The Experts below are selected from a list of 16014 Experts worldwide ranked by ideXlab platform
Craig Purdam - One of the best experts on this subject based on the ideXlab platform.
-
Achilles Tendinopathy.
Manual therapy, 2020Co-Authors: J L Cook, K M Khan, Craig PurdamAbstract:Achilles tendon injury (Tendinopathy) and pain occur in active individuals, when the tendon is subject to high or unusual load. Achilles Tendinopathy can be resistant to treatment, and symptoms may persist despite both conservative and surgical intervention. The pathology of overuse Tendinopathy is non-inflammatory, with a degenerative or failed healing tendon response. The diagnosis of Achilles Tendinopathy requires excellent differential diagnosis and an understanding of the role of tendon imaging. Conservative treatment must include exercise, with a bias to eccentric contractions. Surgical treatment is effective after complete tendon rupture, but may not assist recovery from overuse Tendinopathy. Further research into the clinical aspects of Achilles Tendinopathy is required.
-
Load management in Tendinopathy: Clinical progression for Achilles and patellar Tendinopathy
Apunts. Medicina De L'esport, 2018Co-Authors: Alfons Mascaró, Craig Purdam, Antoni Morral, Andreu Roig, Jill CookAbstract:Abstract Achilles and patellar tendons are commonly affected by Tendinopathy. Injury to these tendons can severely impact upon sports, recreational and everyday activities. Eccentric musculotendinous loading has become the dominant conservative intervention strategy for Achilles and patellar Tendinopathy over the last two decades. Eccentric loading involves isolated, slow lengthening muscle contractions. Systematic reviews have evaluated the evidence for eccentric muscle loading in Achilles and patellar Tendinopathy, concluding that outcomes are promising but high-quality evidence is lacking. Eccentric loading may not be effective for all patients (athletes and non-athletes) affected by Tendinopathy. It is possible that in athletes, eccentric work is an inadequate load on the muscle and tendon. A rehabilitation program aiming to increase tendon load tolerance must obviously include strength exercises, but should also add speed and energy storage and release. The aim of this paper is to document a rehabilitation protocol for Achilles and patellar Tendinopathy. It consists of simple and pragmatic exercises designed to incorporate progressive load to the tendon: isometric work, strength, functional strength, speed and jumping exercises to adapt the tendon to the ability to store and release energy. This article would be the first step for an upcoming multicentre randomized controlled trial to investigate its efficacy.
-
patellar Tendinopathy clinical diagnosis load management and advice for challenging case presentations
Journal of Orthopaedic & Sports Physical Therapy, 2015Co-Authors: Jill Cook, Craig Purdam, Peter MalliarasAbstract: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, ...
-
Is compressive load a factor in the development of Tendinopathy?
British Journal of Sports Medicine, 2012Co-Authors: J L Cook, Craig PurdamAbstract:Tendons are designed to take tensile load, but excessive load can cause overuse Tendinopathy. Overuse Tendinopathy results in extensive changes to the cells and extracellular matrix, resulting in activated cells, increase in large proteoglycans and a breakdown of the collagen structure. Within these pathological changes, there are areas of fibrocartilaginous metaplasia, and mechanotransduction models suggest that this response could be due to compressive load. As load management is a cornerstone of treating overuse Tendinopathy, defining the effect of tensile and compressive loads is important in optimising the clinical management of Tendinopathy. This paper examines the potential role of compressive loads in the onset and perpetuation of Tendinopathy, and reviews the anatomical, epidemiological and clinical evidence that supports consideration of compressive loads in overuse Tendinopathy.
-
is tendon pathology a continuum a pathology model to explain the clinical presentation of load induced Tendinopathy
British Journal of Sports Medicine, 2009Co-Authors: Jillianne Leigh Cook, Craig PurdamAbstract:Overuse Tendinopathy is problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments. The pathology of Tendinopathy has been described as degenerative or failed healing. Neither of these descriptions fully explains the heterogeneity of presentation. This review proposes, and provides evidence for, a continuum of pathology. This model of pathology allows rational placement of treatments along the continuum. A new model of Tendinopathy and thoughtful treatment implementation may improve outcomes for those with Tendinopathy. This model is presented for evaluation by clinicians and researchers.
Jill Cook - One of the best experts on this subject based on the ideXlab platform.
-
Physiotherapy Management of Patellar Tendinopathy in Tennis Players
Tennis Medicine, 2020Co-Authors: Hio Teng Leong, Jill Cook, Sean DockingAbstract:Patellar Tendinopathy (often called jumper’s knee) is a common cause of knee pain in both recreational and elite tennis players. It can affect playing ability or even prevent a player from being on court. Management of patellar Tendinopathy relies on understanding the pathophysiology of patellar Tendinopathy; a detailed history and assessment of an individual with patellar Tendinopathy to differentiate it from other potential diagnoses of anterior knee pain; recognizing the possible risk factors; and then prescribing appropriate treatment approaches and direction for the rehabilitation program of patellar Tendinopathy.
-
Current trends in Tendinopathy management.
Best Practice & Research: Clinical Rheumatology, 2019Co-Authors: Tanusha B. Cardoso, Tania Pizzari, Rita Kinsella, Danielle Hope, Jill CookAbstract:Abstract Tendinopathy (pain and dysfunction in a tendon) is a prevalent clinical musculoskeletal presentation across the age spectrum, mostly in active and sporting people. Excess load above the tendon's usual capacity is the primary cause of clinical presentation. The propensity towards chronicity and the extended times for recovery and optimal function and the challenge of managing Tendinopathy in a sporting competition season make this a difficult condition to treat. Tendinopathy is a heterogeneous condition in terms of its pathology and clinical presentation. Despite ongoing research, there is no consensus on tendon pathoetiology and the complex relationship between tendon pathology, pain and function is incompletely understood. The diagnosis of Tendinopathy is primarily clinical, with imaging only useful in special circumstances. There has been a surge of Tendinopathy treatments, most of which are poorly supported and warrant further exploration. The evidence supports a slowly progressive loading program, rather than complete rest, with other treatment modalities used as adjuncts mainly targeted at achieving pain relief.
-
Load management in Tendinopathy: Clinical progression for Achilles and patellar Tendinopathy
Apunts. Medicina De L'esport, 2018Co-Authors: Alfons Mascaró, Craig Purdam, Antoni Morral, Andreu Roig, Jill CookAbstract:Abstract Achilles and patellar tendons are commonly affected by Tendinopathy. Injury to these tendons can severely impact upon sports, recreational and everyday activities. Eccentric musculotendinous loading has become the dominant conservative intervention strategy for Achilles and patellar Tendinopathy over the last two decades. Eccentric loading involves isolated, slow lengthening muscle contractions. Systematic reviews have evaluated the evidence for eccentric muscle loading in Achilles and patellar Tendinopathy, concluding that outcomes are promising but high-quality evidence is lacking. Eccentric loading may not be effective for all patients (athletes and non-athletes) affected by Tendinopathy. It is possible that in athletes, eccentric work is an inadequate load on the muscle and tendon. A rehabilitation program aiming to increase tendon load tolerance must obviously include strength exercises, but should also add speed and energy storage and release. The aim of this paper is to document a rehabilitation protocol for Achilles and patellar Tendinopathy. It consists of simple and pragmatic exercises designed to incorporate progressive load to the tendon: isometric work, strength, functional strength, speed and jumping exercises to adapt the tendon to the ability to store and release energy. This article would be the first step for an upcoming multicentre randomized controlled trial to investigate its efficacy.
-
Pathophysiology of Tendinopathy
Muscle and Tendon Injuries, 2017Co-Authors: Michael Girdwood, Sean Docking, Jill CookAbstract:Tendon injuries are common, especially in athletic populations, and result in pain and dysfunction in the tendon (called Tendinopathy). Clinicians require a thorough understanding of normal structure and behaviour of tendons, as well as factors contributing to pathology to be able to successfully manage Tendinopathy.
-
At What Age Do Children and Adolescents Develop Lower Limb Tendon Pathology or Tendinopathy? A Systematic Review and Meta-analysis
Sports Medicine, 2016Co-Authors: Mitchell Simpson, Emmanuel Rio, Jill CookAbstract:BackgroundTendon pathology and Tendinopathy have been reported in children and adolescents; however, the age at onset and prevalence of the conditions have not been examined systematically.ObjectiveTo examine the prevalence of lower limb tendon pathology and Tendinopathy in children and adolescents, and the factors associated with these conditions in this population.MethodsSix databases were searched (MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Scopus, the Web of Science and the Allied and Complementary Medicine Database). Studies were included if the prevalence of lower limb tendon pathology and/or Tendinopathy were reported in humans under the age of 18 years. Studies were divided according to the method of diagnosis (physical examination, ultrasound or a questionnaire) and further divided into studies that reported prevalence data by tendon [reported two data points (right and left) for each participant] and those that reported prevalence data for each participant [reporting one data point (right or left) per participant].ResultsSeventeen studies met the inclusion criteria. Lower limb Tendinopathy prevalence (presence of pain and dysfunction) ranged between 8.2 and 33.3 %, and increased in prevalence as age increased up to 18 years. The odds ratio for studies reporting Tendinopathy by tendon was 0.37 (95 % confidence interval 0.20–0.69) in favour of boys presenting with Tendinopathy. Study aims and reporting methods were heterogeneous.ConclusionsThe age at onset of lower limb Tendinopathy in children and adolescents has not been widely studied. This systematic review found that Tendinopathy is present in children and adolescents, and increases in prevalence with age up to 18 years. Male sex is significantly associated with Tendinopathy in studies that report Tendinopathy by tendon.
Nicola Maffulli - One of the best experts on this subject based on the ideXlab platform.
-
Achilles Tendinopathy.
Sports medicine and arthroscopy review, 2020Co-Authors: Umile Giuseppe Longo, Mario Ronga, Nicola MaffulliAbstract:Achilles Tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles Tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, sex, body weight and height, pes cavus, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles Tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and subsequent increase in noncollagenous matrix. Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles Tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles Tendinopathy. Despite the morbidity associated with Achilles Tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of stripping of neovessels from the Kager's triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the Achilles tendon, but these studies are still at their infancy.
-
Insertional and Midsubstance Achilles Tendinopathy
2020Co-Authors: Amol Saxena, Umile Giuseppe Longo, Vincenzo Denaro, Nicola MaffulliAbstract:Achilles Tendinopathy is characterized by pain, impaired performance, and swelling in and around the tendon.1 It can be categorized as insertional and noninsertional, two distinct disorders with different underlying pathophysiologies and management options.2 Other terms used as synonymous of noninsertional Tendinopathy include Tendinopathy of the main body of the Achilles tendon (AT) and mid-portion Achilles Tendinopathy. In this chapter, we give a detailed overview of insertional Tendinopathy of the AT and Tendinopathy of the main body of the AT.
-
an Operative Approach to Achilles Tendinopathy
Sports Medicine and Arthroscopy Review, 2020Co-Authors: Francesco Benazzo, Giacomo Zanon, Nicola MaffulliAbstract:Summary: Achilles Tendinopathy is one of the most common overuse problems in running athletes. When conservative management is unsuccessful, surgery is indicated to increase the likelihood that the patient will return to high levels of sporting activity. Circulatory, metabolic, and mechanical factors are involved in the pathogenesis of the Tendinopathy. In surgery for chronic paraTendinopathy, we use different techniques depending on the extension of the adhesions and the thickening of the paratenon, removing the fibrotic rinds of the fascia and the hypertrophic parts of the paratenon, taking care not to disturb the mesotendon. In paraTendinopathy associated with Tendinopathy of the main body of the tendon and in isolated Tendinopathy of the main body of the tendon, we free the tendon from fibrotic adhesions and remove the degenerated nodules. Longitudinal tenotomies are performed to try to re-establish tendon nutrition, or at least to cause tendon scarring. Moreover, to improve the blood supply in tendons with extensive degeneration, we have started to place a bundle of soleus muscle within the tendon itself. In insertional Tendinopathy, the pre-Achilles bursa is removed, together with the lateral and medial outgrowth of bone and cartilage of the posterior border of the calcaneus, as is done with Haglund deformity, thus preventing further impingement of the tendon insertion.
-
Current pharmacological approaches to the treatment of Tendinopathy.
Expert Opinion on Pharmacotherapy, 2020Co-Authors: Rocco Aicale, Rocco Domenico Bisaccia, Antonio Oliviero, Francesco Oliva, Nicola MaffulliAbstract:INTRODUCTION Tendinopathies are common in elite and recreational athletes: traditionally considered overuse injuries, they involve excessive tensile loading and subsequent breakdown of the loaded tendon. Many pharmacological treatments have been proposed for the management of Tendinopathy, with no agreement regarding the overall best option available both for Achilles and patellar Tendinopathy. AREAS COVERED The present article reports the best scientific evidence regarding the efficacy and safety of different pharmacological treatments in different types of Tendinopathy, focusing on Achilles and patellar Tendinopathy, the conditions on which more studies have been published. EXPERT OPINION No univocal evidence exists regarding the best non-operative management, which includes non-steroidal anti-inflammatory drugs, platelet-rich plasma, high volume image-guided injections, hyaluronic acid, and prolotherapy, for Tendinopathy (in particular Achilles and patellar tendinopathies) as a suitable alternative to the commonly used eccentric loading rehabilitation regimen. It is unclear whether the combination of pharmacological substances with physical therapy would produce better results than physical therapy alone. There is an overall lack of published well-performed randomized controlled trials comparing the various options available for the management of Tendinopathy, studying large cohorts of patients for adequately long follow-up periods and with well-validated standardized scores and scales.
-
Update on non-insertional Achilles Tendinopathy
Fuß & Sprunggelenk, 2019Co-Authors: Nicola Maffulli, R. AicaleAbstract:Abstract In the past three decades, the incidence of overuse Tendinopathy has risen. Tendinopathy affects also middle-aged overweight patients with no history of increased physical activity. Tendinopathy is the result of a chronic failure of healing response. Several conservative therapeutic options have been proposed. The management of Tendinopathy is primarily conservative, and many patients respond to such measures. Eccentric exercises and shock wave therapy provide promising excellent clinical results. High-volume injection of normal saline solution, corticosteroids, and local anesthetic can reduce pain and improve long-term function. The use of injectable platelet-rich plasma in and around the tendon is not supported by strong clinical evidence. If clinical conditions do not improve after 6 months of conservative management, surgery is recommended.
Jillianne Leigh Cook - One of the best experts on this subject based on the ideXlab platform.
-
Adiposity and Tendinopathy.
Disability and Rehabilitation, 2009Co-Authors: J E Gaida, Jillianne Leigh Cook, Shona BassAbstract:Purpose. Tendon injuries (Tendinopathy) are prevalent across the population, affecting active and inactive individuals and manual workers. The aetiology of Tendinopathy is not known. However, extrinsic factors such as load are known to affect the prevalence. More recently, intrinsic factors have been shown to also affect tendons; genes, biomechanics, and strength have been shown to influence tendon disease. One intrinsic factor that appears to have an association with Tendinopathy is body composition; more specifically central adiposity. Several studies have reported this association, and several studies have found the association when reporting other aspects of Tendinopathy.Method. This paper will detail what is known about the association between Tendinopathy and body composition, examine the strength of the association by evaluating studies in the area and speculate on potential mechanisms for the association.Results. The association between tendon health and adiposity, especially central adiposity, wa...
-
is tendon pathology a continuum a pathology model to explain the clinical presentation of load induced Tendinopathy
British Journal of Sports Medicine, 2009Co-Authors: Jillianne Leigh Cook, Craig PurdamAbstract:Overuse Tendinopathy is problematic to manage clinically. People of different ages with tendons under diverse loads present with varying degrees of pain, irritability, and capacity to function. Recovery is similarly variable; some tendons recover with simple interventions, some remain resistant to all treatments. The pathology of Tendinopathy has been described as degenerative or failed healing. Neither of these descriptions fully explains the heterogeneity of presentation. This review proposes, and provides evidence for, a continuum of pathology. This model of pathology allows rational placement of treatments along the continuum. A new model of Tendinopathy and thoughtful treatment implementation may improve outcomes for those with Tendinopathy. This model is presented for evaluation by clinicians and researchers.
-
a treatment algorithm for managing achilles Tendinopathy new treatment options
British Journal of Sports Medicine, 2007Co-Authors: Hakan Alfredson, Jillianne Leigh CookAbstract:Achilles Tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in Tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles Tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful, then surgery relieves pain in the majority of cases. Directing a patient through the algorithm presented here will maximise positive treatment outcomes.
Roald Bahr - One of the best experts on this subject based on the ideXlab platform.
-
Neuropeptides in Tendinopathy.
Frontiers in Bioscience, 2009Co-Authors: Alex Scott, Roald BahrAbstract:: Overuse Tendinopathy remains a major clinical burden for sports medicine and general practitioners. Recent studies have highlighted the role of sensory and autonomic nerves in generating or perpetuating the symptoms and tissue abnormalities associated with Tendinopathy. We outline the neuroanatomy and potential roles of nerves and associated neuropeptides in Tendinopathy. In addition, intriguing new data is reviewed which suggests that there may be a substantial intrinsic source of neuropeptides within tendons - namely, the tenocytes themselves. The potential roles of Substance P and mast cells are highlighted in particular. We discuss the implications for conservative management including sclerosing injections and exercise training.
-
Pronociceptive and Antinociceptive Neuromediators in Patellar Tendinopathy
American Journal of Sports Medicine, 2006Co-Authors: Øystein Lian, Johan Dahl, Paul W. Ackermann, Frede Frihagen, Lars Engebretsen, Roald BahrAbstract:BACKGROUND: The occurrence of nerve ingrowth and its relation to chronic tendon pain (Tendinopathy) are still largely unknown. In healthy tendons, the innervation is confined to the paratenon, whereas the tendon proper is devoid of nerve fibers. In this study on the pathogenesis of Tendinopathy, the authors examined sensory and sympathetic nerve fiber occurrence in the patellar tendon. HYPOTHESIS: Nerve ingrowth and altered expression of sensory and sympathetic neuromediators play a major role in the pathophysiology of pain in patellar Tendinopathy. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Biopsies from the patellar tendon in patients with patellar Tendinopathy (n = 10) were compared with biopsies from a control group (n = 10) without any previous or current knee symptoms compatible with patellar Tendinopathy. The biopsies were stained immunohistochemically for sensory and autonomic nerve markers. The biopsies from the 2 groups were compared using subjective and semiquantitative methods. RESULTS: Chronic painful patellar tendons exhibited increased occurrence of sprouting nonvascular sensory, substance P-positive nerve fibers and a decreased occurrence of vascular sympathetic nerve fibers, positive to tyroxin hydroxylase, a marker for noradrenaline. CONCLUSION: The altered sensory-sympathetic innervation suggests a role in the pathophysiology of Tendinopathy. Ingrowth of sprouting substance P fibers presumably reflects a nociceptive and maybe a proliferative role, possibly as reactions to repeated microtraumata, whereas the decreased occurrence of tyroxin hydroxylase may represent a reduced antinociceptive role. These findings could be used to develop targeted pharmacotherapy for the specific treatment of Tendinopathy.
-
no effect of eccentric training on jumper s knee in volleyball players during the competitive season a randomized clinical trial
Clinical Journal of Sport Medicine, 2005Co-Authors: Havard Visnes, Jill Cook, Aasne Hoksrud, Roald BahrAbstract:Background:The effect of surgery on patellar Tendinopathy (jumper's knee) is questionable, and conservative treatment protocols have not been properly documented.Purpose:The aim of this study was to investigate the effect of a newly developed eccentric training program for patellar Tendinopathy in v
-
performance characteristics of volleyball players with patellar Tendinopathy
American Journal of Sports Medicine, 2003Co-Authors: Øystein Lian, Lars Engebretsen, Peregil Refsnes, Roald BahrAbstract:BackgroundPatellar Tendinopathy is assumed to result from chronic tendon overload. There may be a relationship between tendon pain and jumping ability.HypothesisThere is no difference in performance characteristics between volleyball players with patellar Tendinopathy and those without.Study DesignProspective cohort study.MethodWe examined the performance of the leg extensor apparatus in high-level male volleyball players with patellar Tendinopathy (N = 24) compared with a control group (N = 23) without knee symptoms. The testing program consisted of different jump tests with and without added load, and a composite jump score was calculated to reflect overall performance.ResultsThe groups were similar in age, height, and playing experience, but the patellar Tendinopathy group did more specific strength training and had greater body weight. They scored significantly higher than the control group on the composite jump score (50.3 versus 39.2), and significant differences were also observed for work done in ...
