Talking Tendons

We have known for a while that type of exercise intervention (e.g. intensity, frequency, etc) does not seem to influence self-reported outcomes such as pain. Maybe all the benefits from exercise are explained by non-specific effects, or maybe exercise has benefits that do not depend on the type of exercise.

In this episode, I discuss 3 studies that look into (at least partly) other benefits that we may see at the level of the musc...

This week, I had an engaging conversation with Anthony Nasser, an up-and-coming researcher on tendinopathy who recently completed his PhD on proximal hamstring tendinopathy. Our discussion covered the reasons for the lack of research attention towards this condition, the current state of evidence, and insights from his doctoral studies. You can find the full conversation here.

Here are Anthony's related publications:

Nasser...

Palpation can be useful for the diagnosis and assessment of tendinopathy, but there are limits. This is because non-painful tendons can be tender, and tenderness in painful tendons seems to be very slow to get better. 

Link to Evidence for Improvement in Local but not Diffuse Pressure Pain Thresholds Following Physical Therapist Interventions for Tendinopathy: A Systematic Review

Link to  Reproducibility and clinical utility of t...

In this episode, I talk about load test pain assessment and how this can also be used to assess kinesiophobia and movement apprehension. 

References

1) Physiotherapy management of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/36274038/

2) Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness...

This is an interesting study from the Delaware tendinopathy group among others investigating a host of structural, tissue property, functional and pain factors that may persist among people with Achilles tendinopathy making a return to running. Provides guidance to clinicians about potential impairments to consider assessing. 

Here's the link to the study:

Corrigan, P., Hornsby, S., Pohlig, R.T., Willy, R.W., Cortes, D.H. and Sil...

In this episode I talk about three qualitative studies that aim to understand the patient perspective and patient motivations in Achilles tendinopathy. I find this work really helps clinicians to understand what patients are gong through so we are able to be empathic and help them. Hope you enjoy!

Here's a link to courses in the UK:

https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009

Here are the ...

This paper is more than 30 years old but it is a beauty. Farley et al talk about human preferred hopping frequency and how it relates to metabolic cost and how fast muscles are contracting, and also how our instructions can influence how well people hop (and the mechanisms that drive this). Important to consider hopping instruction when assessing submaximal hopping in the clinic. 

Here's a link to the paper

Farley, C.T., Blickhan...

There is so much debate about the use of steroids for tendinopathy. Opinions vary between 'you should never use steroid as will lead to recurrence, worse pain or rupture' to 'it's fine, do as much steroid as you like'. Opinions dominate as we have limited data. Until now. This is the first trial looking at 2 year outcome for exercise +/- steroid for Achilles tendinopathy. Interesting findings!

Here's the link to the study:

Johann...

This is a new and lovely to read randomised trial comparing pain science education (including lots of good biopsychosocial info) versus placebo education for Achilles tendinopathy. Some interesting findings and potential avenues for further study. Definitely worth a listen and read. 

Here is a link to the actual paper: 

https://journals.lww.com/pain/Abstract/9900/The_effects_of_pain_science_education_plus.122.aspx

See omnystudio.c...

This is a new study from my PhD student, Igor Sancho. He looks at strength, psychological and other factors that may be different between health runners and runners with Achilles tendinopathy. Seated calf raise 6RM seems to be the strongest predictor of having Achilles tendinopathy. Some interesting other findings and clinical implications. 

Here is a link to this paper, and Igor's other PhD papers:

• Sancho, I., Morriss...

On this episode I focus on a new study from my PhD student Eman Merza. It is a cross-over randomised trial testing the effect of high and low contraction time and high and low intensity isometric contractions on acute changes to tendon volume and stiffness. Some very interesting potential insights for tendon adaptation. Good work, Eman!

Hope you enjoy. 

Peter

Here is a link to the study (open access for a few weeks): 

Had a lovely chat with Shawn Hanlon who is a PhD candidate about his relatively new paper exploring patient features and clinical characteristics and how they may define certain subgroups of Achilles tendinopathy . Lots more to learn in this field and this is early work, but we discuss some of the juicy potential clinical implications.

Hope you enjoy!

And here is the link to the paper and also the 

1/ Hanlon, S.L., Pohlig, ...

There is lots of debate about the pain mechanisms, particularly if there are central changes, in Achilles and other tendinopathies. Most studies in the literature use proxy measures of central sensitisation like pressure pain threshold away from the painful site, Other measures like conditioned pain modulation have been investigated less frequently. In this episode of talking tendons I discuss a huge new study investigating CPM in ...

This is one of my favourite narrative expert reviews that discusses the benefits of human biologic springs like the Achilles tendon. These benefits can be summarised as follows: 

• Metabolic energy conservation
• Amplification of muscle power output
• Attenuation of muscle power input

Some really interesting mechanisms and insights for rehabilitation . I hope you enjoy!

Here is the link to the study:

Roberts, T.J....

I had a great time talking Gluteal tendinopathy with Chris Clifford. Chris is an experienced clinician from Glasgow who is in the throws of completing his PhD on this condition. We chatted about rehab, the use of isometrics, difficult patient groups and how to navigate them, and much more. 

I hope you enjoy!

Here is 2 related publications from Chris' PhD: 

1/ Clifford, C., Paul, L., Syme, G. and Millar, N.L., 2019. Iso...

Patients often ask about dietary supplements and if they may be helpful in recovering from a tendinopathy problem. There is a new systematic review out which has attempted to answer this question and it is the subject of this episode of talking tendons.

I hope you enjoy. 

Here is the reference

Qiu, F., Li, J. and Legerlotz, K., 2022. Does Additional Dietary Supplementation Improve Physiotherapeutic Treatment Outcome...