Treating Tendinopathy

Joseph, Michael; Denegar, Craig R.

doi:10.1016/j.csm.2014.12.006

Cited by 23 publications

(8 citation statements)

References 65 publications

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“…This has direct relevance in the clinical setting, such as in the treatment of tendinopathy or the prevention of acute tendon injury; exercises that elicit maximal tendon strain might evoke the greatest improvements in tendon stiffness and tensile strength as well as reductions in pain and injury risk. Indeed, squat lift training is the most common non-surgical treatment for patellar tendinopathy (Malliaras et al, 2013; Joseph and Denegar, 2015). While previous studies have demonstrated that tendon strain increases with movement speed in running and (relatively small range of motion) jumping exercises (Finni et al, 2001; Ishikawa et al, 2007; Lichtwark et al, 2013; Malliaras et al, 2013), the present study is the first to observe such a relationship in a commonly-performed exercise with a fixed external load.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, whilst running and jumping movements are common in sports and daily activities, they are relatively ineffective for stimulating tendon adaptation when compared to resistance exercise and are therefore not commonly used with the specific aim of altering tendon properties (Hansen et al, 2003; Arampatzis et al, 2007; Gosset et al, 2009; Lichtwark et al, 2013; Bohm et al, 2014). Exercises involving large muscular forces performed through a large range of motion at slower movement speeds, however, are commonly used to influence tendon stiffness or treat tendinopathy (Kongsgaard et al, 2010; Malliaras et al, 2013; Joseph and Denegar, 2015; Wiesinger et al, 2015). Because, the running and jumping exercises performed in those previous studies did not utilize additional loading strategies, and were performed through relatively small ranges of motion and for short (total time) durations, these data do not allow speculation as to how tendons might behave during loaded multi-joint movements such as squat lifts or loaded jumps (Hansen et al, 2003; Arampatzis et al, 2007; Gosset et al, 2009; Lichtwark et al, 2013; Bohm et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…Because, the running and jumping exercises performed in those previous studies did not utilize additional loading strategies, and were performed through relatively small ranges of motion and for short (total time) durations, these data do not allow speculation as to how tendons might behave during loaded multi-joint movements such as squat lifts or loaded jumps (Hansen et al, 2003; Arampatzis et al, 2007; Gosset et al, 2009; Lichtwark et al, 2013; Bohm et al, 2014). Thus, it is unknown how speed of movement might influence both tendon stiffness and tendon health during exercises commonly prescribed to elicit tendon adaptation (Kongsgaard et al, 2010; Malliaras et al, 2013; Joseph and Denegar, 2015; Wiesinger et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

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Faster Movement Speed Results in Greater Tendon Strain during the Loaded Squat Exercise

et al. 2016

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Introduction: Tendon dynamics influence movement performance and provide the stimulus for long-term tendon adaptation. As tendon strain increases with load magnitude and decreases with loading rate, changes in movement speed during exercise should influence tendon strain.Methods: Ten resistance-trained men [squat one repetition maximum (1RM) to body mass ratio: 1.65 ± 0.12] performed parallel-depth back squat lifts with 60% of 1RM load at three different speeds: slow fixed-tempo (TS: 2-s eccentric, 1-s pause, 2-s concentric), volitional-speed without a pause (VS) and maximum-speed jump (JS). In each condition joint kinetics, quadriceps tendon length (LT), patellar tendon force (FT), and rate of force development (RFDT) were estimated using integrated ultrasonography, motion-capture, and force platform recordings.Results: Peak LT, FT, and RFDT were greater in JS than TS (p < 0.05), however no differences were observed between VS and TS. Thus, moving at faster speeds resulted in both greater tendon stress and strain despite an increased RFDT, as would be predicted of an elastic, but not a viscous, structure. Temporal comparisons showed that LT was greater in TS than JS during the early eccentric phase (10–14% movement duration) where peak RFDT occurred, demonstrating that the tendon's viscous properties predominated during initial eccentric loading. However, during the concentric phase (61–70 and 76–83% movement duration) differing FT and similar RFDT between conditions allowed for the tendon's elastic properties to predominate such that peak tendon strain was greater in JS than TS.Conclusions: Based on our current understanding, there may be an additional mechanical stimulus for tendon adaptation when performing large range-of-motion isoinertial exercises at faster movement speeds.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Faster Movement Speed Results in Greater Tendon Strain during the Loaded Squat Exercise

et al. 2016

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“…Moreover, while NSAIDs and corticosteroid injections may offer temporary relief, they lead to an increased risk of detrimental effects on tendon metabolism and repair with long-term use and are ill-suited for long-term use in this chronic disease. 44,45 After injury or disease, the original biological properties of the tendon are not restored because the tendon ECM is irrevocably altered and the reparative ability of cells is diminished. In a total rupture, the ECM can be replaced surgically with biosimilar materials that replicate tendon mechanical properties to some degree.…”

Section: Advances In Therapeutic Strategy Development For Tendinopathymentioning

confidence: 99%

Advances in the development of gene therapy, noncoding RNA, and exosome‐based treatments for tendinopathy

Ilaltdinov

Yang

Leong

et al. 2020

Annals of the New York Academy of Sciences

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Tendinopathy is a common musculoskeletal disorder characterized by chronic low-grade inflammation and tissue degeneration. Tendons have poor innate healing ability and there is currently no cure for tendinopathy. Studies elucidating mechanisms underlying the pathogenesis of tendinopathy and mechanisms mediating the genesis of tendons during development have provided novel targets and strategies to enhance tendon healing and repair. This review summarizes the current understanding and treatments for tendinopathy. The review also highlights recent advances in gene therapy, the potential of noncoding RNAs, such as microRNAs, and exosomes, which are nanometer-sized extracellular vesicles secreted from cells, for the treatment of tendinopathy.

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“…Best practices suggest that once a tendon is relatively pain free at rest, a loading program should be initiated to promote tendon healing. [97][98][99] Although eccentric loading is the most common type of strengthening used, isometric, concentric, and graduated programs have also been described. 100 However, there is no clear consensus on when to initiate loading after PRP injection.…”

Section: Postprocedures Mobilization and Exercise Initiationmentioning

confidence: 99%

Post‐Procedure Protocols Following Platelet‐Rich Plasma Injections for Tendinopathy: A Systematic Review

Townsend

Rickenbach

Bailowitz

et al. 2020

PM&R

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Objective Platelet‐rich plasma (PRP) has been increasingly studied as a treatment for tendinopathy. Many factors may influence outcomes after PRP, including different protocols following administration. It was hypothesized that there would be heterogeneity in post‐PRP protocols. Literature Survey A systematized review of the literature on post‐PRP protocols for tendinopathy was conducted using an electronic search of MEDLINE and Embase databases through September 2018. Methodology After duplicates were removed, English language articles involving adult patients who received PRP for tendinopathy were reviewed. Exclusion criteria included studies with fewer than 10 patients, PRP used to treat pathology other than tendinopathy, multiple protocols in one study, and surgical settings. Protocol specifics were extracted including nonsteroidal anti‐inflammatory drugs (NSAID) restrictions before and after injection, postinjection restrictions on movement and weight bearing, use of orthoses, activity modifications, and postinjection rehabilitation protocols. Given limitations in the data, a meta‐analysis was not performed. Synthesis Eighty‐four studies met inclusion criteria. Following PRP injection, weight‐bearing restrictions were mentioned rarely (12% of protocols). Orthosis use was uncommon overall (18%) but more common in Achilles tendinopathy protocols (53%). The majority of protocols instituted a period of stretching (51%) and strengthening (54%). Stretching programs generally began 2‐7 days following injection, and strengthening programs began within 2‐3 weeks. Preinjection NSAID restriction was reported rarely (20%), whereas postinjection NSAID restriction was more common (56%), with a typical restriction of greater than 2 weeks (38%). Return to play or full activity was reported in 42% of protocols, most commonly at 4‐6 weeks following injection. Conclusion Although the clinical effectiveness of PRP remains controversial, even less is known about the effect of post‐PRP protocols, which may affect the outcomes attributed to PRP itself. No studies directly compare post‐PRP protocols, and the protocols studied demonstrate substantial heterogeneity. Some consensus regarding post‐PRP protocols exists, although the rationale for these recommendations is limited.

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Treating Tendinopathy

Cited by 23 publications

References 65 publications

Faster Movement Speed Results in Greater Tendon Strain during the Loaded Squat Exercise

Faster Movement Speed Results in Greater Tendon Strain during the Loaded Squat Exercise

Advances in the development of gene therapy, noncoding RNA, and exosome‐based treatments for tendinopathy

Post‐Procedure Protocols Following Platelet‐Rich Plasma Injections for Tendinopathy: A Systematic Review

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