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NSEMS May 2015 summary
- 2. Achilles Tendinopathy • Tendinopathy is a clinical diagnosis (Maffuli et al 2006) • Effects 2-50% of the population (De Jonge et al 2011 , Kujala et al 2005 , Kvist 1994, Marti et al 1984) • Primarily a degenerative process (Cook and Purdam 2009) • BUT some inflammatory pathways (Rees et al 2013, Abate et al 2009, Fu et al 2010, Scot et al 2013) • Treatment effects are varied (29-94% success) (Carcia et al 2010, Magnussen et al 2009, Kramer et al 2010, Kingma et al 2007)
- 3. Differential diagnosis • Mid-tendon tendinopathy • Paratenonitis • Insertional tendinopathy • Plantaris • Fascia Crura tears • Longitudinal tears • Partial ruptures/complete Ruptures • Accessory Soleus • Hagglund’s • Bursal/fat pad
- 4. Differential diagnosis • Site • Stage (continuum model) • Type of disorder – “intrasubstance split”, paratenon, tendon ? • Stability of symptoms (SIN factor) • Systematic vs Biomechanical factors?
- 5. Insertional tendinopathy is due to calcaneal compression
- 6. Risk factors Intrinsic • Previous injury • Increasing Age Longo et al • Gender • Genetic predisposition • Muscle weakness • Tendon Structure • Increased BMI and/or Adiposity • Diabetes • Medication – Abx, Steriods • Lower limb Biomechanics Extrinsic • “Training errors” • Cold Weather training • Footwear • Training surface
- 8. Why does exercise trigger tendinopathy? Magnusson et al 2010 30Km
- 9. Structure can predict symptoms Fredberg et al 2009
- 10. But structure does not correspond to pain or recovery
- 11. Previous injury, age, offseason, preseason, and strength Are they all the same factor?
- 12. Soleus 52% Med Gas 32% Lat Gas 16% Albracht et al 2008
- 13. Soleus contributes 50% of total vertical support force
- 14. CONSERVATIVE MANAGEMENT OF MENISCAL INJURIES Dr Clodagh Dugdale Nottingham Sports and Exercise Medicine Society Notts County Football Club
- 15. WHAT FACTORS INFLUENCE DATA COLLECTION AND INTERPRETATION Definition of meniscal injury – acute or degenerative Cohort studied Athletes General population Military Study methodology Age group? Gender? – Gender itself – or a function of different lifestyles? Presentation - Incidence may be higher than reported in studies as some (many?) may be silent
- 16. INCIDENCE OF MENISCAL INJURIES IN THE MILITARY US military incidence rate 8.27/1000 person years at risk 10 times that of the civilian population. Jones et al 2012 Risk in the over 40s = 4 x that in the under 20s. UK military ?????
- 17. TREATMENT OPTIONS FOR MENISCAL INJURY Nothing Change of lifestyle Rehabilitation only Rehabilitation as a precursor to surgery Rehabilitation (failed ) – leading to surgery Surgery
- 18. MENISCAL DERANGEMENT AND OA In patients with radiographic evidence of OA 63% of those with symptoms had a meniscal tear, and 60 % of those who were asymptomatic had a meniscal tear. Is this a function of age? Lifestyle? Correlation does not automatically equal causality BUT Without radiographic evidence – 32% and 23% 61% of those with meniscal tears had not had any pain or stiffness in the previous month
- 19. Strength and Speed Trainability and the Effect on Power Development in Youth Rhys Morris
- 21. Todays focus…
- 22. Biological Maturation age… • Maturation implies growth towards a fully mature state – differ in timing & tempo • Growth refers to changes in size whether that be stature (entire individual) or segments (cardiovascular system, skeletal system etc) (Baxter-Jones, 2005).
- 23. Rehabilitation of the Sporting Tendon Becki Knight First Team Physiotherapist Notts County F.C
- 24. Key Learning Points • Tendinopathy Therories • Pain Sources • Aims of rehabilitation • NSAIDs • Rehabilitation exercise examples
- 25. Limitations of Continuum model • Pathology Model • Fails to account for pain • Does disrepair phase move back to reactive phase?
- 27. Prevention of Tendinopathy • Caution with long term injured athletes • Caution with special groups • Transitioning athletes (YTFT) • Older athletes • Cautious of key parts of season • High training volume (Pre-season) • Fixture/Match Congestion (Xmas/NY/Tournaments) • Change in training load (New Manager)
Editor's Notes
- The UK has an estimated 1.9 Million regular runners (Sport England 2011), a potential 133,000 - 228,000 of those runners may develop Achilles
- Expand and discuss physical activity/loading and how various intrinsic factors affect this.
- Avoid prophylatic eccentric exercsie Focus on S&C Focus on managing load.