This week I talk about a feasibility cohort study which sought to determine whether a larger cohort study addressing this question would be feasible. Listen to hear some interesting preliminary findings. Merza, E.Y., Pearson, S.J., Mallows, A.J. and Malliaras, P., 2023. The relationship between psychological, cognitive, and contextual factors and r…

We have known for a while that type of exercise intervention (e.g. intensity, frequency, etc) does not seem to influence self-reported outcomes such as pain. Maybe all the benefits from exercise are explained by non-specific effects, or maybe exercise has benefits that do not depend on the type of exercise. In this episode, I discuss 3 studies that…

This week, I had an engaging conversation with Anthony Nasser, an up-and-coming researcher on tendinopathy who recently completed his PhD on proximal hamstring tendinopathy. Our discussion covered the reasons for the lack of research attention towards this condition, the current state of evidence, and insights from his doctoral studies. You can fin…

Palpation can be useful for the diagnosis and assessment of tendinopathy, but there are limits. This is because non-painful tendons can be tender, and tenderness in painful tendons seems to be very slow to get better. Link to Evidence for Improvement in Local but not Diffuse Pressure Pain Thresholds Following Physical Therapist Interventions for Te…

Interesting perspective paper from Arampatzis et al talking about how we should consider tuning of muscle tendon unit in terms of muscle strength and tendon stiffness when considering training for specific groups. See omnystudio.com/listener for privacy information.Auscast Network

This talking tendons episode will discuss a study by Igor Sancho, PhD, assessing Achilles forces during common rehab exercises and habitual activities and how this relates to reported pain among runners. Some interesting implications for practice. Achilles tendon forces and pain during common rehabilitation exercises in male runners with Achilles t…

In this episode, I am discussing kinesiophobia in the context of tendon rehab and how rehab can be conceptualised as graded exposure for some people. References 1) Physiotherapy management of Achilles tendinopathy See omnystudio.com/listener for privacy information.Auscast Network

In this episode, I talk about load test pain assessment and how this can also be used to assess kinesiophobia and movement apprehension. References 1) Physiotherapy management of Achilles tendinopathy: https://pubmed.ncbi.nlm.nih.gov/36274038/ 2) Kinesiophobia Severity Categories and Clinically Meaningful Symptom Change in Persons With Achilles Ten…

This is an interesting study from the Delaware tendinopathy group among others investigating a host of structural, tissue property, functional and pain factors that may persist among people with Achilles tendinopathy making a return to running. Provides guidance to clinicians about potential impairments to consider assessing. Here's the link to the…

In this episode I talk about three qualitative studies that aim to understand the patient perspective and patient motivations in Achilles tendinopathy. I find this work really helps clinicians to understand what patients are gong through so we are able to be empathic and help them. Hope you enjoy! Here's a link to courses in the UK: https://www.eve…

This paper is more than 30 years old but it is a beauty. Farley et al talk about human preferred hopping frequency and how it relates to metabolic cost and how fast muscles are contracting, and also how our instructions can influence how well people hop (and the mechanisms that drive this). Important to consider hopping instruction when assessing s…

There is so much debate about the use of steroids for tendinopathy. Opinions vary between 'you should never use steroid as will lead to recurrence, worse pain or rupture' to 'it's fine, do as much steroid as you like'. Opinions dominate as we have limited data. Until now. This is the first trial looking at 2 year outcome for exercise +/- steroid fo…

This is a new and lovely to read randomised trial comparing pain science education (including lots of good biopsychosocial info) versus placebo education for Achilles tendinopathy. Some interesting findings and potential avenues for further study. Definitely worth a listen and read. Here is a link to the actual paper: https://journals.lww.com/pain/…

This is a new study from my PhD student, Igor Sancho. He looks at strength, psychological and other factors that may be different between health runners and runners with Achilles tendinopathy. Seated calf raise 6RM seems to be the strongest predictor of having Achilles tendinopathy. Some interesting other findings and clinical implications. Here is…

On this episode I focus on a new study from my PhD student Eman Merza. It is a cross-over randomised trial testing the effect of high and low contraction time and high and low intensity isometric contractions on acute changes to tendon volume and stiffness. Some very interesting potential insights for tendon adaptation. Good work, Eman! Hope you en…

Had a lovely chat with Shawn Hanlon who is a PhD candidate about his relatively new paper exploring patient features and clinical characteristics and how they may define certain subgroups of Achilles tendinopathy . Lots more to learn in this field and this is early work, but we discuss some of the juicy potential clinical implications. Hope you enj…

There is lots of debate about the pain mechanisms, particularly if there are central changes, in Achilles and other tendinopathies. Most studies in the literature use proxy measures of central sensitisation like pressure pain threshold away from the painful site, Other measures like conditioned pain modulation have been investigated less frequently…

This is one of my favourite narrative expert reviews that discusses the benefits of human biologic springs like the Achilles tendon. These benefits can be summarised as follows: Metabolic energy conservation Amplification of muscle power output Attenuation of muscle power input Some really interesting mechanisms and insights for rehabilitation . I …

I had a great time talking Gluteal tendinopathy with Chris Clifford. Chris is an experienced clinician from Glasgow who is in the throws of completing his PhD on this condition. We chatted about rehab, the use of isometrics, difficult patient groups and how to navigate them, and much more. I hope you enjoy! Here is 2 related publications from Chris…

Patients often ask about dietary supplements and if they may be helpful in recovering from a tendinopathy problem. There is a new systematic review out which has attempted to answer this question and it is the subject of this episode of talking tendons. I hope you enjoy. Here is the reference Qiu, F., Li, J. and Legerlotz, K., 2022. Does Additional…

Will midportion Achilles pain improve if you wait and see? This is often a really important question to discuss with patients. Luckily we have some evidence to answer it which I explore in this short podcast (9 minutes). Hope you enjoy. Here are the related studies 1/ Horstmann, T., Jud, H.M., Fröhlich, V., Mündermann, A. and Grau, S., 2013. Whole-…

We all understand providing education for people with rotator cuff tendinopathy (and other conditions) is really important but we have very few resources or guidance regarding what should be delivered and how. In this episode I discuss two qualitative studies exploring the views of patients and expert clinicians about what needs to be included in e…

Here is my recent chat with Dr Ruth Chimenti about Achilles tendinopathy We touched on some interesting topics, including Kinesiophobia and whether it changes with treatment Pain education for tendinopathy - what should it involve? does it work? Patient centred rehabilitation Here is a link to some brand new trial data from Ruth's lab - she tested …

Enjoyable chat with Colin Griffin who is undertaking an exercise trial for Achilles tendinopathy. We touched on so many important rehab considerations, including: Strength profiling for Achilles tendinopathy Assessing endurance, maximal dynamic and isometric calf capacity, and plyometric function and reactivity Home vs gym based rehab Why some peop…

In this episode I talk about a new systematic review on plantarflexor muscle impairments in Achilles tendinopathy. It is clear that the relationship is not as clear as what you might think, and there are also some very interesting insights to how plantarflexor dysfunctions may change following rehabilitation. Link to paper Are Plantarflexor Muscle …

This high quality trial provides further evidence to shift us away from eccentric training for Patelar Tendinoapthy. See omnystudio.com/listener for privacy information.Auscast Network

In this episode I talk about a relatively new trial investigating pressure massage versus eccentric exercise for Achilles tendinopathy in a randomised trial. I hope you enjoy! Also, if you have some time on your hands during this time of isolation and need to catch up on CPD head on over to www.tendinoapthyrehab.com. I am offering my online Masteri…

Hi All, On this talking tendons episode, I dive into the very murky world of isometric exercise and their effect on tendon pain. A new study by Sinead Holden and team brings some (just a little) light to the evidence. I argue that isometrics are useful for managing tendinopathy, but using them for short term pain reduction is just the tip of the ic…

Hi All, In this episode of Talking Tendons I have an enjoyable chat with PhD student and Spanish physio, Igor Sancho. He has recently published a study that assessed the feasibility of using jumping and hopping as rehabilitation for people with Achilles tendinopathy. We discuss the study and how to apply these findings in clinic. See omnystudio.com…

Isometric exercise for tendinopathy has exploded onto the scene over the last few years. Unfortunately, the certainty of evidence surrounding their use is far less certain and compelling than what we are told about them but some people. They may work, but the reality is we don't fully understand how and for whom. This episode delves into this uncer…

Despite our best intentions, not everyone with tendinopathy will respond to conservative treatments. Clinicians need alternative options like injection therapy. Injections such as steroid and platelet-rich plasma continue to be popular for tendinopathy, and there are other emerging injections such as the high-volume injection. Injection TherapyIn T…

Understanding how tendon recovers from injury and adapts to load is so important and has huge implications on how we manage tendons and the education and advice that we provide patients. This podcast features a relatively new study providing insights into the collagen turnover in healthy tendons and those with tendinopathy, adding critical knowledg…

In this week's podcast, I delve into the minefield that is isometric exercise. Is it the best thing since sliced bread? Does everyone respond? What are the key questions we need to understand? See omnystudio.com/listener for privacy information.Auscast Network

In this podcast we consider some new research exploring psychological factors and tendinopathy. There is emerging evidence that, as per other musculoskeletal conditions and as you would expect, they do play a role. I discuss which ones appear to be most strongly linked with tendinopathies. See omnystudio.com/listener for privacy information.…

Hi all, this episode we focus on two recent randomised controlled trials evaluating education and exercise interventions for gluteal tendinopathy, One of them is the best RCT I have read in ages. Well worth a look at their methods, findings and exercise interventions. Hope you enjoy! See omnystudio.com/listener for privacy information.…

This episode we focus on technology use in rehab. I'm inspired by the patient will see you now by Dr Eric Topol which I recently read so this weeks podcast covers 2 technology focused systematic reviews. The first is on the efficacy of exergames for treating musculoskeletal pain, and the second is on basically the use of accelerometers and other we…

Hi all This week on Talking Tendons we discuss Non-uniform Achilles tendon strain and displacement and tackle the important questions…what is it? And should we care? The paper is by Prof Finni from Finland supported by an international team. This is an exciting space that has already and will continue to improve our understanding of tendon function…

This episode I discuss a recent systematic review that concluded that PRP is more efficacious than control injections for tendinopathy, but the plot thickens when we scratch the surface a little. See omnystudio.com/listener for privacy information.Auscast Network