement (D) and creep (C) were taken non-weight bearing (NWB) and weight bearing (WB) using the Myoton-PRO. Results. Median WB F scores were significantly higher than NWB F scores. D was significantly (P<0.005) higher NWB than WB for both AT and GM. S decreased from point 1 to point 8. GM S measurements were significantly (P<0.005) higher WB to NWB. C increased along course of tendon in the NWB condition and was significantly (P<0.005) higher at the GM. R was significantly (P<0.005) higher in the NWB condition for the AT and GM. R incrementally increased along the course of the AT in both NWB and WB conditions. Conclusions. There was an overall increased stiffness of the AT and GM during the weight bearing condition compared to the non-weightbearing condition. Further studies are required to develop a robust clinical application of this technology.