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The 3D geometry of the Achilles tendon is complex (essentially made up of tendons from the three calf muscles that are twisted together) and influences the strain that occurs in different components of the tendon. This is enabled by sliding that occurs between these subtendons. They can act independently to some extent. This team aimed to develop a mathematical model to test whether the geometry of the Achilles and different rehab exercises influence Achilles strain.
Exercise dose: Is it important for tendinopathy rehabilitation?
Monitoring Physical Activity Using Wearable Technology in People With Achilles Tendinopathy Undergoing Physiotherapy Treatment: A Feasibility Prospective Cohort Study
Exercise is a recommended treatment for many pain and musculoskeletal conditions, including tendinopathy. It is really clear in other areas such as exercise for general health (e.g., heart health) that the more exercise you do, the better. Things don’t really work in this linear way for pain. Pain is complex. Maybe doing more exercise will make our pain and musculoskeletal patients stronger and more functional, but why should it improve their pain?
This week I talk about a feasibility cohort study which sought to determine whether a larger cohort study addressing this question would be feasible. Listen to hear some interesting preliminary findings.
We have known for a while that type of exercise intervention (e.g. intensity, frequency, etc) does not seem to influence self reported outcomes such as pain. Maybe all the benefits from exercise are explained by non-specific effects, or maybe exercise has benefits that do not depend on the type of exercise.
This week, I had an engaging conversation with Anthony Nasser, an up-and-coming researcher on tendinopathy who recently completed his PhD on proximal hamstring tendinopathy. Our discussion covered the reasons for the lack of research attention towards this condition, the current state of evidence, and insights from his doctoral studies. You can find the full conversation here.
Palpation can be useful for the diagnosis and assessment of tendinopathy, but there are limits. This is because non-painful tendons can be tender, and tenderness in painful tendons seems to be very slow to get better.
Interesting perspective paper from Arampatzis et al talking about how we should consider tuning of muscle tendon unit in terms of muscle strength and tendon stiffness when considering training for specific groups.
This talking tendons episode will discuss a study by Igor Sancho, PhD, assessing Achilles forces during common rehab exercises and habitual activities and how this relates to reported pain among runners. Some interesting implications for practice.
In this episode, I am discussing kinesiophobia in the context of tendon rehab and how rehab can be conceptualised as graded exposure for some people.
In this episode I talk about how load test pain assessment and how this can also be used to assess kinesiophobia and movement apprehension.
Clinical gems and awesome management models. Your patients will love you for it!