Talking Tendons

Latest Episodes:

Humans are lazy (or efficient!) hoppers: the importance of instructions in submaximal human hopping Jul 16, 2022

Show notes

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.

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Steroid injection for Achilles tendinopathy? Jul 15, 2022

Show notes

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.

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Does pain science education improve outcomes for Achilles tendinopathy? Jun 28, 2022

Show notes

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

Here is a link to the actual paper:

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

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Strength and other impairments in runners with Achilles tendinopathy Jun 15, 2022

Show notes

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 & 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.

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Exciting new insights into tendon adaptation with load May 26, 2022

Show notes

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/jeb243741/275395

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Achilles tendinopathy clinical and patient subgroups May 05, 2022

Show notes

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 & 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 & sports physical therapy, 45(11)

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Central pain processing and Achilles tendinopathy Apr 23, 2022

Show notes

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.

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The amazing benefits of biologic springs like the Achilles tendon Apr 20, 2022

Show notes

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.

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Gluteal tendinopathy chat with Chris Clifford Apr 18, 2022

Show notes

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 & 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 & exercise medicine, 6(1), p.e000760.

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Do dietary supplements improve outcomes in tendinopathy? Apr 11, 2022

Show notes

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-211689

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