Hamstring strength testing is crucial in assessing this important muscle group during rehabilitation and injury prevention. The purpose of this study was to evaluate the reliability and validity of ...measuring strength in a maximally lengthened position using a handheld dynamometer (HHD) compared to isokinetic testing.
Twenty healthy and active participants were recruited, and isometric strength testing was performed both on the Biodex machine and isometric end-range hamstring testing with the HHD on two occasions.
Significant strong correlations (r= 0.87, p < 0.0001) were found between strength testing on the Biodex machine and the HHD for both the right and left sides. Bland-Altman plots demonstrated agreement between the two measurements. Excellent intra-rater reliability (ICC= 0.91-0.93) and moderate to good inter-rater reliability (ICC = 0.71-0.83) for the HHD test was demonstrated.
The HHD provides a reliable and valid alternative to isokinetic testing for assessing hamstring strength in a maximally lengthened position. This assessment can be valuable in monitoring rehabilitation progress and detecting deficits before and after returning to play. The HHD is an accessible and cost-effective option for assessing hamstring strength at long lengths in a clinical setting.
3.
Human Achilles tendon glycation and function in diabetes Couppé, Christian; Svensson, Rene Brüggebusch; Kongsgaard, Mads ...
Journal of applied physiology,
2016-Jan-15, 2016-01-15, 20160115, Letnik:
120, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles ...tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between collagen glycation, Achilles tendon stiffness parameters, and plantar pressure in poorly (n = 22) and well (n = 22) controlled diabetic patients, including healthy age-matched (45-70 yr) controls (n = 11). There were no differences in any of the outcome parameters (collagen cross-linking or tendon stiffness) between patients with well-controlled and poorly controlled diabetes. The overall effect of diabetes was explored by collapsing the diabetes groups (DB) compared with the controls. Skin collagen cross-linking lysylpyridinoline, hydroxylysylpyridinoline (136%, 80%, P < 0.01) and pentosidine concentrations (55%, P < 0.05) were markedly greater in DB. Furthermore, Achilles tendon material stiffness was higher in DB (54%, P < 0.01). Notably, DB also demonstrated higher forefoot/rearfoot peak-plantar-pressure ratio (33%, P < 0.01). Overall, Achilles tendon material stiffness and skin connective tissue cross-linking were greater in diabetic patients compared with controls. The higher foot pressure indicates that material stiffness of tendon and other tissue (e.g., skin and joint capsule) may influence foot gait. The difference in foot pressure distribution may contribute to the development of foot ulcers in diabetic patients.
Background
Plantar fasciitis (PF) is a common disorder without objective parameters for disease severity.
Purpose
To investigate whether structural changes in the plantar fascia and heel fat pad ...determined by ultrasound scanning with or without contrast are related to outcome measures in patients with symptomatic PF and to investigate whether there is an association between changes in US findings and improvement in pain and function.
Methods
All patients (n = 90) in a randomized controlled trial treated with training and/or glucocorticosteroid injection were assessed for morning pain, function pain, Foot Function Index (FFI), and ultrasound measured thickness of the fascia and heel fat pad at entry and after 6 months. Thirty patients were included in a longitudinal study that assessed pain, function, and microvascular volume (MV) by contrast‐enhanced ultrasound at entry and after 5 months of treatment.
Results
None of the ultrasound parameters at the initial examination were related to clinical outcomes at 5–6 months. Changes in US measured thickness of the fascia but not the fat pad correlated with improvement in all outcome measures at 6 months (FFI: r = 0.30, p = 0.005, morning pain: r = 0.21, p = 0.046, function pain: r = 0.28, p = 0.007). MV did not change despite significant improvement in symptoms.
Conclusion
Changes in ultrasound measured fascia thickness are associated with clinical improvement in PF patients.
Importance Corticosteroid injections and exercise therapy are commonly used to treat chronic midportion Achilles tendinopathy, but the evidence for this combination is limited. Objective To ...investigate the effect of corticosteroid injection and exercise therapy compared with placebo injection and exercise therapy for patients with Achilles tendinopathy. Design, Setting, and Participants This was a participant-blinded, physician-blinded, and assessor-blinded randomized clinical trial of patients with Achilles tendinopathy verified by ultrasonography. Assessment of pain and function were conducted at baseline and at 1, 2, 3, 6, 12, and 24 months. Patients were recruited from a university medical clinic and a private rheumatology clinic in Denmark between April 2016 and September 2018. Data analysis was performed from June to September 2021. Interventions Corticosteroid injection and placebo injection were performed with ultrasonography guidance. Exercise therapy was based on previous trials and consisted of 3 exercises done every second day. Main Outcomes and Measures The primary outcome was the Victorian Institute of Sports Assessment–Achilles (VISA-A) score (range, 1-100, with 100 representing no symptoms) at 6 months. Secondary outcomes included pain measured using a 100-mm Visual Analog Scale for morning pain and pain during exercise (with higher scores indicating worse pain), global assessment (Likert scale), and tendon thickness. Results A total of 100 patients were included, with 52 randomized to placebo (mean age, 46 years 95% CI, 44-48 years; 32 men 62%) and 48 randomized to corticosteroid injection (mean age, 47 years 95% CI, 45-49 years; 28 men 58%). Patients in the 2 groups had similar height (mean SD, 177 8 cm), weight (mean SD, 79 12 kg), and VISA-A score (mean SD, 46 18) at baseline. The group receiving exercise therapy combined with corticosteroid injections had a 17.7-point (95% CI, 8.4-27.0 points;P < .001) larger improvement in VISA-A score compared with patients receiving exercise therapy combined with placebo injections at 6 months. No severe adverse events were observed in either group, and there was no deterioration in the long term (2-year follow-up). Conclusions and Relevance Corticosteroid injections combined with exercise therapy were associated with better outcomes in the treatment of Achilles tendinopathy compared with placebo injections and exercise therapy. A combination of exercise therapy and corticosteroid injection should be considered in the management of long-standing Achilles tendinopathy. Trial Registration ClinicalTrials.gov Identifier:NCT02580630
IntroductionAnterior cruciate ligament (ACL) injury is a serious knee injury that occurs in both children and adolescents and the incidence is increasing. The purpose of the study was to investigate ...children’s development of their physical function 1 year and 3 years after undergoing ACL-reconstruction.Materials and MethodsData was collected from a cohort running as part of clinical practice at Bispebjerg and Frederiksberg Hospitaler. From 2011 to 2022, 148 children were at that time at least 3 years postoperative after ACL-reconstruction. The children’s physical function was assessed with 4 hop tests and in a power rig, where the strength ratio between the operated leg and the healthy leg was measured with the Limb Symmetry Index (LSI). The anterior knee stability was assessed with a rolimeter and the children completed the Pedi-IKDC and KOOS-Child questionaries to evaluate their own experience of knee function. ResultsLSI was well over 90% on all 4 hop tests as well as in the power rig both at the 1-year and 3-year test. Anterior knee laxity was less than 2 mm at both 1-year test and 3-year test. The self-reported questionnaire Pedi-IKDC showed significant improvement in the score from 1-year test to 3-year test and KOOS-Child showed significant improvement in 2 of the 5 domains. ConclusionThe included children had good physical function both 1 year and 3 years after ACL-reconstruction. The children did not feel that their sport specific function and quality of life were at the best possible level.
To examine acromio-humeral distance (AHD) and shoulder isometric strength for external rotation (ER) and internal rotation (IR) in national elite badminton players.
Seven elite badminton players with ...asymptomatic shoulders aged 24 ± 4 (mean ± SD) from the Danish national badminton team were investigated. Shoulder AHD, isometric strength in ER and IR were bilaterally assessed with ultrasonography and a hand-held dynamometer (HHD).
AHD was greater on the dominant vs. the nondominant side (
= 0.018). Moreover, IR strength was greater on the dominant side vs. the nondominant side (
= 0.041). Furthermore, AHD and ER strength were highly correlated on the dominant side (
= 0.007,
= 0.900). A correlation was also shown between AHD and the ER/IR strength ratio on the dominant side (
= 0.033,
= 0.793).
This preliminary study demonstrates that shoulder ER strength is strongly associated with AHD size, largely reflecting supraspinatus tendon-muscle hypertrophy as a result of sport-specific adaptation in national elite badminton players with asymptomatic shoulders. These novel data also suggest that habitual loading of the shoulder improves the supraspinatus tendon size, which may lower the mechanical stress and potentially reduce the risk of injury. This warrants strengthening the shoulder external rotators as a potential strategy to reduce the risk of future shoulder injury.
Tendons are often injured and heal poorly. Whether this is caused by a slow tissue turnover is unknown, since existing data provide diverging estimates of tendon protein half-life that range from 2 ...mo to 200 yr. With the purpose of determining life-long turnover of human tendon tissue, we used the (14)C bomb-pulse method. This method takes advantage of the dramatic increase in atmospheric levels of (14)C, produced by nuclear bomb tests in 1955-1963, which is reflected in all living organisms. Levels of (14)C were measured in 28 forensic samples of Achilles tendon core and 4 skeletal muscle samples (donor birth years 1945-1983) with accelerator mass spectrometry (AMS) and compared to known atmospheric levels to estimate tissue turnover. We found that Achilles tendon tissue retained levels of (14)C corresponding to atmospheric levels several decades before tissue sampling, demonstrating a very limited tissue turnover. The tendon concentrations of (14)C approximately reflected the atmospheric levels present during the first 17 yr of life, indicating that the tendon core is formed during height growth and is essentially not renewed thereafter. In contrast, (14)C levels in muscle indicated continuous turnover. Our observation provides a fundamental premise for understanding tendon function and pathology, and likely explains the poor regenerative capacity of tendon tissue.
Fibromyalgia is one of the most prevalent chronic pain disorders. Fibromyalgia is characterised by generalised pain. In addition, patients with fibromyalgia often have co-morbidity. Since no cure is ...available, the treatment is based on symptom management, with physical exercise being the recommended first-line treatment. Different exercise modalities have been examined, including the practice of stretching exercises. The aim of the systematic review is to summarise the efficacy of stretching exercises on fibromyalgia symptoms and to study the content and the quality of the current evidence. The review followed the recommendations of the PRISMA statement. The search for articles was performed in April 2023. We searched on MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, AMED, PEDro, ClinicalTrials.gov and the Cochrane Collaboration Trials Register. The search was updated in March 2024. The protocol was registered in PROSPERO. Risk of Bias was assessed using the Cochrane Risk of Bias tool, and quality assessment was performed using the GRADE approach. In total, 2586 studies were found in the database searches, of which nine were included in the analysis. The primary outcome was pain. Secondary outcomes were self-reported quality of life, fatigue and physical and mental functioning. The available evidence shows that stretching exercises may improve pain, health-related quality of life and physical and mental functioning, but the level of evidence is low. The main limitation is due to issues with the heterogeneity of the interventions and small sample sizes. Trial registration: PROSPERO registration number CRD42023399614. Key Points • Stretching exercises show promise in the treatment of fibromyalgia. They may improve pain, health-related quality of life, physical functioning and mental health, but the level of evidence is low. • This study goes beyond previous research by presenting a more comprehensive and detailed analysis of the content and methodological quality of the current evidence. • Further research with clearly outlined protocols must be carried out to advance our understanding of the benefits of stretching exercises on fibromyalgia symptoms.Fibromyalgia is one of the most prevalent chronic pain disorders. Fibromyalgia is characterised by generalised pain. In addition, patients with fibromyalgia often have co-morbidity. Since no cure is available, the treatment is based on symptom management, with physical exercise being the recommended first-line treatment. Different exercise modalities have been examined, including the practice of stretching exercises. The aim of the systematic review is to summarise the efficacy of stretching exercises on fibromyalgia symptoms and to study the content and the quality of the current evidence. The review followed the recommendations of the PRISMA statement. The search for articles was performed in April 2023. We searched on MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, AMED, PEDro, ClinicalTrials.gov and the Cochrane Collaboration Trials Register. The search was updated in March 2024. The protocol was registered in PROSPERO. Risk of Bias was assessed using the Cochrane Risk of Bias tool, and quality assessment was performed using the GRADE approach. In total, 2586 studies were found in the database searches, of which nine were included in the analysis. The primary outcome was pain. Secondary outcomes were self-reported quality of life, fatigue and physical and mental functioning. The available evidence shows that stretching exercises may improve pain, health-related quality of life and physical and mental functioning, but the level of evidence is low. The main limitation is due to issues with the heterogeneity of the interventions and small sample sizes. Trial registration: PROSPERO registration number CRD42023399614. Key Points • Stretching exercises show promise in the treatment of fibromyalgia. They may improve pain, health-related quality of life, physical functioning and mental health, but the level of evidence is low. • This study goes beyond previous research by presenting a more comprehensive and detailed analysis of the content and methodological quality of the current evidence. • Further research with clearly outlined protocols must be carried out to advance our understanding of the benefits of stretching exercises on fibromyalgia symptoms.
Purpose
To assess children's physical function and subjective knee status 1 and 3 years after anterior cruciate ligament (ACL) reconstruction. It was hypothesised that there was no difference between ...the operated and normal legs in relation to physical strength and function, that there was <‐2 mm side‐to‐side difference in knee laxity, and that the subjective knee function was better 3 years after ACL reconstruction compared to 1 year after.
Methods
Children (<16 years of age) who had an ACL reconstruction had follow‐up with physical function tests (four hop tests and strength measurement in a power rig PR), anterior knee laxity (measured using a Rolimeter) and patient‐reported outcome measures (Pedi‐International Knee Documentation Committee IKDC and Knee injury and Osteoarthritis Outcome Score KOOS‐Child) 1 and 3 years postoperatively. Changes from 1‐ to 3‐year follow‐up were evaluated with a paired t test.
Results
Out of 148 ACL reconstructed children, 60 had all measures. The four hop tests and the PR all yielded a Limb Symmetry Index >90% at both follow‐ups. There was a significant improvement from 1‐ to 3‐year follow‐up in two‐hop tests (6 m on time and crossover hop). Side‐to‐side knee laxity was >2 mm in four children at 1‐ and 3‐year tests. Pedi‐IKDC scores increased, and KOOS‐Child improved significantly from 1 to 3 years in two of the five domains: ‘Sport’ and ‘Quality of life’, but scores were lower than in a cohort of normal children.
Conclusion
The children had good objective physical function 1 and 3 years after ACL reconstruction. However, scores from the KOOS‐Child sport‐specific function and quality of life domains were lower than in normal children.
Level of evidence
Level II.
Background
T2* mapping has proven useful in tendon research and may have the ability to detect subtle changes at an early stage of tendinopathy.
Purpose
To investigate the difference in T2* between ...patients with early tendinopathy and healthy controls, and to investigate the relationship between T2* and clinical outcomes, tendon size, and mechanical properties.
Study Type
Prospective cross‐sectional.
Subjects
Sixty‐five patients with early tendinopathy and 25 healthy controls.
Field Strength/Sequence
Three Tesla, ultrashort time to echo magnetic resonance imaging.
Assessment
Tendon T2* was quantified using a monoexponential fitting algorithm. Clinical symptoms were evaluated using the Victorian Institute of Sports Assessment‐Achilles/Patella (VISA‐A/VISA‐P). In vivo mechanical properties were measured using an ultrasound‐based method that determined force and deformation simultaneously in tendons of patellar tendinopathy patients.
Statistical Tests
A generalized linear model adjusted for age was applied to investigate the difference between patients and controls. In the two patient groups, linear regressions were applied to investigate the association between T2* and tendon size, clinical outcomes, and biomechanical properties.
Results
There was a significant difference in T2* between patients and healthy controls (204.8 95% CI: 44.5–365.0 μsec, P < 0.05). There was a positive correlation between tendon size and T2* for both Achilles (r = 0.72; P < 0.05) and patellar tendons (r = 0.53; P < 0.05). There was no significant correlation between VISA‐A and T2* (r = −0.2; P = 0.17) or VISA‐P and T2* (r = −0.5; P = 0.0504). Lastly, there was a negative correlation between modulus and T2* (r = −0.51; P < 0.05).
Data Conclusions
T2* mapping can detect subtle structural changes that translate to altered mechanical properties in early‐phase tendinopathy. However, T2* did not correlate with clinical scores in patients with early‐phase Achilles and patellar tendinopathy. Thus, T2* mapping may serve as a tool for early detection of structural changes in tendinopathy but does not necessarily describe the clinical severity of disease.
Level of Evidence
1
Technical Efficacy Stage
2
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