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

项目摘要/摘要 跟腱病在普通人群中的发病率为2.35/1000，最常见的是 中年人(35-55岁/岁)，但发生在所有年龄段的男性和女性。主要症状是疼痛 在日常活动中，如散步和锻炼，如跑步。除了疼痛，跟腱病 已被证明显著降低了体力活动水平，导致对整体的进一步负面影响 健康和幸福。证据最多的跟腱病的治疗是古怪的 锻炼，提供肌肉-肌腱单元的机械负荷。在最近的一项系统回顾中，所有研究 报告患者报告的症状有显著改善，但在12周时，平均数在69-80之间 (100人完全康复)表明即使接受了最有效的治疗，个人仍在继续 症状。此时，其他更具侵入性的干预措施，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，建议进行手术，尽管他们对运动治疗缺乏了解 这些因素与持续存在的问题有关。只是通过治疗来减少疼痛和症状 不能确保肌腱结构异常的解决。事实上，评估回收的研究 肌腱结构的运动提示，可能至少需要24周才能观察到明显的变化。 其他个人因素，如性别、肌腱结构损伤程度和功能缺陷也被提出。 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，使量身定制的治疗方法得以开发。这项研究开始 通过评估肌腱结构(超声)的恢复时间进程来实现这一长期目标 成像)和粘弹性特性(弹性成像)以及症状(患者报告的结果)和 安慰剂治疗跟腱病男性和女性的肌腱功能(功能测试) 锻炼计划。目的1是评估症状、肌腱和肌腱随时间的变化是否存在差异。 跟腱病男、女患者的功能、肌腱结构和力学性能比较 接受运动治疗。目的2是调查肌腱结构的存在和大小 基础状态异常会影响跟腱运动治疗后的恢复能力和恢复时间 肌腱病。目标3是探索在16周评估中继续出现症状的患者是否会 治疗后症状、肌腱功能、肌腱结构和力学性能进一步改善。 一年的课程。这项研究将首次评估在肌腱结构恢复方面是否存在差异 男性和女性跟腱病患者接受运动治疗后的力学性能。 这也将是第一项使用结果评估运动干预肌腱病恢复情况的研究。 肌腱结构和力学性能的测量以及肌肉-肌腱的验证测量 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.