Achilles Tendinopathy

This week I talk about a feasibility cohort study which sought to determine whether a larger cohort study addressing this question would be feasible. Listen to hear some interesting preliminary findings.  Merza, E.Y., Pearson, S.J., Mallows, A.J. and Malliaras, P., 2023. The relationship between psychological, cognitive, and contextual factors and rehabilitation outcomes in Achilles tendinopathy: A prospective feasibility cohort study. Physical Therapy in Sport.Mallows, A., Jackson, J., Littlewood, C. and Debenham, J., 2020. The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study). Musculoskeletal Care, 18(2), pp.169-176.See omnystudio.com/listener for privacy information.

This week I talk about a feasibility cohort study which sought to determine whether a larger cohort study addressing this question would be feasible. Listen to hear some interesting preliminary findings.  <a href="https://pubmed.ncbi.nlm.nih.gov/36796168/" rel="nofollow" target="_blank">Merza, E.Y., Pearson, S.J., Mallows, A.J. and Malliaras, P., 2023. The relationship between psychological, cognitive, and contextual factors and rehabilitation outcomes in Achilles tendinopathy: A prospective feasibility cohort study. Physical Therapy in Sport.</a> <a href="https://pubmed.ncbi.nlm.nih.gov/31997555/" rel="nofollow" target="_blank">Mallows, A., Jackson, J., Littlewood, C. and Debenham, J., 2020. The association of working alliance, outcome expectation, adherence and self‐efficacy with clinical outcomes for Achilles tendinopathy: A feasibility cohort study (the MAP study). Musculoskeletal Care, 18(2), pp.169-176.</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Do psychological, cognitive, and contextual factors influence rehab outcomes in Achilles tendinopathy?

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 muscle and tendon from higher-load exercise interventions.  References: Radovanović, G., Kunz, J., Bohm, S., Arampatzis, A. and Legerlotz, K., 2021. Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function. Journal of Sports Sciences, 39(24), pp.2786-2795. Radovanović, G., Bohm, S., Peper, K.K., Arampatzis, A. and Legerlotz, K., 2022. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Medicine-Open, 8(1), pp.1-19. Radovanović, G., Bohm, S., Arampatzis, A. and Legerlotz, K., 2023. In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial. Journal of Clinical Medicine, 12(3),See omnystudio.com/listener for privacy information.

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 muscle and tendon from higher-load exercise interventions.  References: <a href="https://www.tandfonline.com/doi/full/10.1080/02640414.2021.1959981" rel="nofollow" target="_blank">Radovanović, G., Kunz, J., Bohm, S., Arampatzis, A. and Legerlotz, K., 2021. Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function. Journal of Sports Sciences, 39(24), pp.2786-2795.</a> <a href="https://pubmed.ncbi.nlm.nih.gov/36538166/" rel="nofollow" target="_blank">Radovanović, G., Bohm, S., Peper, K.K., Arampatzis, A. and Legerlotz, K., 2022. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Medicine-Open, 8(1), pp.1-19.</a> <a href="https://pubmed.ncbi.nlm.nih.gov/36769750/" rel="nofollow" target="_blank">Radovanović, G., Bohm, S., Arampatzis, A. and Legerlotz, K., 2023. In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial. Journal of Clinical Medicine, 12(3),</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Does high load and high strain exercise have any benefit for Achilles tendinopathy?

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, A.M., Pizzari, T., Grimaldi, A., Vicenzino, B., Rio, E. and Semciw, A.I., 2021. Proximal hamstring tendinopathy; expert physiotherapists’ perspectives on diagnosis, management and prevention. Physical Therapy in Sport, 48, pp.67-75. Nasser, A.M., Vicenzino, B., Grimaldi, A., Anderson, J. and Semciw, A.I., 2021. Proximal hamstring tendinopathy: a systematic review of interventions. International journal of sports physical therapy, 16(2), p.288. Nasser, A., Semciw, A., Grimaldi, A., Rio, E., Pizzari, T. and Vicenzino, B., 2022. Core outcome set development for proximal hamstring tendinopathy (COS-PHT): a study protocol. Physical Therapy Reviews, 27(4), pp.313-319.    See omnystudio.com/listener for privacy information.

This week, I had an engaging conversation with <a href="https://twitter.com/TonyNasserPT" rel="nofollow" target="_blank">Anthony Nasser</a>, 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: <a href="https://pubmed.ncbi.nlm.nih.gov/33378733/" rel="nofollow" target="_blank">Nasser, A.M., Pizzari, T., Grimaldi, A., Vicenzino, B., Rio, E. and Semciw, A.I., 2021. Proximal hamstring tendinopathy; expert physiotherapists’ perspectives on diagnosis, management and prevention. Physical Therapy in Sport, 48, pp.67-75.</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33842025/" rel="nofollow" target="_blank">Nasser, A.M., Vicenzino, B., Grimaldi, A., Anderson, J. and Semciw, A.I., 2021. Proximal hamstring tendinopathy: a systematic review of interventions. International journal of sports physical therapy, 16(2), p.288.</a> <a href="https://www.researchgate.net/publication/360743382_Core_outcome_set_development_for_proximal_hamstring_tendinopathy_COS-PHT_a_study_protocol" rel="nofollow" target="_blank">Nasser, A., Semciw, A., Grimaldi, A., Rio, E., Pizzari, T. and Vicenzino, B., 2022. Core outcome set development for proximal hamstring tendinopathy (COS-PHT): a study protocol. Physical Therapy Reviews, 27(4), pp.313-319.</a> See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Proximal Hamstring Tendinopathy - the forgotten tendinopathy

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 tendon palpation to detect patellar tendinopathy in young basketball playersSee omnystudio.com/listener for privacy information.

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 <a href="https://academic.oup.com/ptj/advance-article-abstract/doi/10.1093/ptj/pzac159/6825273?redirectedFrom=fulltext" rel="nofollow" target="_blank">Evidence for Improvement in Local but not Diffuse Pressure Pain Thresholds Following Physical Therapist Interventions for Tendinopathy: A Systematic Review</a> Link to  <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724272/" rel="nofollow" target="_blank">Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

How useful is palpation for diagnosis and assessment?

Interesting perspective paper from Arampatzis et al talking about how we should consider tuning of muscle tendon unit in terms of muscle strength and tendon stiffness when considering training for specific groups. See omnystudio.com/listener for privacy information.

Interesting perspective paper from Arampatzis et al talking about how we should consider tuning of muscle tendon unit in terms of muscle strength and tendon stiffness when considering training for specific groups. See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Muscle and tendon tuning and implications for tendon rehabilitation

This talking tendons episode will discuss a study by Igor Sancho, PhD, assessing Achilles forces during common rehab exercises and habitual activities and how this relates to reported pain among runners. Some interesting implications for practice. Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory studySee omnystudio.com/listener for privacy information.

This talking tendons episode will discuss a study by Igor Sancho, PhD, assessing Achilles forces during common rehab exercises and habitual activities and how this relates to reported pain among runners. Some interesting implications for practice. <a href="https://pubmed.ncbi.nlm.nih.gov/36640640/" rel="nofollow" target="_blank">Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles tendinopathy. A laboratory study</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Achilles forces during common rehab exercises and habitual activities.

In this episode, I am discussing kinesiophobia in the context of tendon rehab and how rehab can be conceptualised as graded exposure for some people.  References 1) Physiotherapy management of Achilles tendinopathySee omnystudio.com/listener for privacy information.

In this episode, I am discussing kinesiophobia in the context of tendon rehab and how rehab can be conceptualised as graded exposure for some people.  References 1) <a href="https://pubmed.ncbi.nlm.nih.gov/36274038/" rel="nofollow" target="_blank">Physiotherapy management of Achilles tendinopathy</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Graded exposure in tendinopathy rehabilitation.

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 to Exercise: https://pubmed.ncbi.nlm.nih.gov/35295417/See omnystudio.com/listener for privacy information.

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: <a href="https://pubmed.ncbi.nlm.nih.gov/36274038/" rel="nofollow" target="_blank">https://pubmed.ncbi.nlm.nih.gov/36274038/</a> 2) Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Tendinopathy in a Cross-Sectional Study: Implications for Assessment and Willingness to Exercise: <a href="https://pubmed.ncbi.nlm.nih.gov/35295417/" rel="nofollow" target="_blank">https://pubmed.ncbi.nlm.nih.gov/35295417/</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Load test pain and kinesiophobia and how they interact in tendinopathy assessment

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 Silbernagel, K.G., 2022. Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return‐to‐sport. Scandinavian Journal of Medicine &amp; Science in Sports. Here's the link to my upcoming course series in the UK in Sept: https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009See omnystudio.com/listener for privacy information.

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 Silbernagel, K.G., 2022. Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return‐to‐sport. Scandinavian Journal of Medicine &amp; Science in Sports. Here's the link to my upcoming course series in the UK in Sept: <a href="https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009" rel="nofollow" target="_blank">https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Functional impairments persist in Achilles tendinopathy when people are returning to running

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 studies: Turner, J., Malliaras, P., Goulis, J. and Mc Auliffe, S., 2020. “It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy. PloS one, 15(5), p.e0233459. Mc Auliffe, S., Synott, A., Casey, H., Mc Creesh, K., Purtill, H. and O'Sullivan, K., 2017. Beyond the tendon: experiences and perceptions of people with persistent Achilles tendinopathy. Musculoskeletal Science and Practice, 29, pp.108-114. Mallows, A., Head, J., Goom, T., Malliaras, P., O'Neill, S. and Smith, B., 2021. Patient perspectives on participation in exercise-based rehabilitation for Achilles tendinopathy: A qualitative study. Musculoskeletal Science and Practice, 56, p.102450.See omnystudio.com/listener for privacy information.

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: <a href="https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009" rel="nofollow" target="_blank">https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-uk-sept-2022-670009</a> Here are the studies: Turner, J., Malliaras, P., Goulis, J. and Mc Auliffe, S., 2020. “It's disappointing and it's pretty frustrating, because it feels like it's something that will never go away.” A qualitative study exploring individuals’ beliefs and experiences of Achilles tendinopathy. PloS one, 15(5), p.e0233459. Mc Auliffe, S., Synott, A., Casey, H., Mc Creesh, K., Purtill, H. and O'Sullivan, K., 2017. Beyond the tendon: experiences and perceptions of people with persistent Achilles tendinopathy. Musculoskeletal Science and Practice, 29, pp.108-114. Mallows, A., Head, J., Goom, T., Malliaras, P., O'Neill, S. and Smith, B., 2021. Patient perspectives on participation in exercise-based rehabilitation for Achilles tendinopathy: A qualitative study. Musculoskeletal Science and Practice, 56, p.102450.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Understanding the patient perspective in Achilles tendinopathy

This podcast will delve deep into the best and most clinically relevant new studies on tendinopathy. The focus is what questions the researchers tried to answer and why, how they did it, what they found, and very importantly, the so what factor. That is, how can it be applied to the clinic and to individual tendinopathy patients.

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, R., Saito, J. and Taylor, C.R., 1991. Hopping frequency in humans: a test of how springs set stride frequency in bouncing gaits. Journal of applied physiology, 71(6), pp.2127-2132.See omnystudio.com/listener for privacy information.

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, R., Saito, J. and Taylor, C.R., 1991. Hopping frequency in humans: a test of how springs set stride frequency in bouncing gaits. Journal of applied physiology, 71(6), pp.2127-2132.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Humans are lazy (or efficient!) hoppers: the importance of instructions in submaximal human hopping

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: Johannsen, F., Olesen, J.L., Øhlenschläger, T.F., Lundgaard-Nielsen, M., Cullum, C.K., Jakobsen, A.S., Rathleff, M.S., Magnusson, P.S. and Kjær, M., 2022. Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy: A Randomized Clinical Trial. JAMA Network Open, 5(7), pp.e2219661-e2219661.See omnystudio.com/listener for privacy information.

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: Johannsen, F., Olesen, J.L., Øhlenschläger, T.F., Lundgaard-Nielsen, M., Cullum, C.K., Jakobsen, A.S., Rathleff, M.S., Magnusson, P.S. and Kjær, M., 2022. Effect of Ultrasonography-Guided Corticosteroid Injection vs Placebo Added to Exercise Therapy for Achilles Tendinopathy: A Randomized Clinical Trial. JAMA Network Open, 5(7), pp.e2219661-e2219661.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Steroid injection for Achilles tendinopathy?

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.aspxSee omnystudio.com/listener for privacy information.

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:  <a href="https://journals.lww.com/pain/Abstract/9900/The_effects_of_pain_science_education_plus.122.aspx" rel="nofollow" target="_blank">https://journals.lww.com/pain/Abstract/9900/The_effects_of_pain_science_education_plus.122.aspx</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Does pain science education improve outcomes for Achilles tendinopathy?

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., Morrissey, D., Willy, R.W., Tayfur, A., Lascurain-Aguirrebeña, I., Barton, C. and Malliaras, P., 2022. Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study. Physical Therapy in Sport, 55, pp.241-247. Sancho, I., Malliaras, P., Barton, C., Willy, R.W. and Morrissey, D., 2019. Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis. Gait &amp; posture, 73, pp.189-201. Sancho, I., Morrissey, D., Willy, R.W., Barton, C. and Malliaras, P., 2019. Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: a single cohort feasibility study. Physical Therapy in Sport, 40, pp.107-116. See omnystudio.com/listener for privacy information.

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: <ul> <li>Sancho, I., Morrissey, D., Willy, R.W., Tayfur, A., Lascurain-Aguirrebeña, I., Barton, C. and Malliaras, P., 2022. Recreational runners with Achilles tendinopathy have clinically detectable impairments: A case-control study. Physical Therapy in Sport, 55, pp.241-247.</li> <li>Sancho, I., Malliaras, P., Barton, C., Willy, R.W. and Morrissey, D., 2019. Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis. Gait &amp; posture, 73, pp.189-201.</li> <li>Sancho, I., Morrissey, D., Willy, R.W., Barton, C. and Malliaras, P., 2019. Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: a single cohort feasibility study. Physical Therapy in Sport, 40, pp.107-116.</li> </ul>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Strength and other impairments in runners with Achilles tendinopathy

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):  https://journals.biologists.com/jeb/article/225/10/jeb243741/275395See omnystudio.com/listener for privacy information.

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):  <a href="https://journals.biologists.com/jeb/article/225/10/jeb243741/275395" rel="nofollow" target="_blank">https://journals.biologists.com/jeb/article/225/10/jeb243741/275395</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Exciting new insights into tendon adaptation with load

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, R.T. and Silbernagel, K.G., 2021. Beyond the diagnosis: Using patient characteristics and domains of tendon health to identify latent subgroups of Achilles tendinopathy. journal of orthopaedic &amp; sports physical therapy, 51(9), pp.440-448. 2/ And this is the bumper issue of JOSPT from 2015 that is all about tendinopathy: journal of orthopaedic &amp; sports physical therapy, 45(11) See omnystudio.com/listener for privacy information.

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, R.T. and Silbernagel, K.G., 2021. Beyond the diagnosis: Using patient characteristics and domains of tendon health to identify latent subgroups of Achilles tendinopathy. journal of orthopaedic &amp; sports physical therapy, 51(9), pp.440-448. 2/ And this is the bumper issue of JOSPT from 2015 that is all about tendinopathy: journal of orthopaedic &amp; sports physical therapy, 45(11) See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Achilles tendinopathy clinical and patient subgroups

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 Achilles tendinopathy with some interesting findings and implications. Hope you enjoy! Here is the link to the study: Mkumbuzi, N.S., Mafu, T.S., September, A.V., Posthumus, M. and Collins, M., 2021. Conditioned pain modulation is not altered in recreational athletes with Achilles tendinopathy. Translational Sports Medicine, 4(1), pp.147-153.See omnystudio.com/listener for privacy information.

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 Achilles tendinopathy with some interesting findings and implications. Hope you enjoy! Here is the link to the study: Mkumbuzi, N.S., Mafu, T.S., September, A.V., Posthumus, M. and Collins, M., 2021. Conditioned pain modulation is not altered in recreational athletes with Achilles tendinopathy. Translational Sports Medicine, 4(1), pp.147-153.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Central pain processing and Achilles tendinopathy

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. and Azizi, E., 2011. Flexible mechanisms: the diverse roles of biological springs in vertebrate movement. Journal of experimental biology, 214(3), pp.353-361.See omnystudio.com/listener for privacy information.

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:  <ul> <li>Metabolic energy conservation</li> <li>Amplification of muscle power output</li> <li>Attenuation of muscle power input</li> </ul> Some really interesting mechanisms and insights for rehabilitation . I hope you enjoy! Here is the link to the study: Roberts, T.J. and Azizi, E., 2011. Flexible mechanisms: the diverse roles of biological springs in vertebrate movement. Journal of experimental biology, 214(3), pp.353-361.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

The amazing benefits of biologic springs like the Achilles tendon

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. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ open sport &amp; exercise medicine, 5(1), p.e000558. 2/ Clifford, C., Challoumas, D., Paul, L., Syme, G. and Millar, N.L., 2020. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ open sport &amp; exercise medicine, 6(1), p.e000760.See omnystudio.com/listener for privacy information.

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. Isometric versus isotonic exercise for greater trochanteric pain syndrome: a randomised controlled pilot study. BMJ open sport &amp; exercise medicine, 5(1), p.e000558. 2/ Clifford, C., Challoumas, D., Paul, L., Syme, G. and Millar, N.L., 2020. Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials. BMJ open sport &amp; exercise medicine, 6(1), p.e000760.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Gluteal tendinopathy chat with Chris Clifford

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 in Tendinopathy? A Systematic Review and Meta-Analysis. Journal of clinical medicine, 11(6), p.1666.   And links to upcoming Mastering Lower Limb Tendinopathy course in Australia https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-live-australia-211689See omnystudio.com/listener for privacy information.

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 in Tendinopathy? A Systematic Review and Meta-Analysis. Journal of clinical medicine, 11(6), p.1666. And links to upcoming Mastering Lower Limb Tendinopathy course in Australia <a href="https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-live-australia-211689" rel="nofollow" target="_blank">https://www.eventbrite.com/cc/mastering-lower-limb-tendinopathy-live-australia-211689</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Do dietary supplements improve outcomes in tendinopathy?

Talking Tendons

Understanding how tendon recovers from injury and adapts to load is so important and has huge implications on how we manage tendons and the education and advice that we provide patients. This podcast features a relatively new study providing insights into the collagen turnover in healthy tendons and those with tendinopathy, adding critical knowledge to what we know about tendon collagen adaptation over time. See omnystudio.com/listener for privacy information.

Understanding how tendon recovers from injury and adapts to load is so important and has huge implications on how we manage tendons and the education and advice that we provide patients. This podcast features a relatively new study providing insights into the collagen turnover in healthy tendons and those with tendinopathy, adding critical knowledge to what we know about tendon collagen adaptation over time. See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Something IS happening in the tendon! Collagen turnover in people with Achilles tendinopathy

This episode we focus on technology use in rehab. I'm inspired by the patient will see you now by Dr Eric Topol which I recently read so this weeks podcast covers 2 technology focused systematic reviews. The first is on the efficacy of exergames for treating musculoskeletal pain, and the second is on basically the use of accelerometers and other wearable sensors to monitor rehab exercises. An exciting area that is set to grow hugely and will be part of all of our practices soon.   References to include at the bottom of the podcast and blog:   O’Reilly M, Caulfield B, Ward T, Johnston W, Doherty C. Wearable Inertial Sensor Systems for Lower Limb Exercise Detection and Evaluation: A Systematic Review. Sports Medicine. 2018;1-26.   Collado‐Mateo D, Merellano‐Navarro E, Olivares PR, García‐Rubio J, Gusi N. Effect of exergames on musculoskeletal pain: A systematic review and meta‐analysis. Scandinavian journal of medicine &amp; science in sports. 2018;28:760-771.See omnystudio.com/listener for privacy information.

This episode we focus on technology use in rehab. I'm inspired by the patient will see you now by Dr Eric Topol which I recently read so this weeks podcast covers 2 technology focused systematic reviews. The first is on the efficacy of exergames for treating musculoskeletal pain, and the second is on basically the use of accelerometers and other wearable sensors to monitor rehab exercises. An exciting area that is set to grow hugely and will be part of all of our practices soon. References to include at the bottom of the podcast and blog: O’Reilly M, Caulfield B, Ward T, Johnston W, Doherty C. Wearable Inertial Sensor Systems for Lower Limb Exercise Detection and Evaluation: A Systematic Review. Sports Medicine. 2018;1-26. Collado‐Mateo D, Merellano‐Navarro E, Olivares PR, García‐Rubio J, Gusi N. Effect of exergames on musculoskeletal pain: A systematic review and meta‐analysis. Scandinavian journal of medicine &amp; science in sports. 2018;28:760-771.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Some cool new technology focused systematic reviews that will change our practice

In this podcast we consider some new research exploring psychological factors and tendinopathy. There is emerging evidence that, as per other musculoskeletal conditions and as you would expect, they do play a role. I discuss which ones appear to be most strongly linked with tendinopathies.See omnystudio.com/listener for privacy information.

In this podcast we consider some new research exploring psychological factors and tendinopathy. There is emerging evidence that, as per other musculoskeletal conditions and as you would expect, they do play a role. I discuss which ones appear to be most strongly linked with tendinopathies.See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Does your psychological wellbeing affect your tendinopathy treatment outcome?

Despite our best intentions, not everyone with tendinopathy will respond to conservative treatments. Clinicians need alternative options like injection therapy. Injections such as steroid and platelet-rich plasma continue to be popular for tendinopathy, and there are other emerging injections such as the high-volume injection. Injection TherapyIn Tendinopathy: Art &amp; Science - 4th May 2019 MELBOURNEbooking via link below:https://www.eventbrite.com.au/e/injection-therapy-in-tendinopathy-art-and-science-tickets-57953819434See omnystudio.com/listener for privacy information.

Despite our best intentions, not everyone with tendinopathy will respond to conservative treatments. Clinicians need alternative options like injection therapy. Injections such as steroid and platelet-rich plasma continue to be popular for tendinopathy, and there are other emerging injections such as the high-volume injection. Injection TherapyIn Tendinopathy: Art &amp; Science - 4th May 2019 MELBOURNEbooking via link below:<a href="https://www.eventbrite.com.au/e/injection-therapy-in-tendinopathy-art-and-science-tickets-57953819434" rel="nofollow" target="_blank">https://www.eventbrite.com.au/e/injection-therapy-in-tendinopathy-art-and-science-tickets-57953819434</a>See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Injection Therapy - What does the evidence tell us?

In this week's podcast, I delve into the minefield that is isometric exercise. Is it the best thing since sliced bread? Does everyone respond? What are the key questions we need to understand?See omnystudio.com/listener for privacy information.

In this week's podcast, I delve into the minefield that is isometric exercise. Is it the best thing since sliced bread? Does everyone respond? What are the key questions we need to understand?See <a href="https://omnystudio.com/listener" rel="nofollow" target="_blank">omnystudio.com/listener</a> for privacy information.

Isometric exercise for tendinopathy - Variation between humans does exist!

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