Defining neuromechanical mechanisms of Achilles tendinopathy

项目总结 中质性跟腱病是一种疼痛、衰弱和慢性肌腱病变。复康 锻炼是患者的首选治疗方案，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，但康复方案 仍然是标准化的，因为没有足够的证据支持精准护理。我们的父R01项目将 确定中质型跟腱病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。在这一辅助R01中，我们将 利用我们创新的高密度表面肌电(HDsEMG)接口测量足底 独立踝关节测试中屈肌神经力学的测功法和步行时的功能任务 不同的年级。我们的初步数据显示，初级足底屈肌的相对贡献 在独立的和功能性的任务中，可以通过改变膝关节角度来修改肌肉。我们将使用这个 测试足底屈肌神经力学和跟腱之间机制联系的实验模型系统 肌腱负荷生物力学和患者预后。在目标1中，我们将定义 跟腱病病情进展。在目标2中，我们将把神经机械特征与跟腱联系起来 载荷分布和应力成像。通过利用我们庞大且具有良好特征的个人队列， 跟腱病，这种辅助R01将建立如何神经机械机制(辅助R01) 调节病理性跟腱病的复杂生物力学负荷分布(亲本R01)。这是一个 下一步发展精确康复的必要步骤，其中包括患者特有的神经力学和跟腱 肌腱生物力学。在成功完成我们提出的目标后，我们将测试 随机临床试验中的精确神经机械康复。

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.