Recovery of symptoms, function, tendon structure and mechanical properties in patients with Achilles Tendinopathy: A comparison between men and women

项目概要/摘要 跟腱病在一般人群中的发病率为每 1000 人 2.35 人，最常见于 中年个体（35-55岁），但发生于所有年龄段的男性和女性。主要症状是疼痛 在日常活动（例如步行）和锻炼（例如跑步）期间。除了疼痛之外，跟腱病 已被证明会显着降低体力活动水平，从而对整体产生进一步的负面影响 健康和福祉。证据级别最高的跟腱病治疗方法是古怪的 锻炼，为肌肉肌腱单元提供机械负荷。在最近的一项系统综述中，所有研究 报告患者报告的症状有显着改善，但在 12 周时平均值为 69-80 （100 人完全康复）表明，即使采用最有效的治疗，个人仍继续患有 症状。此时，其他更具侵入性的干预措施，例如注射疗法（例如富含血小板的血浆） 对于运动治疗失败的患者，尽管缺乏了解，仍建议进行手术 因素与持续存在的问题有关。通过治疗也能减轻疼痛和症状 不能确保肌腱结构异常的解决。事实上，研究评估了 运动后的肌腱结构表明，可能需要至少 24 周才能观察到显着变化。 还提出了其他个体因素，例如性别、肌腱结构损伤程度和功能缺陷 影响恢复的时间进程和成功率。我们研究的长期目标是推进 了解肌腱损伤和修复，从而能够开发出量身定制的治疗方法。这项研究开始 通过评估肌腱结构的恢复时间过程（超声 成像）和粘弹性特性（弹性成像）以及症状（患者报告的结果）和 患有跟腱病的男性和女性的肌肉肌腱功能（功能测试电池） 锻炼计划。目标 1 是评估症状、肌肉肌腱随时间的变化是否存在差异 男性和女性跟腱病患者的功能、肌腱结构和机械特性 接受运动治疗。目标 2 是调查肌腱结构是否存在及其程度 基线异常会影响跟腱运动治疗的恢复能力和时间进程 肌腱病。目标 3 是探讨在 16 周评估中持续出现症状的患者是否会 症状、肌腱功能、肌腱结构和机械性能比 课程为期一年。这项研究将是第一个评估肌腱结构恢复是否存在差异的研究 以及接受运动治疗的跟腱病男性和女性之间的机械特性。 这也将是第一项利用结果来评估运动干预肌腱病恢复情况的研究 肌腱结构和机械性能的测量以及经过验证的肌肉肌腱测量 功能和症状。

Project Summary/Abstract Achilles tendinopathy has an incidence rate of 2.35 per 1000 in the general population and is most prevalent in middle-aged individuals (35-55 y/o), but occurs in men and women of all ages. The primary symptom is pain during daily activities such as walking and exercising such as running. Aside from the pain, Achilles tendinopathy has been shown to significantly decrease physical activity level, resulting in further negative effects on overall health and well-being. The treatment for Achilles tendinopathy with the highest level of evidence is eccentric exercise, providing mechanical loading of the muscle-tendon unit. In a recent systematic review, all studies reported significant improvements in patient-reported symptoms but at 12 weeks the means ranged from 69-80 (100 being fully recovered) indicating that even with the most effective treatment individuals continued to have symptoms. At this time, other more invasive interventions such as injection therapies (ex. platelet-rich plasma) and surgery are recommended for patients who fail exercise treatment despite a lack of understanding of what factors are related to continued problems. Just achieving a reduction in pain and symptoms with treatment also does not ensure resolution of the tendon's structural abnormalities. In fact, studies evaluating the recovery of tendon structure with exercise suggest that at least 24 weeks may be needed to observe a significant change. Other individual factors such as sex, degree of tendon structural damage and functional deficits are also proposed to influence both the time course and success rate of recovery. The long-term goal of our research is to advance understanding of tendon injuries and repair, enabling tailored treatments to be developed. This study begins to address this long-term goal by evaluating the time-course of recovery in terms of tendon structure (ultrasound imaging) and viscoelastic properties (elastography) along with symptoms (patient-reported outcomes) and muscle-tendon function (functional test-battery) in men and women with Achilles tendinopathy treated with an exercise program. Aim 1 is to evaluate if there are differences in change over time in symptoms, muscle-tendon function, tendon structure, and mechanical properties between males and females with Achilles tendinopathy receiving exercise treatment. Aim 2 is to investigate whether the presence and magnitude of tendon structural abnormality at baseline will affect the ability and time-course of recovery with exercise treatment for Achilles tendinopathy. Aim 3 is to explore if patients who continue to have symptoms at the 16-week evaluation will further improve in symptoms, muscle-tendon function, tendon structure and mechanical properties over the course of one year. This study will be the first to evaluate if there is a difference in recovery of tendon structure and mechanical properties between males and females with Achilles tendinopathy receiving exercise treatment. It will also be the first study to evaluate recovery of tendinopathy with exercise intervention using outcome measures for tendon structure and mechanical properties along with validated measures of muscle-tendon function and symptoms.