Defining neuromechanical mechanisms of Achilles tendinopathy

项目摘要 中间物质跟腱病是一种疼痛，衰弱和慢性肌腱病理。康复 运动是患者的第一治疗选择，但临床研究报告称，20-60%的患者 5年后继续经历疼痛和症状。尽管结果不佳，康复方案 由于没有足够的证据支持精确护理，因此仍然保持标准化。我们的R 01项目将 确定跟腱中段病变患者肌腱负荷和生物力学的相似性 以及这些相似性如何影响肌腱愈合、疼痛和功能结果。在本辅助R 01中，我们将 利用我们创新的高密度表面肌电图（HDsEMG）接口测量足底 在步行过程中使用测力计和功能任务进行的孤立踝关节测试期间的屈肌神经力学 不同的等级。我们的初步数据表明，初级跖屈肌的相对贡献， 在单独的和功能性的任务中，可以通过改变膝关节角度来改变肌肉。我们将使用这个 实验模型系统，以测试跖屈肌神经力学，跟腱之间的机械联系 肌腱负荷生物力学和患者结局。在目标1中，我们将定义神经力学剖面， 跟腱疾病进展。在目标2中，我们将把神经力学剖面与跟腱连接起来， 载荷分布和应力成像。通过利用我们庞大且特征鲜明的个人群体， 跟腱病，本辅助R 01将确定神经力学机制（辅助R 01） 介导病理性跟腱病的复杂生物力学载荷曲线（亲本R 01）。这是一 发展精确康复所需的下一步，即考虑患者特定的神经力学和跟腱 肌腱生物力学在成功完成我们提出的目标后，我们将测试 精确神经机械康复的随机临床试验。

PROJECT SUMMARY Mid-substance Achilles tendinopathy is a painful, debilitating, and chronic tendon pathology. Rehabilitation exercises are the first treatment option for patients, but clinical studies have reported 20-60% of patients continue to experience pain and symptoms 5-years later. Despite these poor outcomes, rehabilitation protocols remain standardized because of insufficient evidence to support precision care. Our Parent R01 project will determine similarities in tendon loading and biomechanics in patients with mid-substance Achilles tendinopathy and how these similarities affect tendon healing, pain, and functional outcomes. In this Ancillary R01, we will leverage our innovative High-Density surface ElectroMyoGraphy (HDsEMG) interface to measure the plantar flexor neuromechanics during isolated ankle testing using dynamometry and functional tasks during walking on differing grades. Our preliminary data demonstrate that the relative contributions of the primary plantar flexor muscles can be modified by changing the knee angle during isolated and functional tasks. We will use this experimental model system to test the mechanistic link between plantar flexor neuromechanics, Achilles tendon loading biomechanics, and patient outcomes. In Aim 1, we will define neuromechanical profiles across Achilles tendinopathy disease progression. In Aim 2, we will link neuromechanical profiles with Achilles tendon loading profiles and stress imaging. By leveraging our large and well-characterized cohort of individuals with Achilles tendinopathy, this Ancillary R01 will establish how neuromechanical mechanisms (Ancillary R01) mediate complex biomechanical loading profiles of pathologic Achilles tendinopathy (Parent R01). This is a necessary next step to develop precision rehabilitation that factor patient-specific neuromechanics and Achilles tendon biomechanics. After successfully completing our proposed aims, we will test the clinical efficacy of precision neuromechanical rehabilitation in a randomized clinical trial.