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

跟腱病患者症状、功能、肌腱结构和机械性能的恢复：男性和女性的比较

• 批准号: 10611080
• 负责人: Karin Marta Eva Gravare Silbernagel
• 金额: $ 6.45万
• 依托单位: UNIVERSITY OF DELAWARE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10611080
• 关键词: Address; Affect; Age; Architecture; Athletic Injuries; Blood Platelets; Clinical; Collagen; Diagnosis; Diffuse; Evaluation; Exercise; Female; General Population; General Practices; Goals; Health; Incidence; Individual; Injection of therapeutic agent; Intervention; Level of Evidence; Measures; Muscle; Operative Surgical Procedures; Outcome Measure; Pain; Patient Outcomes Assessments; Patients; Personal Satisfaction; Physical activity; Plasma; Play; Property; Prospective cohort study; Proteoglycan; Recovery; Recurrence; Reporting; Research; Resolution; Role; Running; Structural defect; Symptoms; Tendinopathy; Tendon Injuries; Tendon structure; Testing; Thick; Time; Tissues; Ultrasonography; Walking; Woman; alternative treatment; base; effective therapy; elastography; exercise intervention; exercise program; experience; follow-up; functional outcomes; improved; individualized medicine; injury and repair; male; mechanical load; mechanical properties; men; middle age; pain symptom; programs; sex; success; systematic review; treatment optimization; viscoelasticity

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.

项目总结/摘要 跟腱病在一般人群中的发病率为2.35/1000， 中年人（35-55岁），但发生在所有年龄段的男性和女性中。主要症状是疼痛 在日常活动中，如步行和锻炼，如跑步。除了疼痛，跟腱病 已被证明会显着降低身体活动水平，导致对整体的进一步负面影响 健康和福祉。证据等级最高的跟腱病的治疗方法是偏心的 运动，提供肌肉-肌腱单位的机械负荷。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著改善，但在12周时，平均值范围为69-80 (100完全康复），这表明即使接受了最有效的治疗， 症状在这个时候，其他更具侵入性的干预措施，如注射疗法（例如，富血小板血浆） 对于运动治疗失败的患者，尽管缺乏对运动治疗的理解， 这些因素与持续存在的问题有关。只是通过治疗减轻疼痛和症状， 并不能确保解决肌腱的结构异常。事实上，研究评估的恢复， 肌腱结构与运动表明，可能需要至少24周才能观察到显著变化。 还提出了其他个体因素，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 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。这项研究开始于 通过评估肌腱结构（超声）方面的恢复时间过程来实现这一长期目标 沿着症状（患者报告的结局）和粘弹性（弹性成像）， 跟腱病患者肌肉-肌腱功能（功能测试组合） 锻炼计划。目的1是评估是否有不同的变化随着时间的推移，症状，肌肉肌腱 男性和女性跟腱病患者的功能、肌腱结构和力学特性 接受锻炼治疗。目的2是研究肌腱结构性损伤的存在和大小， 基线时的异常将影响跟腱运动治疗的恢复能力和时间进程 肌腱病目的3是探索在16周评估时仍有症状的患者是否会 进一步改善症状，肌肉肌腱功能，肌腱结构和机械性能， 一年的课程。这项研究将是第一个评估是否有不同的恢复肌腱结构 跟腱病患者运动治疗前后力学性能的差异。 这也将是第一个使用结果评估运动干预肌腱病恢复的研究。 肌腱结构和力学性能的测量沿着与肌肉肌腱的有效测量 功能和症状。

项目成果

Differences at the Achilles Insertion Between Adults with Insertional and Midportion Achilles Tendinopathy as Observed Using Ultrasound.

• DOI: 10.32098/mltj.02.2022.04
• 发表时间: 2022-04
• 期刊: MLTJ-MUSCLES LIGAMENTS AND TENDONS JOURNAL
• 作者: Alghamdi, N. Hamdan;Pohlig, R. T.;Sions, J. M.;Silbernagel, K. Gravare
• 通讯作者: Silbernagel, K. Gravare

Putting the fear-avoidance model into practice - what can patients with chronic low back pain learn from patients with Achilles tendinopathy and vice versa?

将恐惧回避模型付诸实践——慢性腰痛患者可以从跟腱病患者身上学到什么，反之亦然？

• DOI: 10.1016/j.bjpt.2023.100557
• 发表时间: 2023
• 期刊: Brazilian journal of physical therapy
• 影响因子: 3.4
• 作者: Smitheman,HayleyPowell;Lundberg,Mari;Härnesand,Malin;Gelfgren,Sara;GrävareSilbernagel,Karin
• 通讯作者: GrävareSilbernagel,Karin

Tendon loading in runners with Achilles tendinopathy: Relations to pain, structure, and function during return-to-sport.

• DOI: 10.1111/sms.14178
• 发表时间: 2022-08
• 期刊: SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS
• 影响因子: 4.1
• 作者: Corrigan, Patrick;Hornsby, Samantha;Pohlig, Ryan T.;Willy, Richard W.;Cortes, Daniel H.;Silbernagel, Karin Gravare
• 通讯作者: Silbernagel, Karin Gravare

The Impact of the Degree of Kinesiophobia on Recovery in Patients With Achilles Tendinopathy.

运动恐惧症程度对跟腱病患者康复的影响。

• DOI: 10.1093/ptj/pzab178
• 发表时间: 2021
• 期刊: Physical therapy
• 影响因子: 3.2
• 作者: Alghamdi,NabeelHamdan;Pohlig,RyanT;Lundberg,Mari;Silbernagel,KarinGrävare
• 通讯作者: Silbernagel,KarinGrävare

ICON 2020-International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy.

• DOI: 10.1007/s40279-021-01588-6
• 发表时间: 2022-03
• 期刊: Sports medicine (Auckland, N.Z.)
• 作者: Grävare Silbernagel K;Malliaras P;de Vos RJ;Hanlon S;Molenaar M;Alfredson H;van den Akker-Scheek I;Antflick J;van Ark M;Färnqvist K;Haleem Z;Kaux JF;Kirwan P;Kumar B;Lewis T;Mallows A;Masci L;Morrissey D;Murphy M;Newsham-West R;Norris R;O'Neill S;Peers K;Sancho I;Seymore K;Vallance P;van der Vlist A;Vicenzino B
• 通讯作者: Vicenzino B