Evidence of accumulated stress in Achilles and anterior knee tendons in elite badminton players.

Tendon-related injuries are a major problem, but the aetiology of tendinopathies is unknown. In tendinopathies as well as during unaccustomed loading, intra-tendinous flow can be detected indicating that extensive loading can provoke intra-tendinous flow. The aim of present study is to evaluate the vascular response as indicated by colour Doppler (CD) activity in both the Achilles and patella tendon after loading during high-level badminton matches. The Achilles tendon was subdivided into a mid-tendon, pre-insertional, and insertional region and the anterior knee tendons into a quadriceps-, patella- and tuberositas region. Intra-tendinous flow was measured using both a semi-quantitative grading system (CD grading) and a quantitative scoring system (CF) on colour Doppler. Intra-tendinous flow in the Achilles and anterior knee tendons was examined in fourteen single players before tournament and after 1st and 2nd match, respectively on both the dominant and non-dominant side. All players had abnormal intra-tendinous flow (Colour Doppler ≥ grade 2) in at least one tendon in at least one scan during the tournament. At baseline, only two of the 14 players had normal flow in all the tendons examined. After 1st match, tendencies to higher intra-tendinous flow were observed in both the dominant patella tendon and non-dominant quadriceps tendon (P-values n.s.). After 2nd match, intra-tendinous flow was significant increased in the dominant patella tendon (P = 0.009). In all other locations, there was a trend towards a stepwise increase in intra-tendinous flow. The preliminary results indicate that high amount of intra-tendinous flow was found in elite badminton players at baseline and was increased after repetitive loading, especially in the patella tendon (dominant leg). The colour Doppler measurement can be used to determine changes in intra-tendinous flow after repetitive loading.

Ultrasonographic investigation of the Achilles tendon in elite badminton players using color Doppler.

BACKGROUND: The most frequent injuries in badminton players are in the lower extremities, especially in the Achilles tendon. HYPOTHESIS: The game of badminton may be related to abnormal intratendinous flow in the Achilles tendon as detected by color Doppler ultrasound. To a certain extent, this blood flow might be physiological, especially when examined after match. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 3. METHODS: Seventy-two elite badminton players were interviewed regarding Achilles tendon pain (achillodynia) in the preceding 3 years. Color Doppler was used to examine the tendons of 64 players before their matches and 46 players after their matches. Intratendinous color Doppler flow was graded from 0 to 4. The Achilles tendon was divided into dominant (eg, right side for right-handed players and vice versa) and nondominant side and classified as midtendon, preinsertional, and calcaneal areas. RESULTS: Of 72 players, 26 had experienced achillodynia in 34 tendons, 18 on the dominant side and 16 on the nondominant side. In 62% of the players with achillodynia, the problems had begun slowly, and the median duration of symptoms was 4 months (range, 0-36 months). Thirty-five percent had ongoing pain in their tendons for a median duration of 12 months (range, 0-12 months). Achillodynia was not associated with the self-reported training load or with sex, age, weight, singles or doubles players, or racket side. Forty-six players were scanned before and after match. At baseline, color Doppler flow was present in the majority of players, and only 7 (16%) players had no color Doppler flow in either tendon. After match, all players had some color Doppler flow in 1 or both tendons. Achillodynia and color Doppler flow were related in the nondominant Achilles tendon (chi-square, P = .008). The grades of Doppler flow also increased significantly after match in the preinsertional area in both the nondominant (P = .0002) and dominant (P = .005) side tendons. CONCLUSION: A large proportion of the players had experienced achillodynia and habitually played with a degree of pain that demanded medication. The self-reported pain was associated with increased intratendinous color Doppler flow in the nondominant Achilles tendon. Doppler flow was found in most players before and in all players after the match and therefore may in part be a physiological response to activity.

Associations between abnormal ultrasound color Doppler measures and tendon pain symptoms in badminton players during a season: a prospective cohort study.

BACKGROUND: Color Doppler ultrasound is widely used to examine intratendinous flow in individuals with overuse tendon problems, but the association between color Doppler and pain is still unclear. HYPOTHESIS: Intratendinous flow is present and associated with pain in badminton players, and intratendinous flow and pain increase during a badminton season. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: Ninety-five semiprofessional badminton players were included in the study at a tournament at the start of the badminton season. All players were interviewed regarding pain. The anterior knee tendons and Achilles tendons were studied. Each tendon was scored using a quantitative grading system (grades 0-5) and a qualitative scoring system (color fraction) using color Doppler ultrasound. Eight months later, 86 of the players (91%) were retested by the same investigators during an equivalent badminton tournament (including 1032 tendon regions; 86 players with 4 tendons each with 3 regions), thus forming the study group. RESULTS: At the start of the season, 24 players (28%) experienced pain in 37 tendons (11%), and at the end of the season, 31 players (36%) experienced pain in 51 tendons (15%), which was a statistically significant increase (P = .0002). Abnormal flow was found in 230 tendon regions in 71 players (83%) at the start of the season compared with 78 tendon regions in 41 players (48%) at the follow-up. The decrease in abnormal flow was statistically significant (P < .0001). Of the 37 painful tendons at the start of the season, 25 had abnormal flow (68%). In contrast, 131 tendons (85%) with abnormal flow at the start of the season were pain free. At the end of the season, 18 of the 51 painful tendons (35%) had abnormal flow. Ninety-six of the 131 pain-free tendons (73%) with abnormal flow at the start of the season were normalized (no pain and normal flow) at the end of the season. CONCLUSION: It was not possible to verify any association between intratendinous flow and pain at the start of the season or at the follow-up (end of the season). Intratendinous flow at the start of the season could not predict symptomatic outcome at the end of the season. The decrease in Doppler flow during the season might suggest that intratendinous flow could be part of a physiological adaptive response to loading and that intratendinous flow as previously believed is not always a sign of pathological changes.