Clinical Excellence Through Social Media

17/09/2014

Thank you for your participation in this short course and research project.

Complete "Survey 2" by September 22nd to obtain a certificate of participation.

Link to survey: https://www.surveymonkey.com/s/smssurvey2facebook

This survey is designed to gather your thoughts and opinions on using social media for the translation of research evidence to clinical practice. It includes an anonymous assessment of your current knowledge and practice with regards to tendon management.

14/09/2014

Compressive loads play a part in many tendinopathies

1. Tendons insert often after passing over a bony prominence
2. Excess compression at this site by movements into extremes of range and / or external compression can cause tendinopathy
3. Limiting compression can help symptoms
4. Morphology may influence the amount of compression

Read morehttp://www.smasa.asn.au/Portals/3/Conferences/2013%20Members%20Conference/Compressive%20Load%20Tendinopathy%20BJSM%20March%2012.pdf

12/09/2014

Eccentric exercise may not be the best intervention for all tendinopathies

1.Tendons need load to stimulate matrix production
2.There is actually limited evidence that eccentrics benefit tendinopathy and may not be appropriate for many
3.Eccentric exercise may not be the best intervention for all tendons
4.There is evidence for heavy slow resistance training
5. Although no evidence there is a clinical perception that isometrics can assist tendon pain

Read more:
http://medicine.tums.ac.ir:803/Users/farzin_halabchi/Journal%20Club/26.5.88/Eccentric%20exercise%20Dr.%20Radmehr.pdf

11/09/2014

Recovery from tendon pain does not correlate directly with improvement in tendon imaging.

1. Ultrasound and MRI can be used as imaging techniques for tendons, however, have poor interobserver and intraobserver reliability.

2. Imaging abnormalities do not necessarily correlate with clinically significant symptoms.

3. “The use of imaging as a primary outcome measure in assessing the efficacy of treatments of tendinopathy is not recommended” (Scott et al., 2013, para 18).

Read more: http://bjsm.bmj.com/content/early/2013/04/19/bjsports-2013-092329.full?g=widget_default

In September 2010, the first International Scientific Tendinopathy Symposium (ISTS) was held in Umeå, Sweden, to establish a forum for original scientific and clinical insights in this growing field of clinical research and practice. The second ISTS was organised by the same group and held in Vancou…

09/09/2014

Tendon pain a day after loading is a good guide to tendon response to load

1. Pain during exercise is not a good guide to tendon capacity
2. There should not be ‘recipe’ programs in tendinopathy management
3. Management of tendinopathy should include loading the tendon at every stage
4. Strength, power and strength -endurance exercises, concentric/eccentric and isometric exercises can be used in tendinopathy management
5. A maintenance strength program may assist in prevention of reoccurrence of tendinopathy symptoms.

Professor Jill Cook’s insights on tendinopathies.

Podcast:
http://physioedge.com.au/?powerpress_pinw=229-podcast

Transcript:
http://physioedge.com.au/pe-005-tendons-and-tendinopathy-with-jill-cook/

07/09/2014

UL tendinopathies are more likely to have a central sensitisation component than LL tendinopathies

1.There is a clear nociceptive driver in tendon pain (even chronic tendon pain), however the CNS has a role in up or downregulating pain

2.The way the CNS responds to tendon pain may be different in different tendons

3.Structural pathology on imaging does not correlate with pain or disability

4.Pain relief in isometrics showed no cross over effect in patellar tendinopathy

Podcast: https://soundcloud.com/bmjpodcasts/tendinopathy-roundtable

If you have wondered about the connection between pain and pathology in tendons, this podcast is for you. In this new forum, a BJSM reader takes the hard questions to the experts, Chris Littlewood

05/09/2014

Some systemic diseases such as diabetes will increase the risk of the development of tendinopathy

1. There are many factors known to increase risk of tendinopathy

2. Systemic conditions (diabetes, high cholesterol) and factors that increase risk of systemic conditions (increased BMI) are well known to increase risk of tendinopathy

Read more: http://rheumatology.oxfordjournals.org/content/early/2013/01/11/rheumatology.kes395.full

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04/09/2014

Load modification is a key intervention in reactive tendinopathy


1. Tendon pathology may have 3 stages, reactive tendinopathy, tendon dysrepair & degenerative tendinopathy, or have 2 stages clinically reactive/early dysrepair or dysrepair/degenerative

2. Reactive tendinopathy may occur from acute overload or blow to tendon. The tendon has the potential to return to normal. This is more common in younger people.

3. Tendon dysrepair may occur across a range of ages and loading environments. This stage may be hard to distinguish clinically, but may be seen on imaging as focal structural changes, with or without vascularity.

4. The degenerative stage is more commonly seen in an older person. Individuals may have had repeated bouts of tendinopathy. Degenerative tendons may be susceptible to rupture.


Read more:http://www.nfkom.com/Is%20tendon%20pathology%20a%20continuum.pdf

02/09/2014

PRP injection for chronic Achilles tendinopathy; no greater improvement in pain and activity than placebo


Study Summary:

• This study aimed to determine if platelet rich plasma (PRP) injection would improve outcomes in chronic mid portion Achilles tendinopathy

• The study was a stratified (by activity level), block randomised, double blind, placebo controlled trial of 54 participants

• Participants were randomised to a group receiving a PRP injection or saline injection. Both groups completed an eccentric exercise program.

• The VISA-A, completed at baseline, 6, 12 & 24 weeks was the main outcome measure.

• Both groups had a statistically significant increase in VISA-A score after 24 weeks, but there was no statistically significant difference in VISA-A scores between groups from baseline to 24 weeks.

• The authors concluded “we do not recommend this treatment for chronic mid portion Achilles tendinopathy” (deVos et al., 2010, para. 31)

Read more: http://jama.jamanetwork.com/article.aspx?articleid=185200

Research from JAMA — Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy — A Randomized Controlled Trial

26/08/2014

Welcome to the social media based short course “Advancing Management of Tendon Pathologies.” The previous post contains an example article. This postings for this course will commence on September 2nd, 2014.

08/08/2014

Is Eccentric Exercise the way to go?

Michael Kjaer, Katja M. Heinemeier. Journal of Applied Physiology, 2014

Eccentric exercise can influence tendon mechanical properties and matrix protein synthesis. mRNA for collagen and regulatory factors thereof are upregulated in animal tendons, independent of muscular contraction type, supporting the view that tendon, compared with skeletal muscle, is less sensitive…