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Tendons in ten minutes
- 1. Hold onto your hats…… Dr. Richard Collins MSK Physician
- 3. Sobrino et al. Orthop J Sports Med 2015 Overuse injuries in Professional Ballet • Anterior Knee Pain (likely included PT) 16% • PatellarTendinopathy 10.5% • AchillesTendinopathy 8% Ramkumar et al. J Dance Med Sci 2016 Injuries in a Professional Ballet Dance Company • Foot & Ankle 38% • Sprain 10% • AchillesTendinopathy 3% • Back related 20% (most costly)
- 4. ‘Many American ballet companies have taken to retaining in-house medical and training staff that, in one company of 70 dancers, demonstrated a $1.2 million savings over a 5-year period while simultaneously decreasing the injury incidence from 94% to 75%’ Ramkumar et al Lower limb tendon care is a core need in Dance Medicine
- 8. Now…
- 10. Causes Collagen health • Systemic health • Pubertal development Disordered Loading • Biomechanics • Periodisation
- 11. Causes Collagen health • Systemic health • Pubertal development Disordered Loading • Biomechanics • Periodisation
- 12. Pubertal factors on overuse injuries J Dance Med Sci 2015 The questions are being asked Where does Collagen come into this?
- 13. Collagen synthesis in puberty • Life-time tendon collagen is synthesised by age 17 • Puberty is a critical period of collagen synthesis • Lower Limb tendon development connected to growth • Tendon collagen is potentially as susceptible to RED-S as bone collagen
- 14. Collagen synthesis in puberty • Life-time tendon collagen is synthesised by age 17 • Puberty is a critical period of collagen synthesis • Lower Limb tendon development connected to growth • Tendon collagen is potentially as susceptible to RED-S as bone collagen
- 15. Collagen synthesis in puberty • Life-time tendon collagen is synthesised by age 17 • Puberty is a critical period of collagen synthesis • Lower Limb tendon development connected to growth • Tendon collagen is potentially as susceptible to RED-S as bone collagen
- 16. Collagen synthesis in puberty • Life-time tendon collagen is synthesised by age 17 • Puberty is a critical period of collagen synthesis • Lower Limb tendon development connected to growth • Tendon collagen is potentially as susceptible to RED-S as bone collagen
- 17. Collagen synthesis in puberty The Australians are on to this!
- 18. Detection Symptom screening • Too subjective • Late presentation UTC – new US technology • Objective data • Good interobserver reproducibility (once trained) • Links to developing research base
- 19. Detection Symptom screening • Too subjective • Late presentation UTC – new US technology • Objective data • Good interobserver reproducibility (once trained) • Links to developing research base
- 20. UTC – UltrasoundTissue Characterisation Dr. Lorenzo Masci hard at work
- 21. UTC – UltrasoundTissue Characterisation
- 22. UTC – UltrasoundTissue Characterisation Adapted from JL Cook, C Purdum Br J Sports Med 2008
- 23. UTC – UltrasoundTissue Characterisation L Masci, H Alfredson Br J Sports Med 2014
- 24. Treatment Intelligent Loading • better models • activity specific Invasive adjuncts • Injections • Surgery
- 25. Treatment Intelligent Loading • better models • activity specific Invasive adjuncts • Injections • Surgery
- 26. Intelligent Loading JL Cook, SI Docking Br J Sports Med August 2015
- 27. Thank you!