Women's preferences for pelvic floor screening in sport and exercise: a mixed-methods study integrating survey and interview data in Australian women.

OBJECTIVES: One in two women experiencing pelvic floor (PF) symptoms stop playing sport or exercising. The study examines the perspective of women with PF symptoms to inform acceptable screening practices within sport and exercise settings. METHODS: Explanatory, sequential, mixed-methods design. Phase 1: survey of 18-65 years, symptomatic, Australian women (n=4556). Phase 2: semistructured interviews with a subset of survey participants (n=23). Integration occurred through connection of phases (study design, sampling) and joint display of data. RESULTS: Findings are represented in three threads: (1) 'women (not) telling'; a majority of women had told no-one within a sport or exercise setting about their PF symptoms due to shame/embarrassment, lack of pelvic health knowledge and not wanting to initiate the conversation, (2) 'asking women (screening for PF symptoms)'; women endorsed including PF symptom questions within existing sport and exercise screening practices but only when conducted in a respectful and considered manner and (3) 'creating safety'; professionals can assist women to disclose by demonstrating expertise, trustworthiness and competency. If health and exercise professionals are provided with appropriate training, they could raise pelvic health awareness and promote a supportive and safe sport and exercise culture. CONCLUSION: Women with PF symptoms support health and exercise professionals initiating conversations about PF health to normalise the topic, and include PF symptoms among other pre-exercise screening questions. However, women should be informed on the relevance and potential benefits of PF screening prior to commencing. Safe screening practices require building trust by providing information, gaining consent, displaying comfort and genuine interest, and being knowledgeable within one's scope of practice to the provision of advice, exercise modifications and referral as appropriate.

Exploring the role of intratendinous pressure in the pathogenesis of tendon pathology: a narrative review and conceptual framework.

Despite the high prevalence of tendon pathology in athletes, the underlying pathogenesis is still poorly understood. Various aetiological theories have been presented and rejected in the past, but the tendon cell response model still holds true. This model describes how the tendon cell is the key regulator of the extracellular matrix and how pathology is induced by a failed adaptation to a disturbance of tissue homeostasis. Such failure has been attributed to various kinds of stressors (eg, mechanical, thermal and ischaemic), but crucial elements seem to be missing to fully understand the pathogenesis. Importantly, a disturbance of tissue pressure homeostasis has not yet been considered a possible factor, despite it being associated with numerous pathologies. Therefore, we conducted an extensive narrative literature review on the possible role of intratendinous pressure in the pathogenesis of tendon pathology. This review explores the current understanding of pressure dynamics and the role of tissue pressure in the pathogenesis of other disorders with structural similarities to tendons. By bridging these insights with known structural changes that occur in tendon pathology, a conceptual model was constituted. This model provides an overview of the possible mechanism of how an increase in intratendinous pressure might be involved in the development and progression of tendon pathology and contribute to tendon pain. In addition, some therapies that could reduce intratendinous pressure and accelerate tendon healing are proposed. Further experimental research is encouraged to investigate our hypotheses and to initiate debate on the relevance of intratendinous pressure in tendon pathology.

The VISA-A (sedentary) should be used for sedentary patients with Achilles tendinopathy: a modified version of the VISA-A developed and evaluated in accordance with the COSMIN checklist.

OBJECTIVE: To develop and evaluate a modified version of the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire, for use in sedentary patients with Achilles tendinopathy, using the Consensus-based Standards for the selection of health Measurement Instruments recommendations. METHODS: Twenty-two sedentary patients with Achilles tendinopathy completed the VISA-A and provided feedback regarding the relevance, comprehensiveness and comprehensibility of each item, response options and instructions. Patient and professional feedback was used to develop the VISA-A (sedentary) questionnaire. Reliability, validity and responsiveness of the VISA-A (sedentary) was evaluated in 51 sedentary patients with Achilles tendinopathy: 47.1% women, mean age 64.8 (SD 11.24). RESULTS: Factor analysis identified two dimensions (symptoms and activity) for the VISA-A (sedentary). Test-retest reliability was excellent for symptoms (intraclass correlation coefficient, ICC=0.991) and activity (ICC=0.999). Repeatability was 1.647 for symptoms and 0.549 for activity. There was a significant difference between the VISA-A and VISA-A (sedentary) scores both pretreatment and post-treatment. There was stronger correlation between the pretreatment to post-treatment change in the VISA-A (sedentary) scores (r=0.420 for symptoms, r=0.407 for activity) and the global rating of change than the VISA-A scores (r=0.253 for symptoms, r=0.186 for activity). CONCLUSION: The VISA-A (sedentary) demonstrates adequate reliability, validity and responsiveness in sedentary patients with Achilles tendinopathy. The VISA-A (sedentary) is a more appropriate measure than the VISA-A for this cohort and is recommended for clinical and research purposes.

ICON PART-T 2019-International Scientific Tendinopathy Symposium Consensus: recommended standards for reporting participant characteristics in tendinopathy research (PART-T).

We aimed to establish consensus for reporting recommendations relating to participant characteristics in tendon research. A scoping literature review of tendinopathy studies (Achilles, patellar, hamstring, gluteal and elbow) was followed by an online survey and face-to-face consensus meeting with expert healthcare professionals (HCPs) at the International Scientific Tendon Symposium, Groningen 2018. We reviewed 263 papers to form statements for consensus and invited 30 HCPs from different disciplines and geographical locations; 28 completed the survey and 15 attended the meeting. There was consensus that the following data should be reported for cases and controls: sex, age, standing height, body mass, history of tendinopathy, whether imaging was used to confirm pathology, loading tests, pain location, symptom duration and severity, level of disability, comorbidities, physical activity level, recruitment source and strategies, and medication use history. Standardised reporting of participant characteristics aims to benefit patients and clinicians by guiding researchers in the conduct of their studies. We provide free resources to facilitate researchers adopting our recommendations.

ICON 2019-International Scientific Tendinopathy Symposium Consensus: There are nine core health-related domains for tendinopathy (CORE DOMAINS): Delphi study of healthcare professionals and patients.

BACKGROUND: The absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a result, substantial synthesis/meta-analysis of tendon research findings is almost futile despite researchers publishing busily. We aimed to determine options for, and then define, core health-related domains for tendinopathy. METHODS: We conducted a Delphi study of healthcare professionals (HCP) and patients in a three-stage process. In stage 1, we extracted candidate domains from clinical trial reports and developed an online survey. Survey items took the form: 'The 'candidate domain' is important enough to be included as a core health-related domain of tendinopathy'; response options were: agree, disagree, or unsure. In stage 2, we administered the online survey and reported the findings. Stage 3 consisted of discussions of the findings of the survey at the ICON (International Scientific Tendinopathy Symposium Consensus) meeting. We set 70% participant agreement as the level required for a domain to be considered 'core'; similarly, 70% agreement was required for a domain to be relegated to 'not core' (see Results next). RESULTS: Twenty-eight HCP (92% of whom had >10 years of tendinopathy experience, 71% consulted >10 cases per month) and 32 patients completed the online survey. Fifteen HCP and two patients attended the consensus meeting. Of an original set of 24 candidate domains, the ICON group deemed nine domains to be core. These were: (1) patient rating of condition, (2) participation in life activities (day to day, work, sport), (3) pain on activity/loading, (4) function, (5) psychological factors, (6) physical function capacity, (7) disability, (8) quality of life and (9) pain over a specified time. Two of these (2, 6) were an amalgamation of five candidate domains. We agreed that seven other candidate domains were not core domains: range of motion, pain on clinician applied test, clinical examination, palpation, drop out, sensory modality pain and pain without other specification. We were undecided on the other five candidate domains of physical activity, structure, medication use, adverse effects and economic impact. CONCLUSION: Nine core domains for tendon research should guide reporting of outcomes in clinical trials. Further research should determine the best outcome measures for each specific tendinopathy (ie, core outcome sets).

Controlled ecological evaluation of an implemented exercise-training programme to prevent lower limb injuries in sport: population-level trends in hospital-treated injuries.

OBJECTIVE: Exercise-training programmes have reduced lower limb injuries in trials, but their population-level effectiveness has not been reported in implementation trials. This study aimed to demonstrate that routinely collected hospital data can be used to evaluate population-level programme effectiveness. METHOD: A controlled ecological design was used to evaluate the effect of FootyFirst, an exercise-training programme, on the number of hospital-treated lower limb injuries sustained by males aged 16-50 years while participating in community-level Australian Football. FootyFirst was implemented with 'support' (FootyFirst+S) or 'without support' (FootyFirst+NS) in different geographic regions of Victoria, Australia: 22 clubs in region 1: FootyFirst+S in 2012/2013; 25 clubs in region 2: FootyFirst+NS in 2012/2013; 31 clubs region 3: control in 2012, FootyFirst+S in 2013. Interrupted time-series analysis compared injury counts across regions and against trends in the rest of Victoria. RESULTS: After 1 year of FootyFirst+S, there was a non-statistically significant decline in the number of lower limb injuries in region 1 (2012) and region 3 (2013); this was not maintained after 2 years in region 1. Compared with before FootyFirst in 2006-2011, injury count changes at the end of 2013 were: region 1: 20.0% reduction (after 2 years support); region 2: 21.5% increase (after 2 years without support); region 3: 21.8% increase (after first year no programme, second year programme with support); rest of Victoria: 12.6% increase. CONCLUSION: Ecological analyses using routinely collected hospital data show promise as the basis of population-level programme evaluation. The implementation and sustainability of sports injury prevention programmes at the population-level remains challenging.

MRI bone marrow oedema precedes lumbar bone stress injury diagnosis in junior elite cricket fast bowlers.

OBJECTIVES: Lumbar bone stress injury ('bone stress injury') is common in junior fast bowlers. The repetitive loading of cricket fast bowling may cause bone marrow oedema (BMO), detectable on MRI, before the bowler suffers from symptomatic bone stress injury. We investigated the temporal relationship between BMO, bone stress injury, along with bowling workload correlates, in elite junior fast bowlers throughout a cricket season. METHODS: 65 junior fast bowlers were prospectively monitored for one 8-month cricket season. For research purposes, participants had up to six MRI scans at set times in the season; findings were withheld from them and their clinicians. Standard practices for bowling workload monitoring and injury diagnosis were followed. RESULTS: 15 (23%) participants developed bone stress injury during the study. All 15 of these participants had BMO detected on at least one of the preceding MRI scans, including the scan immediately prior to diagnosis. The risk of BMO progressing to bone stress injury during the season was greatest for participants with BMO present 2 weeks prior to the national championship tournament (period of high load) (RR=18.9, OR=44.8). Both bone stress injury and BMO were associated with bowling a higher percentage of days in training and having a shorter bowling break during the season. The number of balls bowled and acute-to-chronic workload were not associated with imaging abnormalities or injury. CONCLUSION: The presence of BMO on MRI in asymptomatic junior cricket fast bowlers confers a very high risk for bone stress injury. The risk may be managed by MRI screening and monitoring bowling frequency.

Don't Assume the Control Group Is Normal-People with Asymptomatic Tendon Pathology Have Higher Pressure Pain Thresholds.

Objective: Pain pressure thresholds (PPT) are used to study peripheral and central pain processing. In the tendon, pathological changes may exist without pain. This pilot study aimed to compare PPT between individuals with normal tendons and asymptomatic tendon pathology, and between individuals with and without a history of tendon pain. Methods: The patellar, Achilles, and supraspinatus tendons of 128 asymptomatic participants were examined with ultrasound. Global PPT average was determined using a digital algometer at the patellar tendon, quadriceps muscle, L3 spinous process, and deltoid muscle insertion. Participants were separated into three groups: (1) healthy control group (no pathology, no history of pain), (2) tendon pathology at any site without a history of pain, (3) history of tendon pain anywhere. Results: There were 92 controls, seven with asymptomatic pathology and 29 with a history of tendon pain. Asymptomatic tendon pathology at any site (without a history of pain) was associated with globally increased PPTs compared with controls (P < 0.001, pathology N = 7, N = 92 controls). Matched pair analysis remained significant (P < 0.004). A history of tendon pain was associated with globally increased PPTs compared with the control group (P = 0.026). Matched pair analysis was not significant (P = 0.122). Conclusions: Asymptomatic tendon pathology is associated with higher PPTs. These findings point toward central nervous system adaptations but in a novel way-central desensitization. This challenges the validity of conclusions drawn from PPT studies that do not verify normal structure in the control group; artificial inflation of control group data may incorrectly indicate decreased PPTs in the comparison group.

Trunk Side Strain Has a High Incidence in First-Class Cricket Fast Bowlers in Australia and England.

OBJECTIVE: To investigate the past incidence of side strain injury and its associated factors in first-class cricket fast bowlers in Australia and England. DESIGN: Retrospective case series. SETTING: Professional cricket. PARTICIPANTS: Cricket fast bowlers who were professionally contracted full time at first-class level in Australia and England in 2011. All bowlers were male and aged 18 or older. A bowler was defined as a fast bowler if the wicketkeeper would take their stance back from the stumps. There were 207 participants. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The association between bowling arm, player height, active trunk lateral flexion range of motion, side bridge endurance, volume of first-class cricket played, and the history of injury was determined. RESULTS: Over half of the bowlers had sustained at least 1 side strain in their career. Seventy-seven percent of primary injuries occurred in bowlers aged 24 or under. A higher proportion of injured bowlers had reached first-class volume in their career. Recurrence occurred in 30% of bowlers, with over 30% of these bowlers sustaining at least 1 further recurrence. Nearly half of all recurrences occurred within 2 years with a further quarter in the next year. The injury was not associated with any measured factors. CONCLUSIONS: Side strain is a common injury among first-class cricket fast bowlers, especially at younger ages. It was associated with the volume of first-class cricket played. Recurrence was common and occurred most frequently in the first 2 years after primary injury.

Physiotherapist-Led Physical Activity Interventions Are Efficacious at Increasing Physical Activity Levels: A Systematic Review and Meta-analysis.

OBJECTIVE: Physical activity (PA) interventions to address noncommunicable disease (NCD) risk are commonly delivered in private practice and outpatient physiotherapy settings. This study reviewed the efficacy of physiotherapist-led physical activity (PLPA) interventions at improving PA levels. DATA SOURCES: Twelve databases were searched using terms related to both physiotherapy and PA. English-language studies of all designs in adults were included. Meta-analyses were conducted separately for interventions measuring the following: (1) participants meeting recommended PA levels; (2) total PA at short- and long-term follow-up; and (3) total PA achieved after short and long PLPA interventions. Pooled effects were calculated using a fixed-effects model as standardized mean differences (SMDs). Nonstatistical analysis was used to identify the effect of PLPA interventions on the volume of PA performed at different intensities. MAIN RESULTS: From an initial 4140 studies, 8 were retained, and risk of bias ranged from low to high. Meta-analysis showed the odds of adults meeting minimum recommended PA levels were doubled in groups provided a PLPA intervention [OR = 2.15, 95% confidence interval (CI) = 1.35-3.43]. Total PA levels were increased in the short term (SMD = 0.15, 95% CI = 0.03-0.27) but not in the long term. Longer term interventions did not improve outcomes. Nonstatistical analysis identified that PLPA interventions were efficacious at increasing the amount of PA adults performed at all intensities. CONCLUSIONS: Clinic-based PLPA interventions delivered in private practice, primary care, and outpatient settings were efficacious at increasing PA in adults at risk of NCDs. Improvements did not last long term and were not enhanced with longer interventions.

Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial.

BACKGROUND: Quadriceps strengthening exercises are part of the treatment of patellofemoral pain (PFP), but the heavy resistance exercises may aggravate knee pain. Blood flow restriction (BFR) training may provide a low-load quadriceps strengthening method to treat PFP. METHODS: Seventy-nine participants were randomly allocated to a standardised quadriceps strengthening (standard) or low-load BFR. Both groups performed 8 weeks of leg press and leg extension, the standard group at 70% of 1 repetition maximum (1RM) and the BFR group at 30% of 1RM. Interventions were compared using repeated-measures analysis of variance for Kujala Patellofemoral Score, Visual Analogue Scale for 'worst pain' and 'pain with daily activity', isometric knee extensor torque (Newton metre) and quadriceps muscle thickness (cm). Subgroup analyses were performed on those participants with painful resisted knee extension at 60°. RESULTS: Sixty-nine participants (87%) completed the study (standard, n=34; BFR, n=35). The BFR group had a 93% greater reduction in pain with activities of daily living (p=0.02) than the standard group. Participants with painful resisted knee extension (n=39) had greater increases in knee extensor torque with BFR than standard (p<0.01). No between-group differences were found for change in Kujala Patellofemoral Score (p=0.31), worst pain (p=0.24), knee extensor torque (p=0.07) or quadriceps thickness (p=0.2). No difference was found between interventions at 6 months. CONCLUSION: Compared with standard quadriceps strengthening, low load with BFR produced greater reduction in pain with daily living at 8 weeks in people with PFP. Improvements were similar between groups in worst pain and Kujala score. The subgroup with painful resisted knee extension had larger improvements in quadriceps strength from BFR. TRIAL REGISTRATION NUMBER: 12614001164684.

Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis.

BACKGROUND: Previous injury is a strong risk factor for recurrent lower limb injury in athletic populations, yet the association between previous injury and a subsequent injury different in nature or location is rarely considered. OBJECTIVE: To systematically review data on the risk of sustaining a subsequent lower limb injury different in nature or location following a previous injury. METHODS: Eight medical databases were searched. Studies were eligible if they reported lower limb injury occurrence following any injury of a different anatomical site and/or of a different nature, assessed injury risk, contained athletic human participants and were written in English. Two reviewers independently applied the eligibility criteria and performed the risk of bias assessment. Meta-analysis was conducted using a random effects model. RESULTS: Twelve studies satisfied the eligibility criteria. Previous history of an ACL injury was associated with an increased risk of subsequent hamstring injury (three studies, RR=2.25, 95% CI 1.34 to 3.76), but a history of chronic groin injury was not associated with subsequent hamstring injury (three studies, RR=1.14, 95% CI 0.29 to 4.51). Previous lower limb muscular injury was associated with an increased risk of sustaining a lower limb muscular injury at a different site. A history of concussion and a variety of joint injuries were associated with an increased subsequent lower limb injury risk. CONCLUSIONS: The fact that previous injury of any type may increase the risk for a range of lower limb subsequent injuries must be considered in the development of future tertiary prevention programmes. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42016039904 (PROSPERO).

Asymptomatic players with a patellar tendon abnormality do not adapt their landing mechanics when fatigued.

This study aimed to explore how asymptomatic athletes with a patellar tendon abnormality (PTA), who are at high risk of developing patellar tendinopathy, alter their landing technique and net patellar tendon loads generated in response to fatigue. Seven asymptomatic players with a PTA performed five successful vertical stop-jump trials before and after a fatigue protocol. Fatigue protocol involved participants repeatedly performing sets of 30 submaximal jump exercises on a sledge apparatus followed by 30 s rest until the task failure criteria were reached. Three-dimensional ground reaction forces, lower limb kinematics and net peak patellar tendon force were recorded during the stop-jump task. No significant between-fatigue condition differences in net patellar tendon loading, or most secondary outcome variables were observed. Only some fatigue changes were seen during the vertical landing phase. Asymptomatic PTA participants did not modify their landing technique or net patellar tendon loading during a stop-jump task in response to fatigue. The lack of between-fatigue condition differences displayed by the asymptomatic PTA participants during both landing phases suggest that these individuals may not be capable of sufficient movement variability in their landing strategies to adapt to fatigue.

Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis.

BACKGROUND: Musculoskeletal symptoms limit adherence to exercise interventions for individuals with type 2 diabetes. People with diabetes may be susceptible to tendinopathy due to chronically elevated blood glucose levels. Therefore, we aimed to investigate this potential association by systematically reviewing and meta-analysing case-control, cross-sectional, and studies that considered both of these conditions. METHODS: Nine medical databases and hand searching methods were used without year limits to identify all relevant English language articles that considered diabetes and tendinopathy. Two authors applied exclusion criteria and one author extracted data with verification by a second author. Meta-analysis was conducted using a random effects model. Results were expressed as odds ratio (OR), mean difference or standardised mean difference with a confidence intervals (95% CI). Heterogeneity was assessed by I(2). FINDINGS: 31 studies were included in the final analysis of which 26 recruited people with diabetes and five recruited people with tendinopathy. Tendinopathy was more prevalent in people with diabetes (17 studies, OR 3·67, 95% CI 2·71 to 4·97), diabetes was more prevalent in people with tendinopathy (5 studies, OR 1·28, 95% CI 1·10 to 1·49), people with diabetes and tendinopathy had a longer duration of diabetes than people with diabetes only (6 studies, mean difference 5·26 years, 95% CI 4·15 to 6·36) and people with diabetes had thicker tendons than controls (9 studies, standardised mean difference 0·79 95% CI 0·47 to 1·12). INTERPRETATION: These findings provide strong evidence that diabetes is associated with higher risk of tendinopathy. This is clinically relevant as tendinopathy may affect adherence to exercise interventions for diabetes.

Does type 1 diabetes mellitus affect Achilles tendon response to a 10 km run? A case control study.

BACKGROUND: Achilles tendon structure deteriorates 2-days after maximal loading in elite athletes. The load-response behaviour of tendons may be altered in type 1 diabetes mellitus (T1DM) as hyperglycaemia accelerates collagen cross-linking. This study compared Achilles tendon load-response in participants with T1DM and controls. METHODS: Achilles tendon structure was quantified at day-0, day-2 and day-4 after a 10 km run. Ultrasound tissue characterisation (UTC) measures tendon structural integrity by classifying pixels as echo-type I, II, III or IV. Echo-type I has the most aligned collagen fibrils and IV has the least. RESULTS: Participants were 7 individuals with T1DM and 10 controls. All regularly ran distances greater than 5 km and VISA-A scores indicated good tendon function (T1DM = 94 ± 11, control = 94 ± 10). There were no diabetic complications and HbA1c was 8.7 ± 2.6 mmol/mol for T1DM and 5.3 ± 0.4 mmol/mol for control groups. Baseline tendon structure was similar in T1DM and control groups - UTC echo-types (I-IV) and anterior-posterior thickness were all p > 0.05. No response to load was seen in either T1DM or control group over the 4-days post exercise. CONCLUSION: Active individuals with T1DM do not have a heightened Achilles tendon response to load, which suggests no increased risk of tendon injury. We cannot extrapolate these findings to sedentary individuals with T1DM.

Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review.

BACKGROUND: Tendon pain occurs in individuals with extreme cholesterol levels (familial hypercholesterolaemia). It is unclear whether the association with tendon pain is strong with less extreme elevations of cholesterol. OBJECTIVE: To determine whether lipid levels are associated with abnormal tendon structure or the presence of tendon pain. METHODS: We conducted a systematic review and meta-analysis. Relevant articles were found through an electronic search of 6 medical databases-MEDLINE, Cochrane, AMED, EMBASE, Web of Science and Scopus. We included all case-control or cross-sectional studies with data describing (1) lipid levels or use of lipid-lowering drugs and (2) tendon structure or tendon pain. RESULTS: 17 studies (2612 participants) were eligible for inclusion in the review. People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol; with mean difference values of 0.66, 1.00, 0.33, and -0.19 mmol/L, respectively. CONCLUSIONS: The results of this review indicate that a relationship exists between an individual's lipid profile and tendon health. However, further longitudinal studies are required to determine whether a cause and effect relationship exists between tendon structure and lipid levels. This could lead to advancement in the understanding of the pathoaetiology and thus treatment of tendinopathy.

Australian football players' Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study.

BACKGROUND/AIM: The Achilles tendon is a tissue that responds to mechanical loads at a molecular and cellular level. In vitro and in vivo studies have shown that the expression of anabolic and/or catabolic proteins can change within hours of loading and return to baseline levels within 72 h. These biochemical changes have not been correlated with changes in whole tendon structure on imaging. We examined the nature and temporal sequence of changes in Achilles tendon structure in response to competitive game loads in elite Australian football players. METHODS: Elite male Australian football players with no history of Achilles tendinopathy were recruited. Achilles tendon structure was quantified using ultrasound tissue characterisation (UTC) imaging, a valid and reliable measure of intratendinous structure, the day prior to the match (day 0), and then reimaged on days 1, 2 and 4 postgame. RESULTS: Of the 18 participants eligible for this study, 12 had no history of tendinopathy (NORM) and 6 had a history of patellar or hamstring tendinopathy (TEN). Differences in baseline UTC echopattern were observed between the NORM and TEN groups, with the Achilles of the TEN group exhibiting altered UTC echopattern, consistent with a slightly disorganised tendon structure. In the NORM group, a significant reduction in echo-type I (normal tendon structure) was seen on day 2 (p=0.012) that returned to baseline on day 4. SUMMARY: There was a transient change in UTC echopattern in the Achilles tendon as a result of an Australian football game in individuals without a history of lower limb tendinopathy.

Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial.

AIM: To evaluate the effectiveness of customised foot orthoses in chronic mid-portion Achilles tendinopathy. METHODS: This was a participant-blinded, parallel-group randomised controlled trial at a single centre (La Trobe University, Melbourne, Australia). One hundred and forty participants aged 18-55 years with mid-portion Achilles tendinopathy were randomised to receive eccentric calf muscle exercises with either customised foot orthoses (intervention group) or sham foot orthoses (control group). Allocation to intervention was concealed. The Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire was completed at baseline, then at 1, 3, 6 and 12 months, with 3 months being the primary end point. Differences between groups were analysed using intention to treat with analysis of covariance. RESULTS: After randomisation into the customised foot orthoses group (n=67) or sham foot orthoses group (n=73), there was 70.7% follow-up of participants at 3 months. There were no significant differences between groups at any time point. At 3 months, the mean (SD) VISA-A score was 82.1 (16.3) and 79.2 (20.0) points for the customised and sham foot orthosis groups, respectively (adjusted mean difference (95% CI)=2.6 (-2.9 to 8.0), p=0.353). There were no clinically meaningful differences between groups in any of the secondary outcome measures. CONCLUSIONS: Customised foot orthoses, prescribed according to the protocol in this study, are no more effective than sham foot orthoses for reducing symptoms and improving function in people with mid-portion Achilles tendinopathy undergoing an eccentric calf muscle exercise programme. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: number ACTRN12609000829213.