The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans
|
|
- Mervin Bishop
- 5 years ago
- Views:
Transcription
1 The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans Author Rees, J., Lichtwark, Glen, Wolman, R., Wilson, A. Published 2008 Journal Title Rheumatology DOI Copyright Statement 2008 Oxford University Press. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Rheumatology following peer review. Please refer to the link for the definitive publisher-authenticated version. Downloaded from Link to published version Griffith Research Online
2 Rheumatology 2008;47: Advance Access publication 22 July 2008 doi: /rheumatology/ken262 The mechanism for efficacy of eccentric loading in Achilles tendon injury; an in vivo study in humans J. D. Rees 1,2, G. A. Lichtwark 1,3,4, R. L. Wolman 1 and A. M. Wilson 1,3 Objective. Degenerative disorders of tendons present an enormous clinical challenge. They are extremely common, prone to recur and existing medical and surgical treatments are generally unsatisfactory. Recently eccentric, but not concentric, exercises have been shown to be highly effective in managing tendinopathy of the Achilles (and other) tendons. The mechanism for the efficacy of these exercises is unknown although it has been speculated that forces generated during eccentric loading are of a greater magnitude. Our objective was to determine the mechanism for the beneficial effect of eccentric exercise in Achilles tendinopathy. Methods. Seven healthy volunteers performed eccentric and concentric loading exercises for the Achilles tendon. Tendon force and length changes were determined using a combination of motion analysis, force plate data and real-time ultrasound. Results. There was no significant difference in peak tendon force or tendon length change when comparing eccentric with concentric exercises. However, high-frequency oscillations in tendon force occurred in all subjects during eccentric exercises but were rare in concentric exercises (P < ). Conclusion. These oscillations provide a mechanism to explain the therapeutic benefit of eccentric loading in Achilles tendinopathy and parallels recent evidence from bone remodelling, where the frequency of the loading cycles is of more significance than the absolute magnitude of the force. KEY WORDS: Tendon, Eccentric exercise, Efficacy. Introduction The management of degenerative disorders of tendons is an enormous clinical challenge. Tendon disorders are extremely common, existing medical treatments are generally unsatisfactory and surgical treatments unpredictable [1 3]. Historically it was believed that tendons were fairly inert structures and rest or immobilization was suggested as a treatment. However, over time the negative effects of rest and immobilization have become recognized and there has been a move towards early functional treatment [4, 5]. Until recently there was much support for the use of NSAIDs and local corticosteroid injections [6]. However, it is now appreciated that chronic tendon disorders are predominantly degenerative in nature and anti-inflammatory strategies are largely ineffective [1, 6]. Various suggestions have been made to account for the pain in chronic tendinopathy. Histological assessment of chronic tendinopathy is devoid of inflammatory cells [7]. Microdialysis of the injured Achilles tendon (AT) has confirmed the presence of the neurotransmitter glutamate [8]; substance P [9] has also been implicated in the aetiology of the pain arising from a chronically inured tendon. Why degenerative tendinopathy is only sometimes painful remains unknown. Recently there has been an increasing interest in the use of eccentric loading in treatment of chronic degenerative disorders of tendon. In an eccentric contraction, the muscle tendon unit lengthens as a load is applied to it. This is in contrast to concentric loading where the muscle tendon unit shortens (Fig. 1). In 1986, in a prospective study of 200 patients with chronic Achilles tendinopathy, Stanish et al. [4] reported that a once-daily, 6-week eccentric loading programme led to complete relief of pain in 44% and a marked improvement in symptoms in a further 43% of the patients. Unfortunately, the study was weak methodologically (there were 1 Department of Sport and Exercise Medicine, Royal National Orthopaedic Hospital, Stanmore, 2 Defence Medical Rehabilitation Centre, Epsom, 3 Structure and Motion Laboratory, The Royal Veterinary College, Hatfield, UK and 4 School of Physiotherapy and Exercise Science, Griffith University, Gold Coast, Australia. Submitted 16 March 2008; revised version accepted 17 June Correspondence to: J. D. Rees, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey KT18 6JN, UK. j.rees@doctors.org.uk no control subjects) and the technique was not widely adopted. More recently, Alfredson confirmed the efficacy of eccentric loading for mid-substance lesions of the AT in prospective randomized trials [10, 11]. Other groups have studied eccentric loading and high success rates (of at least 60% either good or excellent) have also been reported [12 14]. This technique has been successfully extended to the patella and supraspinatus tendons and its use has become widespread, particularly over the last 5 yrs [15 18]. The mechanism for the efficacy of eccentric loading is unknown. Stanish and colleagues [4, 19] proposed that in eccentric loading the tendon is subjected to greater forces than in concentric loading and hence to a greater re-modelling stimulus. Whilst there is evidence from Komi [20] that eccentric contractions can develop greater forces in muscle during dynamic movements, this evidence does not extend to the exercises in the Stanish (or Alfredson) eccentric loading protocol. During sonography of the eccentrically loaded AT, Alfredson observed a temporary compression of the new vessel formation (neovascularization) that often accompanies degenerative Achilles tendinopathy. Although there are some (uncontrolled) data to suggest eccentric loading may lead to a normalization of tendon structure in the long term [21], there is no evidence to suggest that temporary interruption of the blood supply accounts for its efficacy. The optimum exercise dose is unknown, both in terms of numbers of repetitions and also the speed of movement; neither is the optimum duration of treatment known. The exercises frequently cause discomfort and, although highly effective for tendinopathy of the body of the Achilles, are more usually ineffective at treating insertional tendon lesions of this tendon [22]. We hypothesize that eccentric loading of the AT results in a fundamentally different physiological loading pattern and stimulus to that seen in concentric loading. We tested this hypothesis by determining tendon length and force during concentric and eccentric exercises in healthy subjects. Materials and methods Materials and general procedure We utilized a method that combines real-time ultrasonography (US) and motion analysis with concurrent force and 1493 ß The Author Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please journals.permissions@oxfordjournals.org
3 1494 J. D. Rees et al. EMG recording. This technique has previously been described and successfully used to determine the in vivo mechanical properties of the human AT during one-legged hopping [23]. By simultaneously determining AT length and the force acting through the tendon during both concentric and eccentric loading exercises, we directly compared the physiological stimulus with the AT during the two exercises. Additionally, EMG data from the major lower leg muscles were collected on three of the subjects to enable us to study the pattern of muscle activation. The AT length was defined as the distance between the medial gastrocnemius muscle tendon junction (MTJ) (tendon origin) and the tendon insertion (at the calcaneum). In order to determine the AT length, we needed to establish the position of both these anatomical sites in terms of 3D coordinates over time (i.e. dynamically). By using the Codamotion (CODA) active marker motion analysis system (Charnwood Dynamics, Leicester, UK), the position of the tendon insertion could be tracked. The position of the MTJ was determined by a combination of US and motion analysis. The MTJ was imaged dynamically by a PC-based (US) system (Echoblaster 128, UAB Telemed, Vilnius, Lithuania) and the precise position of the US probe itself was synchronously measured by the CODA system. Electronic synchronization of the two systems then allowed us to determine the position of the MTJ relative to the tendon insertion and hence determine overall tendon length. The 3D ground reaction force was measured using a mm 2 force plate (Bertec Corporation, Columbus, OH, USA). The ankle joint centre was estimated by creating a virtual point relative to markers on medial and lateral malleolus corresponding to an approximation of the centre of rotation of the ankle joint. AT force was calculated by dividing the ankle joint moment by the moment arm between the AT and the ankle joint centre. A more detailed explanation of the methodology for determination of the MTJ position from our laboratory has previously been published and the reader is referred to that paper for a more detailed explanation of the methodology [23]. Research subjects Seven adult participants (average age range yrs) gave written consent to take part in the study, which was approved by the hospital ethics committee. There were four male and three female participants. This male : female ratio was similar to that used in the original Alfredson study [10]. In none of the participants was there a past history of AT disorder. The subjects weight and height were recorded. Exercises, data collection and data analysis We adopted the Alfredson protocol for eccentric loading [10]. The subject stands on the toes of one foot with the heel raised; the subject then lowers the heel in a controlled manner. The exercise is performed over a step to increase the distance that the heel (and hence whole body) may be lowered (Fig. 1). For the concentric exercise, we used the subject starting with the heel below the toes and raised the heel (and hence body) during the exercise. This particular concentric exercise was one of the exercises in the Alfredson concentric comparison group [11]. Concentric and eccentric exercises were both performed with the knee extended and with the knee flexed. The subjects were shown how to perform the exercises by the lead author (J.D.R.). At the start of the exercise all of the weight would be on the studied leg. At the end of the exercise the subjects would then transfer their weight to the non-study leg, which was used to help get the subject back to the start position. In the Alfredson protocol, there is no mention of the speed at which the exercises should be performed [7]. Subjects were therefore asked to perform the exercises in a controlled moderate speed manner. For each subject, three 10-s data sets were collected for each of the four separate exercises. Some subjects needed to steady themselves by holding onto a chair but they were instructed not to push up on it. Five individual cycles of data from each of the four exercises described above were randomized and then analysed in order to avoid systemic bias. For each data set it was necessary to determine the position of the MTJ on the video recording (at 50 Hz) of the US trace. From this it was possible to determine the AT length. AT force and ankle angle were also determined in accordance with our previously described method [23]. Statistical analysis Data for tendon length and peak AT force were tested for normality of distribution by plotting them and performing a Shapiro Wilk W test showing that both parameters were close to a normal distribution. Residuals were also plotted after the statistical test and the models were observed to be a good fit for the data. Tendon length and peak AT force were then analysed using a general linear model in Statistica AXA 8.0 (Statsoft, Tulsa, OK, USA) with subject and exercise modality as fixed factors. Data are presented with 95% CIs. P-values <0.05 were considered statistically significant. FIG. 1. Eccentric and concentric loading of the Achilles tendon. (A) Image showing the starting position for eccentric loading. The Achilles tendon lengthens as the heel is lowered below the level of the forefoot (B). Concentric loading involves shortening of the Achilles tendon and is the reverse procedure. Figure reproduced from Ref. [1].
4 Mechanism for efficacy of eccentric loading 1495 Results During heel lowering the AT length increased through the movement and during heel rise AT length decreased, which we attributed to the dynamics of the movement being different (see Discussion). The length changes were not significantly different when comparing concentric and eccentric exercises (P ¼ 0.23). During concentric movement tendon length decreased on average by 14.9 mm (95% CI 1.9 mm), and during eccentric movement tendon length increased by 13.6 mm on average (95% CI 1.6 mm). Peak AT forces during both eccentric and concentric exercises showed minimal (non-significant) intra-subject variability (Fig. 2). There was a much more marked variation in calculated peak AT force between subjects, however, and there was a linear relationship between maximum tendon force and body mass for both eccentric and concentric loading (R 2 ¼ 0.59 and 0.49, respectively). The pattern of loading/unloading of the tendon was different between concentric and eccentric loading. In Fig. 3, the typical relationship of derived AT force and AT length over time for two subjects during concentric and eccentric movement is shown. As expected, for the concentric exercises peak force occurs at the start of the exercise (raising the heel and accelerating the body upwards against gravity), and for eccentric exercises peak force occurs at the end of the exercise (decelerating the centre of mass at the end of the movement thus overcoming gravity and momentum). In essence, AT force rises through the course of an eccentric loading movement and falls during a concentric loading movement. In concentric exercises, there was a very smooth force trace. However, the eccentric movement pattern consistently demonstrated a sinusoidal waveform appearance with frequent inversions of the force trace. Indeed, over all eccentric observations there were, on average, two force inversions per cycle (1.94 inversions per cycle, 95% CI 0.54). For concentric loading force inversions were uncommon and occurred less than once every two cycles (0.47 inversions per cycle, 95% CI 0.28). Furthermore, when the inversions did occur in concentric movements they tended to occur early in the cycle and not during the main part of the exercise, and hence not during rapid tendon shortening or lengthening. Whilst the individual number of inflexions per trial was not a normally distributed or continuous variable, the average number Max Concentric Eccentric Subject FIG. 2. Maximum (peak) AT force (N/S) during concentric and eccentric loading. There was no significant difference in the maximum AT force between concentric and eccentric exercises. Vertical bars are 95% CIs. of inflexions per subject (across all the trials) passed tests for normality of distribution and a t-test was performed on these figures. This difference was highly significant (P ¼ ). The analysis was repeated using a Kolmogorov Smirnov non-parametric test and a high level of significance shown. Typical plots of each of two representative subjects are presented (Fig. 3), as are data on number of inversions for all subjects (Fig. 4). In three subjects, EMG data were simultaneously collected from the gastrocnemius and from tibialis anterior as the main representative of the antagonist muscle group. The data showed similar values for root mean square (RMS) signal for gastrocnemius activation for both concentric and eccentric loading. Tibialis anterior tended to have higher RMS values both at the start of concentric loading and at the end of eccentric loading, suggesting that this muscle may have a role in the initiation of concentric loading and the termination of eccentric loading. Discussion Eccentric loading regimes have been shown in clinical trials to offer promise for mid-substance tendon lesions, particularly of the AT. This is the first article to examine the mechanism by which eccentric loading is effective. Our data show that at the start of concentric movement the calf muscles are activated, the AT length decreases and the subject accelerates upwards and then slows to a halt. The peak derived AT force occurs at the beginning of the exercise when the subject is accelerating against gravity. In the eccentric movement, the subject starts to drop under control. The movement is controlled (resisted) by lengthening of the activated calf muscle and by stretching of the AT. The maximal derived AT force occurs at the end of the eccentric movement when maximum force is required to decelerate the subject against gravity. Our results show that peak tendon forces in eccentric loading are of the same magnitude as those seen in concentric loading. This means that tendon force magnitude, as originally suggested by Stanish et al. [4], alone cannot be responsible for the therapeutic benefit seen in eccentric loading. Furthermore, the data on AT length change, confirming that both concentric and eccentric exercises have the same magnitude of length change and are also supportive of the force being the same for both exercises. If the efficacy of eccentric loading cannot be explained by the magnitude of force, then what is responsible? Intriguingly, we observed a pattern of sinusoidal loading and unloading in eccentric loading. The fluctuations in force probably reflect the difficulty in controlling a dynamic movement with a lengthening muscle, similar to the experience that it is easier to lift a heavy weight under precise control than to lower the same weight. We propose that these fluctuations in force may provide an important stimulus for the re-modelling of tendon. Certainly in the remodelling of bone it is known that bone responds to high frequency loading and appropriate mechanical signals can lead to a dramatic increase in bone density [24]. These force fluctuations provide a possible explanation for the therapeutic benefit seen. Whilst the number of inflexions appears to represent a small change in the mechanical environment of the tendon, the fluctuation in the force and length in the muscle tendon unit will be much greater that that observed externally due to the mechanical low pass filtering effects of the inertia of the foot and limb. It is likely that additional higher frequency oscillations also exist in the muscle tendon unit, which are not apparent in the external forces. Our data were collected in healthy subjects and it is possible that in injured patients the eccentric control is impaired thus leading to even more pronounced force fluctuations than those demonstrated in the healthy subjects. During the ageing process tendinous tissue becomes more compliant [25]. Resistance exercises can mitigate this reduction in tendon stiffness and may therefore reduce tendon stress and risk of injury possibly enabling the tissue to operate closer to the
5 1496 J. D. Rees et al. optimum region of the length tension relationship [26]. Eccentric loading exercises may be particularly effective in increasing tendon stiffness. A potential criticism of our method is that our data were collected using inverse dynamics rather than from direct measurements, such as those from a directly implanted transducer around the AT [27] and does not take into account the contribution from the antagonist muscle group (tibialis anterior in particular). However, we do not believe that this invalidates our conclusions. Our method is less invasive and has been shown to be reliable in previous studies [23]. Furthermore, the antagonist muscles are small in comparison with the gastrocnemius and soleus complex. And, as they oppose the calf muscles in both concentric and eccentric movements, their effect will at least in part cancel out. Our technique of tracking the Achilles MTJ frame by frame initially suggests that during eccentric loading the tendon is operating at a shorter range than during concentric loading. Since the tendon is never unloaded, we cannot discriminate between whether the shape of the MTJ is different during either a concentric or eccentric contraction and it is possible (or probable) that a different point of interest of the MTJ is tracked in each of the two exercises. An alternative, or contributory, explanation is that the tendon is longer throughout eccentric loading cycle than during concentric loading cycle. The speed of the eccentric movement, and its relationship to force fluctuations, is of particular interest and worthy of further research. It may be that a protocol with faster eccentric movements (such as a protocol with a progressive increase in the speed of the eccentric exercises) will lead to greater force fluctuations and hence a greater re-modelling stimulus. This is the first article to examine why eccentric loading is successful as a therapeutic intervention for mid-substance lesions of the AT. We suggest that the pattern of tendon loading, with its force fluctuations, rather than the magnitude of the force, is responsible for the therapeutic benefit seen. This parallels evidence from bone remodelling. The challenge now is to improve eccentric loading protocols, and hence outcome, for tendinopathy. Greater understanding of the tendon loading pattern should lead to improved rehabilitation protocols. Inflexions per cycle Concentric Eccentric Subject FIG. 4. Mean number of inflexions per cycle for each subject/activity. No error bars due to low number of potential values. Inflexions of the AT force pattern occurred much more frequently during eccentric loading of the AT rather than during concentric loading for all subjects (P < ). Eccentric Loading (1) Eccentric Loading (2) Concentric Loading (1) AT length Concentric Loading (2) AT force FIG. 3. Force characteristics for eccentric and concentric loading of the AT. In eccentric loading the AT is subject to repeated unloading and loading in a sinusoidal-type pattern. In concentric loading, this additional loading and unloading is largely absent. Typical examples are shown for one female (subject 1) and one male (subject 2). Eccentric loading is shown in the top two graphs and concentric loading in the bottom two graphs.
6 Mechanism for efficacy of eccentric loading 1497 Disclosure statement: The authors have declared no conflicts of interest. References Rheumatology key message Increased force fluctuations, rather than force magnitude, provide a mechanism to explain the therapeutic benefit of eccentric loading in Achilles tendinopathy. 1 Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology 2006;45: Maffulli N, Binfirld PM, Moore D, King J.B. Surgical decompression of chronic central core lesions of the Achilles tendon. Am J Sports Med 1999;27: Sharma P, Maffulli, N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am 2005;87: Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res 1986;208: Kangas J, Pajala A, Siira P, Hamalainen M, Leppilahti J. Early functional versus early immobilization in tension of the musculotendinous unit after Achilles rupture repair: a prospective, randomized, clinical study. J Trauma 2003;54: Speed CA. Fortnightly review: corticosteroid injections in tendon lesions. Br Med J 2001;323: Khan KM, Cook JL, Maffulli N, Kannus P. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 2000;34: Scott A, Alfredson H, Forsgren S. VgluT2 expression in painful Achilles and patellar tendinosis: evidence of local glutamate release by tenocytes. J Orthop Res 2008;26: Andersson G, Danielson P, Alfredson H, Forsgren S. Presence of substance P and the neurokinin-1 receptor in tenocytes of the human Achilles tendon. Regul Pept. Advance Access published March 4, 2008, doi: /j.regpep Alfredson H, Pietilä T, Jonsson, P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998;26: Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 2001;9: Rompe JD, Nate B, Fuira JP, Maffulli N. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of the tendo Achilles: a randomized control trial. Am J Sports Med 2007;35: Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport 2007;10: Silbernagel KG, Thomeé R, Thomeé P, Karlsson J. Eccentric overload training for patients with chronic Achilles tendon pain a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports 2001;11: Cannell LJ, Taunton JE, Clement DB, Smith C, Khan KM. A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper s knee in athletes; pilot study. Br J Sports Med 2001;35: Purdam CR, Jonsson P, Alfredson H, Lorentzon R, Cook JL, Khan KM. A pilot study of the eccentric decline squat in the management of painful chronic patella tendonopathy. Br J Sports Med 2004;34: Young MA, Cook JL, Purdham CR, Kiss ZS, Alfredson H. Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patella tendinopathy in volleyball players. Br J Sports Med 2005; 39: Jonsson P, Wahlström P,Öhberg L, Alfredson H. Eccentric training in chronic painful impingement syndrome of the shoulder; results of a pilot study. Knee Surg Sports Traumatol Arthrosc 2006;14: Fyfe I, Stanish WD. The use of eccentric training and stretching treatment and prevention of tendon injuries. Clin Sports Med 1992;11: Komi PV. Neuromuscular performance: factors influencing force and speed production. Scand J Sports Sci 1979;1: Öhberg L, Lorentzon R, Alfredson, H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med 2004;38: Fahlström M, Jonsson P, Lorentzon R, Alfredson H. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc 2003;11: Lichtwark GA, Wilson AM. In vivo mechanical properties of the human Achilles tendon during one legged hopping. J Exp Biol 2005;208: Rubin C, Turner AS, Bain S, Mallinckrodt C, McLeod K. Low mechanical signals strengthen long bones. Nature 2001;412: Mian OS, Thom JM, Ardigò LP, Minetti AE, Narici MV. Gastrocnemius muscletendon behaviour during walking in young and older adults. Acta Physiol 2007;189: Magnusson SP, Narici MV, Maganaris CN, Kjaer M. Human tendon behaviour and adaptation, in vivo. J Physiol 2008;586: Fukashiro S, Komi PV, Jarvinen M, Miyashita M. In vivo Achilles tendon loading during jumping in humans. Eur J Physiol Occcup Physiol 1995;5:453 8.
Dr Hamish Osborne. Sport & Exercise Medicine Physician Dunedin
Dr Hamish Osborne Sport & Exercise Medicine Physician Dunedin New Approaches to Handling Tendinopathies By Hamish Osborne Definition Tendinopathy Absence of tightly packed collagen bundles Large amount
More informationWhy research on tendon?
To be or not to be Active with Painful Tendinopathy? Practical Clinical Applications Based on Current Research Using the Achilles Tendon as a Model Why research on tendon? Karin Grävare Silbernagel, PhD,
More informationC hronic tendinopathies are common in both recreational
217 REVIEW The evolution of eccentric training as treatment for patellar tendinopathy (jumper s knee): a critical review of exercise programmes Håvard Visnes, Roald Bahr... Br J Sports Med 2007;41:217
More informationHOW TO CITE THIS ARTICLE:
A STUDY TO COMPARE THE EFFICACY OF ULTRASOUND WITH ECCENTRIC EXERCISES AND ULTRASOUND WITH CONCENTRIC EXERCISES ON TENDO ACHILLES TENDINITIS IN ATHELETES Ravish V. N 1, R. Raja 2, S. R. Sarala 3, Pavan
More informationNON-SURGICAL MANAGEMENT OF ACHILLES TENDINOPATHY IMAGE GUIDED HIGH VOLUME INJECTION
NON-SURGICAL MANAGEMENT OF ACHILLES TENDINOPATHY IMAGE GUIDED HIGH VOLUME INJECTION ACHILLES (Homer 800BC) When Achilles mother Thetis made her son invulnerable by submerging him in the Styx, the river
More informationSPORTS MEDICINE. Abstract In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric
Knee Surg, Sports Traumatol, Arthrosc (2001) 9 :42 47 SPORTS MEDICINE DOI 10.1007/s001670000148 N. Mafi R. Lorentzon H. Alfredson Superior short-term results with eccentric calf muscle training compared
More informationIt is time to abandon the myth that eccentric
VOLUME 12.1, 2016 D.O.I: http: doi.org/10.4127/jbe.2016.0097 Stasinopoulos Dimitrios (PhD) 1, Peter Malliaras 2 It is time to abandon the myth that eccentric training is best practice. 1 Vice-Chairperson
More informationPain Enduring Eccentric Exercise for the Treatment of Chronic Achilles Tendinopathy
Pain Enduring Eccentric Exercise for the Treatment of Chronic Achilles Tendinopathy Claire Dixon Laureen Holloway Janice Meier Nick Lo Teresa Lee Supervisors: W Darlene Reid Ph.D. & Sunita Mathur Ph.D.
More informationMuscle-tendon mechanics of a heel drop-raise exercise
Muscle-tendon mechanics of a heel drop-raise exercise Taija Finni Neuromuscular Research Center Department of Biology of Physical Activity University of Jyväskylä Stretch-Shortening Cycle Braking phase
More informationAchilles tendon injury
Achilles tendon injury Achilles tendinopathy is highly prevalent in athletes who participate in running-based sports but can also occur in racket sports and in sedentary people. Research suggests there
More informationMusculoskeletal health is a necessary component of overall
ORIGINAL ARTICLE No Effect of Eccentric Training on Jumper s Knee in Volleyball Players During the Competitive Season A Randomized Clinical Trial Håvard Visnes, Stud Med, PT,* Aasne Hoksrud, Stud Med,*
More information2/02/2011. Purdam et al , Silbernagel 2004 Structure towards high, low, medium
The cornerstones Define the tendon as pain source Defining the stage of tendinopathy Patient history Diagnostic ultrasound Quantify tendon symptoms & function VISA - medium term Loading tests 24 hr response
More informationUEL. Sport Rehabilitation: Injury to Optimal Performance PTM 0114
UEL Sport Rehabilitation: Injury to Optimal Performance PTM 0114 The role of eccentric training in the management of Achilles Tendinopathy Analysing and discussing Herrington L. and McCulloch R. (2007)
More informationL J Cannell, J E Taunton, D B Clement, C Smith, K M Khan
60 The Allan McGavin Sports Medicine Centre and School of Human Kinetics, University of British Columbia, Vancouver, Canada L J Cannell J E Taunton D B Clement C Smith K M Khan Correspondence to: Dr Khan
More informationprogramme in the treatment of rotator cuff tendinopathy A pilot trial to study the effectiveness of an exercise Abstract
VOLUME 10.2, 2014 A pilot trial to study the effectiveness of an exercise programme in the treatment of rotator cuff tendinopathy D.O.I: http:doi.org/10.4127/jbe.2014.0079 Stasinopoulos Dimitrios 1, Stasinopoulos
More informationDepartment of Physical Therapy, Sahmyook University, Seoul, Republic of Korea 2
Journal of Sports Science and Medicine (2012) 11, 136-140 http://www.jssm.org Research article Comparison of pathway and center of gravity of the calcaneus on non-involved and involved sides according
More informationLifting your toes up towards your tibia would be an example of what movement around the ankle joint?
NAME: TEST 1 ANATOMY IN SPORT SCIENCE: SEMESTER 1, 2017 TOTAL MARKS = 58 Total: / 58 marks Percentage: Grade: TERMINOLOGY: The structures that connect bone to bone are called: The ankle joint is to the
More informationAchilles Tendinopathy (Mid-portion)
Achilles Tendinopathy (Mid-portion) What is Achilles tendinopathy? Achilles tendinopathy or tendinitis is a term that has been used for many years to describe pain, swelling and thickening around the Achilles
More informationLifting your toes up towards your tibia would be an example of what movement around the ankle joint?
NAME: TEST 1 ANATOMY IN SPORT SCIENCE: SEMESTER 2, 2016 TOTAL MARKS = 72 Total: /72 marks Percentage: Grade: TERMINOLOGY: The structures that connect bone to bone are called: The hip joint is to the shoulder
More informationAchilles tendinopathy rehabilitation Non-insertional
Achilles tendinopathy rehabilitation Non-insertional The Achilles tendon inserts into the back of your heel, and has its origins in the gastrocnemius and soleus muscles in your lower leg. Achilles tendinopathy
More informationPhysiotherapy information for Achilles Tendinopathy
Physiotherapy information for Achilles Tendinopathy What is Achilles Tendinopathy? Achilles Tendinopathy is a condition that can cause pain, swelling and weakness of the Achilles Tendon. This joins your
More informationACTIVITY TYPE. Stretching COACHING RESOURCE
ACTIVITY TYPE Stretching 161 Stretching, Warm-up and Cool-down A regular stretching, warm-up and cool-down routine is an essential component of any athlete s program no matter what their age or competition
More informationMELDING EXPLOSIVE POWER WITH TECHNIQUES IN THE LONG JUMP. Explosive Strength IS THE RATE OF FORCE DEVELOPMENT AT THE START OF A MUSCLE CONTRACTION.
MELDING EXPLOSIVE POWER WITH TECHNIQUES IN THE LONG JUMP Jake Jacoby Jumps Coach University of Louisville jake.jacoby@louisville.edu Explosive Strength IS THE RATE OF FORCE DEVELOPMENT AT THE START OF
More informationAbsolutePT s Tendinitis Approach. By Chad Reilly, President of Absolute Physical Therapy.
AbsolutePT s Tendinitis Approach. By Chad Reilly, President of Absolute Physical Therapy. Tendinitis, tendinosis, tendinopathy; the name is currently in transition due to the fact that there are no outward
More informationSPORTSSOCIETY Developing attractive and dynamic societies via sports Project Nr: CB67. Preventative and rehabilitation exercises of sports injures
Preventative and rehabilitation exercises of sports injures Diagnosis: Plantar Facitis What is Plantar Facitis? Plantar fascitis(pf) is a painful inflammatory process of the plantar fascia, the connective
More informationAETIOLOGY TENDINOPATHY RESEARCH UPDATE - NOVEMBER Contents
TENDINOPATHY RESEARCH UPDATE - NOVEMBER 2012 Contents AETIOLOGY... 1 A lower limb assessment tool for athletes at risk of developing patellar tendinopathy.... 1 Triceps surae activation is altered in male
More informationA calf strain often occurs when the calf muscles are working eccentrically ( working while under a stretch), such as coming down from a jump, and
A calf strain often occurs when the calf muscles are working eccentrically ( working while under a stretch), such as coming down from a jump, and also during the time when you are about to push off to
More informationA 5-year follow-up study of Alfredson s heel-drop exercise programme in chronic midportion Achilles tendinopathy
1 Sports Medicine Department, The Hague Medical Centre, Leidschendam, The Netherlands 2 Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands 3 Department of Orthopaedics, Leiden
More informationNHS Buckinghamshire Musculoskeletal Integrated Care Service (MusIC) Achilles tendinopathy
NHS Buckinghamshire Musculoskeletal Integrated Care Service (MusIC) Achilles tendinopathy What is the Achilles tendon? The Achilles tendon is the biggest and strongest tendon in the body. It is found at
More informationNATURAL DEVELOPMENT AND TRAINABILITY OF PLYOMETRIC ABILITY DURING CHILDHOOD BY KIRSTY QUERL SPORT SCIENTIST STRENGTH AND CONDITIONING COACH
NATURAL DEVELOPMENT AND TRAINABILITY OF PLYOMETRIC ABILITY DURING CHILDHOOD BY KIRSTY QUERL SPORT SCIENTIST STRENGTH AND CONDITIONING COACH The truth... Youth are not as active as they used to be, Decline
More informationNew insights into the mechanisms of tendon injury
New insights into the mechanisms of tendon injury What is normal tendon? A extracellular matrix tissue Type 1 collagen Small amounts of CRITICAL proteins Ground substance Proteoglycans, glycoproteins Structures
More informationAchilles and Patellar Tendinopathy Loading Programmes
Sports Med (2013) 43:267 286 DOI 10.1007/s40279-013-0019-z SYSTEMATIC REVIEW Achilles and Patellar Tendinopathy Loading Programmes A Systematic Review Comparing Clinical Outcomes and Identifying Potential
More informationIntratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4 year cohort.
Intratendinous tears of the Achilles tendon - a new pathology? Analysis of a large 4 year cohort. Poster No.: C-1680 Congress: ECR 2014 Type: Scientific Exhibit Authors: S. Morton, T. Parkes, O. Chan,
More informationCitation for published version (APA): Zwerver, J. (2010). Patellar tendinopathy: Prevalence, ESWT treatment and evaluation. Groningen: s.n.
University of Groningen Patellar tendinopathy Zwerver, Johannes IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationNovel Physical Therapy Protocol Results in Increased Compressive Strain and Improved Outcomes in Insertional Achilles Tendinopathy
Novel Physical Therapy Protocol Results in Increased Compressive Strain and Improved Outcomes in Insertional Achilles Tendinopathy Meghan Kelly MD PhD, Mary A Bucklin, Ruth Chimenti PhD, Rachel E Olsen,
More informationLower Extremity Physical Performance Testing. Return to Function (Level I): Core Stability
Physical performance testing is completed with patients in order to collect data and make observations regarding the overall function of the limb integrated into the entire functional unit of the body,
More informationAN ELECTROMYOGRAPHIC COMPARISON BETWEEN THE SQUAT IN A DECLINE BOARD AND IN A FLAT SURFACE WITH DIFFERENT OVERLOADS
AN ELECTROMYOGRAPHIC COMPARISON BETWEEN THE SQUAT IN A DECLINE BOARD AND IN A FLAT SURFACE WITH DIFFERENT OVERLOADS Gustavo Leporace, Glauber Pereira, Daniel Chagas, Jomilto Praxedes, Maithe Araújo, Maria
More informationCHAPTER 2: Muscular skeletal system - Biomechanics. Exam style questions - pages QUESTIONS AND ANSWERS. Answers
CHAPTER 2: Muscular skeletal system - Biomechanics Exam style questions - pages 32-35 1) A Level. Warm up is considered to be an essential element of a training programme. Explain how the muscular and
More informationSPECIFICITY OF STRENGTH DEVELOPMENT FOR IMPROVING THE TAKEOFF ABILITY IN JUMPING EVENTS
SPECIFICITY OF STRENGTH DEVELOPMENT FOR IMPROVING THE TAKEOFF ABILITY IN JUMPING EVENTS By Warren Young WARREN YOUNG of the Australian Institute of Sport examines specific speed strength qualities in the
More informationSymptoms usually come on gradually. Depending on the severity of the injury, they can include:
What is the Achilles tendon? The Achilles tendon is situated above the heel and forms the lower part of the calf muscles. It is a continuation of the two calf muscles, the gastrocnemius and soleus muscles,
More informationANTERIOR KNEE PAIN. Explanation. Causes. Symptoms
ANTERIOR KNEE PAIN Explanation Anterior knee pain is most commonly caused by irritation and inflammation of the patellofemoral joint of the knee (where the patella/kneecap connects to the femur/thigh bone).
More informationSPORTS MEDICINE OVERUSE MANAGEMENT PRINCIPLES FOR
SPORTS MEDICINE OVERUSE INJURIES: DIAGNOSIS AND MANAGEMENT PRINCIPLES FOR THE FAMILY PHYSICIAN DR NG CHUNG SIEN MBBS (SPORE) MSPMED (AUSTRALIA) DFD CAW SENIOR REGISTRAR CHANGI SPORTS MEDICINE CENTRE CHANGI
More informationPREVALANCE. Is eccentric loading better than concentric in rehab of tendinopathy? 9/29/10. Tendinopathy - prevalance
Is eccentric loading better than concentric in rehab of tendinopathy? Dr. Henning Langberg DMSc, PhD, PT Institute of Sports Medicine Copenhagen, Denmark PREVALANCE Tendinopathy - prevalance (Alfredson
More informationProtocols for Posterior Tibial Tendon Dysfunction & Achilles Tendinosis. Tara Bries, PT
Protocols for Posterior Tibial Tendon Dysfunction & Achilles Tendinosis Tara Bries, PT Non-Operative Protocol for Posterior Tibialis Tendon Dysfunction Based on research by Alvarez et al. (2006) entitled
More informationDAY 2 III. WORKOUT RULES
DAY 2 III. WORKOUT RULES A. Order of Exercise 1. Largest amount of muscle mass to smallest amount of muscle mass, eg., squats -- calf raises 2. Complex exercise to assisting, eg., squats -- leg ext. 3.
More informationAchilles Tendon Rupture
43 Thames Street, St Albans, Christchurch 8013 Phone: (03) 356 1353 Website: philip-bayliss.com Achilles Tendon Rupture Summary Achilles tendon ruptures commonly occur in athletic individuals in their
More informationJ umper s knee (chronic patellar tendinosis) is a troublesome
423 ORIGINAL ARTICLE and pain in jumper s knee: a prospective clinical and sonographic study in elite junior volleyball players K Gisslén, H Alfredson... See end of article for authors affiliations...
More informationKNEE AND LEG EXERCISE PROGRAM
KNEE AND LEG EXERCISE PROGRAM These exercises are specifically designed to rehabilitate the muscles of the hip and knee by increasing the strength and flexibility of the involved leg. This exercise program
More informationDr. Gene Desepoli Anterolateral Shin Splints Summary Treatment Sheet
Dr. Gene Desepoli Anterolateral Shin Splints Summary Treatment Sheet Pathology: Anterolateral shin splints results from strain to the tibialis anterior muscle from eccentric overuse, running on hard ground
More informationPrinciples of Treatment. Case Studies. Principles of Treatment. Clinical Perspectives for the GP
Principles of Treatment Clinical Perspectives for the GP Case Studies 1. Jumping athlete with an acute exacerbation of chronic patellar tendinopathy major competition in 9 days time 2 week tournament 2.
More information26/09/16. Tendon hierarchy. Eccentric exercise for tendon rehabilita2on (?) Collagen synthesis and tendon metabolism in vivo
Eccentric exercise for tendon rehabilita2on (?) Tendon hierarchy S. Peter Magnusson ECM PG & GAG Ins+tute of Sports Medicine Copenhagen & Musculoskeletal Rehabilita+on Research Unit Bispebjerg Hospital,
More informationshaving to treat patellar tendinopathy/jumper s knee? A randomised controlled study
1 Capio Artro Clinic, Stockholm Sports Trauma Research Centre, Karolinska Institutet, Stockholm, Sweden 2 Sports Medicine Unit, Department of Surgical and Perioperative Science, University of Umeå, Umeå,
More informationThe Power of Plyometrics
The Power of Plyometrics Plyometric training has been regularly prescribed to strength and power athletes for the last 30 years. This form of training originated in Russia during the 1960 s and was known
More informationKnee Conditioning Program
Knee Conditioning Program Purpose of Program After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Following
More informationTendon Structure s Lack of Relation to Clinical Outcome After Eccentric Exercises in Chronic Midportion Achilles Tendinopathy
Journal of Sport Rehabilitation, 2012, 21, 34-43 2012 Human Kinetics, Inc. Tendon Structure s Lack of Relation to Clinical Outcome After Eccentric Exercises in Chronic Midportion Achilles Tendinopathy
More informationKnee Conditioning Program
Prepared for: Prepared by: Purpose of Program After an injury or surgery, an exercise conditioning program will help you return to daily activities and enjoy a more active, healthy lifestyle. Following
More informationIJSPT ORIGINAL RESEARCH ABSTRACT
IJSPT ORIGINAL RESEARCH CLINICAL OUTCOMES OF THE ADDITION OF ECCENTRICS FOR REHABILITATION OF PREVIOUSLY FAILED TREATMENTS OF GOLFERS ELBOW Timothy F. Tyler, MS, PT, ATC 1,2 Stephen J. Nicholas, MD 2 Brandon
More informationNovel approaches to the treatment of tendinopathy the case of the patellar tendon Physiotherapy management - the first line
Novel approaches to the treatment of tendinopathy the case of the patellar tendon Physiotherapy management - the first line Ben Clarsen PT PhD Research Fellow Oslo Sports Trauma Research Center Specialist
More information*Agonists are the main muscles responsible for the action. *Antagonists oppose the agonists and can help neutralize actions. Since many muscles have
1 *Agonists are the main muscles responsible for the action. *Antagonists oppose the agonists and can help neutralize actions. Since many muscles have more than 1 action sometimes a muscle has to neutralize
More informationTendo Achilles rupture
Tendo Achilles rupture Conservative and surgical management Therapy Department 01935 475 122 yeovilhospital.nhs.uk What is the Achilles tendon? The Achilles tendon is a large tendon at the back of the
More informationBadminton. 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) Website: philip-bayliss.com
43 Thames Street, St Albans, Christchurch 8013 Phone: (03) 356 1353 Website: philip-bayliss.com Badminton Badminton's origin may be traced as far back as fifth century China when players would volley a
More informationFunctional Movement Screen (Cook, 2001)
Functional Movement Screen (Cook, 2001) TEST 1 DEEP SQUAT Purpose - The Deep Squat is used to assess bilateral, symmetrical, mobility of the hips, knees, and ankles. The dowel held overhead assesses bilateral,
More informationChapter 14 Training Muscles to Become Stronger
Chapter 14 Training Muscles to Become Stronger Slide Show developed by: Richard C. Krejci, Ph.D. Professor of Public Health Columbia College 11.22.11 Objectives 1. Describe the following four methods to
More informationIn an adult population are eccentric exercises effective in reducing pain and improving function in Achilles tendinopathy? Clinical bottom line
Specific Question: In an adult population are eccentric exercises effective in reducing pain and improving function in Achilles tendinopathy? Clinical bottom line There is moderate quality evidence for
More informationMuscle-Tendon Mechanics Dr. Ted Milner (KIN 416)
Muscle-Tendon Mechanics Dr. Ted Milner (KIN 416) Muscle Fiber Geometry Muscle fibers are linked together by collagenous connective tissue. Endomysium surrounds individual fibers, perimysium collects bundles
More informationMuscular Strength and Endurance:
PE 1- Assignment #5 6 1 Name: Per: Date: Teacher: STRESS BREAK Participating in physical activities that improve your self-esteem is a great way to deal with stress. The better you feel about yourself,
More informationAchilles Tendon Ruptures Accelerated Functional Rehab vs Immobilization
Achilles Tendon Ruptures Accelerated Functional Rehab vs Immobilization Michael D. Dujela DPM, FACFAS Fellowship Trained Foot and Ankle Surgeon Washington Orthopaedic Center Director, Foot and Ankle Surgery,
More informationSupplements are to be used to improve performance in the gym and to enhance health on a day to day basis.
Workout Plans: - 3 Days per week weight training with 20 mins PWO SSC Cardio - 2 Days per week conditioning/hiit training - 2 Rest Day per week Nutrition Plans: Diet should consist of a lower carbohydrate
More informationPGYVC Volleyball Circuit Athletic Plan
PGYVC Volleyball Circuit Athletic Plan Workout Plan: This workout plan is to introduce and promote off court training for PGYVC athletes as well as to build confidence for athletes who have not done physical
More information11/23/10. An update on Achilles tendon rehabilitation. Research area the last y. Four-sequence in understanding Achilles injuries
An update on Achilles tendon rehabilitation Research area the last 10-15 y Tendon Collagen Muscle Collagen From science to rehab Dr.med Henning Langberg DMSc, PhD, PT Myofibril lar Institute of Sports
More informationToe walking gives rise to parental concern. Therefore, toe-walkers are often referred at the 3 years of age.
IDIOPATHIC TOE WALKING Toe walking is a common feature in immature gait and is considered normal up to 3 years of age. As walking ability improves, initial contact is made with the heel. Toe walking gives
More informationTHE MUSCULAR SYSTEM CHAPTER 5
THE MUSCULAR SYSTEM CHAPTER 5 MUSCULAR SYSTEM Only tissue capable of shortening or contracting Responsible for both powerful and graceful movements Control movements of eyes, food, and heart Three categories
More informationmechanical stresses on the tendon with repetitive loading
Tendinopathy.. How does it happen? mechanical stresses on the tendon with repetitive loading Impingement of the tendon between adjacent structures (bones, ligaments) and impaired blood supply Presentation
More informationIntroduction. Anatomy
the patella is called the quadriceps mechanism. Though we think of it as a single device, the quadriceps mechanism has two separate tendons, the quadriceps tendon on top of the patella and the patellar
More informationCourse Outline. Muscular Adaptations. Training Modifications. Common Hiking Injuries and Anatomy/Physiology. Hiking Exercises
Course Outline Muscular Adaptations Strength, Endurance, Balance/Coordination, Flexibility Training Modifications Repetitions, Sets, Rest Periods, Surfaces, Movements Common Hiking Injuries and Anatomy/Physiology
More informationConfusion. Confusion. Confusion. Confusion Confusio Confusio. n Confusion Confusion. Confusion. Confusion. Confusion. Confusion.
Centre for Sports and Exercise Medicine Patellar Tendinopathy Conservative and surgical managment Nicola Maffulli Centre Lead and Professor Consultant Trauma and Orthopaedic Surgeon Centre for Sport and
More informationMENTOR METHOD OF TRAINING
MENTOR METHOD OF TRAINING When trying to improve performance on the field of play or on the court, whatever your sport, it is important that you understand where it all begins. For an athlete there are
More informationACL Rehabilitation and Return To Play
ACL Rehabilitation and Return To Play Seth Gasser, MD Director of Sports Medicine Florida Orthopaedic Institute Introduction Return to Play: the point in recovery from an injury when a person is safely
More informationInformation and Exercise Booklet
FACULTY OF HEALTH SCIENCES School of Allied Health Department of Physiotherapy Appendix E Information and Exercise Booklet Project: Does oestrogen, exercise or a combination of both, improve pain and function
More informationTHE EFFECT OF THE ACHILLES TENDON MOMENT ARM ON KNEE JOINT CONTACT FORCE. Ashley E. Warren. A Senior Honors Project Presented to the.
THE EFFECT OF THE ACHILLES TENDON MOMENT ARM ON KNEE JOINT CONTACT FORCE by Ashley E. Warren A Senior Honors Project Presented to the Honors College East Carolina University In Partial Fulfillment of the
More informationNEURAL CONTROL OF ECCENTRIC AND POST- ECCENTRIC MUSCLE ACTIONS
NEURAL CONTROL OF ECCENTRIC AND POST- ECCENTRIC MUSCLE ACTIONS 1, 2 Daniel Hahn, 1 Ben W. Hoffman, 1 Timothy J. Carroll and 1 Andrew G. Cresswell 1 School of Human Movement Studies, University of Queensland,
More informationFoot and Ankle Mobility and Stability. Andy Baksa, PT, DPT Results Physiotherapy
Foot and Ankle Mobility and Stability Andy Baksa, PT, DPT Results Physiotherapy Background Exercise Science degree from UTK in 2007. Doctorate of physical therapy from UTC in 2013 Ran track and cross country
More informationRehabilitation Guidelines for Patellar Tendon and Quadriceps Tendon Repair
UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Patellar Tendon and Quadriceps Tendon Repair The knee consists of four bones that form three joints. The femur is the large bone in the thigh
More informationShockwave Therapies for Musculoskeletal Problems Useful Literature
Shockwave Therapies for Musculoskeletal Problems Useful Literature I have some 1600 references related to shockwave therapy. Those listed below are the main musculoskeletal related papers from 2005-07
More informationMODULE: SQUAT JUMP BRIEF DESCRIPTION:
MODULE: SQUAT JUMP BRIEF DESCRIPTION: Squat jump is a vertical jump and among the most often used tests for maximal anaerobic power output of the lower extremities. It is a concentric muscle action which
More informationDynamic Flexibility and Mobility
Dynamic Flexibility and Mobility Below is the standard dynamic flexibility series. Your workout should have a prescribed warm-up, but if it doesn't a three minute total body warm-up, (i.e., jogging, rope
More informationPreventative Exercises for the Achilles
Preventative Exercises for the Achilles Outline 1. Toe walk x 15 each foot 2. Feet out walk x 15 each foot 3. Feet in walk x 15 each foot 4. Ankle in walk x 10 each foot 5. Ankle out walk x 10 each foot
More informationThe American Journal of Sports Medicine
The American Journal of Sports Medicine http://ajs.sagepub.com/ Mechanical Properties of the Achilles Tendon Aponeurosis Are Altered in Athletes With Achilles Tendinopathy Sally Child, Adam L. Bryant,
More informationACHILLES TENDON DISORDERS
MUSCULOSKELETAL YOUR GUIDE TO ACHILLES TENDON DISORDERS An IPRS Guide to provide you with exercises and advice to ease your condition Contents What is the Achilles Tendon?.....................................
More informationAugust 2015 Getting Hip to Arthroscopic Surgery Much like surgery of the shoulder
Getting Hip to Arthroscopic Surgery Much like surgery of the shoulder or knee, arthroscopic hip surgery is finding more and more favor among surgeons. It is utilized when painful hip conditions fail to
More informationMEDIAL HEAD GASTROCNEMIUS TEAR (Tennis Leg)
MEDIAL HEAD GASTROCNEMIUS TEAR (Tennis Leg) Description Expected Outcome Medial head gastrocnemius tear is a strain of the inner part (medial head) of the major calf muscle (gastrocnemius muscle). Muscle
More informationWarm-Up and Stretching Exercises
Warm-Up and Stretching Exercises Most athletes (swimmers included) use a combination of controlled movement exercises and specific joint/muscle stretching to improve performance potential. The proposed
More informationThe American Journal of Sports Medicine
The American Journal of Sports Medicine http://ajs.sagepub.com/ Chronic Achilles Tendinopathy Wolf Petersen, Robert Welp and Dieter Rosenbaum Am J Sports Med 2007 35: 1659 originally published online June
More informationPreventative Exercises for the Achilles
Preventative Exercises for the Achilles Outline 1. Toe walk x 15 each foot 2. Feet out walk x 15 each foot 3. Feet in walk x 15 each foot 4. Ankle in walk x 10 each foot 5. Ankle out walk x 10 each foot
More informationACHILLES TENDON REPAIR REHAB GUIDELINES
ACHILLES TENDON REPAIR REHAB GUIDELINES Typically patients are discharged on the day of the operation or the next day. The leg is usually immobilized in a cast or hinged brace, ranging from 4-8 weeks.
More informationdifferentiate between the various types of muscle contractions; describe the factors that influence strength development;
CHAPTER 6 Muscles at Work After completing this chapter you should be able to: differentiate between the various types of muscle contractions; describe the factors that influence strength development;
More informationA Patient s Guide to Adult-Acquired Flatfoot Deformity
A Patient s Guide to Adult-Acquired Flatfoot Deformity Glendale Adventist Medical Center 1509 Wilson Terrace Glendale, CA 91206 Phone: (818) 409-8000 DISCLAIMER: The information in this booklet is compiled
More informationDisorders of the Achilles tendon The ageing athlete
Disorders of the Achilles tendon The ageing athlete John P. Negrine F.R.A.C.S. Foot and Ankle Surgeon Orthosports Sydney The Bad news Maximum heart rate decreases VO2 Max decreases Runners when compared
More informationThe Takeoff in the Long Jump & Other Running Jumps. James Hay (Sanders & Gibson eds)
The Takeoff in the Long Jump & Other Running Jumps James Hay (Sanders & Gibson eds) Despite its importance to success in the long jump, the takeoff has been accorded little attention by sports biomechanists.
More informationFunctional Movement Test. Deep Squat
Functional Movement Test Put simply, the FMS is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional
More information