Adiposity and tendinopathy

Gaida, James Edmund; Cook, Jillianne Leigh; Bass, Shona

doi:10.1080/09638280701786864

Cited by 74 publications

(46 citation statements)

References 74 publications

(55 reference statements)

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“…Over the past decades there has been increasing focus on metabolic factors as contributors to tendon pathology. Based on epidemiological and clinical case-control studies, obesity has been proposed as a risk factor for developing tendon pathology, independent of the increased mechanical loading associated with obesity (24,25). Mechanical changes of weight-bearing tendons have been reported in obese animal models.…”

Section: Discussionmentioning

confidence: 98%

Systemic stiffening of mouse tail tendon is related to dietary advanced glycation end products but not high-fat diet or cholesterol

Eriksen

Svensson

Scheijen

et al. 2014

Journal of Applied Physiology

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Tendon pathology is related to metabolic disease and mechanical overloading, but the effect of metabolic disease on tendon mechanics is unknown. This study investigated the effect of diet and apolipoprotein E deficiency (ApoE(-/-)) on mechanical properties and advanced glycation end product (AGE) cross-linking of non-weight-bearing mouse tail tendons. Twenty ApoE(-/-) male mice were used as a model for hypercholesterolemia along with 26 wild-type (WT) mice. One-half of the mice from each group was fed a normal diet (ND) and the other half was fed a high-fat diet (HFD) to induce obesity. All were killed at 40 wk, and tail tendon fascicles were mechanically tested to failure and analyzed for AGEs. Diets were also analyzed for AGEs. ApoE(-/-) mice displayed a 14% increase in plateau modulus compared with WT mice (P < 0.05), whereas HFD mice displayed a 13% decrease in plateau modulus (P < 0.05) and a 12% decrease in total modulus (P < 0.05) compared with ND mice. Tail tendons of HFD mice had significantly lower concentrations of AGEs [carboxymethyllysine (CML): 26%, P < 0.0001; methylglyoxal-derived hydroimidazolone 1 (MG-H1): 15%, P < 0.005; pentosidine: 13%, P < 0.0005]. The HFD had ∼44-fold lower content of CML (P < 0.01), ∼29-fold lower content of carboxyethyllysine (P < 0.005), and ∼16-fold lower content of MG-H1 (P < 0.05) compared with ND. ApoE(-/-) increased, whereas HFD decreased mouse tail tendon stiffness. Dietary AGE content may be a crucial determinant for accumulation of AGE cross-links in tendons and for tissue compliance. The results demonstrate how systemic metabolic factors may influence tendon health.

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Section: Discussionmentioning

confidence: 98%

Systemic stiffening of mouse tail tendon is related to dietary advanced glycation end products but not high-fat diet or cholesterol

Eriksen

Svensson

Scheijen

et al. 2014

Journal of Applied Physiology

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“…37,38,40,41,63 Systemic pathological drivers associated with tendinopathy include increased central adiposity, [ clinical commentary ] CONCLUSION P atellar tendinopathy can frequently be difficult to manage. This review highlights key clinical aspects in diagnosis, examination, and management.…”

mentioning

confidence: 99%

Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations

Malliaras¹,

Cook²,

Purdam³

et al. 2015

Journal of Orthopaedic & Sports Physical Therapy

237

207

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® T t SYNOPSIS:The hallmark features of patellar tendinopathy are (1) pain localized to the inferior pole of the patella and (2) load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon. While imaging may assist in differential diagnosis, the diagnosis of patellar tendinopathy remains clinical, as asymptomatic tendon pathology may exist in people who have pain from other anterior knee sources. A thorough examination is required to diagnose patellar tendinopathy and contributing factors. Management of patellar tendinopathy should focus on progressively developing load tolerance of the tendon, the musculoskeletal unit, and the kinetic chain, as well as addressing key biomechanical and other risk factors. Rehabilitation can be slow and sometimes frustrating. This review aims to assist clinicians with key concepts related to examination, diagnosis, and management of patellar tendinopathy. Difficult clinical presentations (eg, highly irritable tendon, systemic comorbidities) as well as common pitfalls, such as unrealistic rehabilitation time frames and overreliance on passive treatments, are also discussed. J Orthop Sports Phys Ther 2015;45(11):887-898. Epub 21 Sep 2015. doi:10.2519/jospt.2015 can induce pathology and a change in the tendon's mechanical properties, which is a risk factor for developing symptoms. 17,61 Energy-storage load is defined in this article as high tendon load, because it is associated with tendon injury.Although the relationship between pain and tendon pathology is unclear, the presence of pathology appears to be a risk factor for an individual becoming symptomatic.17,61 Thus, it is important for clinicians to have an appreciation of tendon pathology. Briefly, tendon pathology includes increases in tenocyte numbers and rounding, and in ground substance expression, causing swelling, matrix degradation, and neovascular ingrowth. 53,58 These changes have been extensively reviewed elsewhere.

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“…One possibility may be a metabolic interaction between adipose tissue and the musculoskeletal system. Albeit not measured in the current investigation, there is increasing evidence supporting such an interaction, with centrally located adipose tissue reportedly related to the development of patella tendinopathy 14 and clinical inflammation. 22 Although DXA scanning is recognized as a criterion method of estimating body composition, 51 it is not a commonly used clinical tool in the context of physical therapy.…”

Section: Discussionmentioning

confidence: 88%

“…Alternatively, increased BMI could be linked to BME via general deconditioning or through the metabolic influences of adipose tissue. 10,14,22 Trunk posture is another physical characteristic reportedly linked to BME in adolescents, with a more slumped trunk posture associated with reduced BME performance. 54 Finally, pain sensitivity has been proposed as a potential contributor to BME performance and, although it has not been directly explored, may be related to motivation and perception of pain.…”

mentioning

confidence: 99%

An Exploration of the Relationship Between Back Muscle Endurance and Familial, Physical, Lifestyle, and Psychosocial Factors in Adolescents and Young Adults

Campbell

Briggs²,

O’Sullivan³

et al. 2011

J Orthop Sports Phys Ther

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Low back pain (LBP) is currently the most prevalent and costly musculoskeletal pain disorder, with increasing incidence throughout adolescence. 59 Adolescent LBP has also been linked to LBP in adulthood. 6 Therefore, clinical strategies have been investigated to prevent and rehabilitate LBP, including addressing back muscle endurance (BME). This previous research has identified that BME, as determined by the Beiring-Sorenson test, is predictive of LBP in specific populations, 3,31 and that reduced BME is a characteristic of some adult and adolescent populations with LBP. 1,23,37 Improving BME has, therefore, become a common focus for the prevention and rehabilitation of LBP in sporting groups, manual workers, and the general population, 42,44,50 with some evidence in sporting populations that BME improvements are associated with a reduced incidence of LBP. 44,50 However, there is little understanding of the association between factors (particularly, familial factors) believed to be predictive of BME performance in adolescents and young adults.A number of individual factors have been shown to be associated with BME. Body mass index (BMI) is frequently reported to be associated with BME in both adult 25,28,33,34 and adolescent 54 T T STUDY DESIGN: Cross-sectional investigation. T T OBJECTIVE:To explore the relationship between back muscle endurance (BME) and a range of familial, physical, lifestyle, and psychosocial variables in adolescents and young adults. T T BACKGROUND:There is evidence that low back pain interventions which focus on improved BME are effective. However, the mechanisms associated with BME performance in adolescents and young adults are largely unclear. In particular, the potential familial relationship between parents and their children remains unexplored. T T METHODS:This study utilized a subset of participants from the Joondalup Spinal Health Study cohort. One hundred nine children (47 boys, 62 girls) and 101 parents (39 fathers, 62 mothers) completed a series of physical, lifestyle, and psychosocial assessments. The univariable relationship between each covariate and BME was explored. Those found to have an association with child BME (P<.2) were included in an initial multivariable model and sequentially removed, until all remaining covariates were statistically significant (P<.05). T T RESULTS:Mothers' BME performance was related to children's performance, accounting for 14.4% of the variance in the children's BME. Fathers' BME performance had a similar, albeit nonsignificant effect. Children's sitting trunk angle, pain sensitivity, percent trunk fat, waist girth, and body mass index were associated with their BME performance, accounting for between 5.2% and 20.9% of BME. T T CONCLUSIONS:The final multivariable model, including mother's BME, percent trunk fat, and sitting trunk angle, explained 28% of the variance in BME performance, suggesting that for successful BME intervention a range of multidimensional variables should be considered.

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Adiposity and tendinopathy

Abstract: There may be an interaction between adiposity and tendon pathology. Adiposity may be a key intrinsic risk factor that is translated into tendon disease in the presence of additional intrinsic (e.g., diabetes) and extrinsic factors (e.g., load).

Cited by 74 publications

References 74 publications

Systemic stiffening of mouse tail tendon is related to dietary advanced glycation end products but not high-fat diet or cholesterol

Systemic stiffening of mouse tail tendon is related to dietary advanced glycation end products but not high-fat diet or cholesterol

Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations

An Exploration of the Relationship Between Back Muscle Endurance and Familial, Physical, Lifestyle, and Psychosocial Factors in Adolescents and Young Adults

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