Publications by authors named "Jill Cook"

204 Publications

Ciprofloxacin reduces tenocyte viability and proteoglycan synthesis in short-term explant cultures of equine tendon.

PeerJ 2021 30;9:e12003. Epub 2021 Aug 30.

Department of Physiology, Anatomy, and Microbiology, La Trobe University, Melbourne, Victoria, Australia.

Fluoroquinolones are an effective, broad-spectrum antibiotic used to treat an array of bacterial infections. However, they are associated with an increased risk of tendinopathy and tendon rupture even after discontinuation of treatment. This condition is known as fluoroquinolone-associated tendinopathy, the underlying mechanisms of which are poorly understood. While many factors may be involved in the pathophysiology of tendinopathies in general, changes in tenocyte metabolism and viability, as well as alteration of proteoglycan metabolism are prominent findings in the scientific literature. This study investigated the effects of ciprofloxacin, a common fluoroquinolone, on cell viability, proteoglycan synthesis, and proteoglycan RNA expression in equine superficial digital flexor tendon explants after 96 h treatment with between 1-300 µg/mL ciprofloxacin, and again after 8 days discontinuation of treatment. Ciprofloxacin caused significant reductions in cell viability by between 25-33% at all dosages except 10 µg/mL, and viability decreased further after 8 days discontinuation of treatment. Proteoglycan synthesis significantly decreased by approximately 50% in explants treated with 100 µg/mL and 300 µg/mL, however this effect reversed after 8 days in the absence of treatment. No significant RNA expression changes were observed after the treatment period with the exception of versican which was down-regulated at the highest concentration of ciprofloxacin. After the recovery period, aggrecan, biglycan and versican genes were all significantly downregulated in explants initially treated with 1-100 µg/mL. Results from this study corroborate previously reported findings of reduced cell viability and proteoglycan synthesis in a whole tissue explant model and provide further insight into the mechanisms underlying fluoroquinolone-associated tendinopathy and rupture. This study further demonstrates that certain ciprofloxacin induced cellular changes are not rapidly reversed upon cessation of treatment which is a novel finding in the literature.
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http://dx.doi.org/10.7717/peerj.12003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8411937PMC
August 2021

Implicit motor imagery of the foot and hand in people with Achilles tendinopathy: a left right judgement study.

Pain Med 2021 Sep 14. Epub 2021 Sep 14.

La Trobe Sport & Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia.

Objective: To determine if impairment in motor imagery processes is present in Achilles tendinopathy (AT), as demonstrated by a reduced ability to quickly and accurately identify the laterality (left-right judgement) of a pictured limb. Additionally, this study aimed to use a novel data pooling approach to combine data collected at 3 different sites via meta-analytical techniques that allow exploration of heterogeneity.

Design: Multi site case-control study.

Methods: Three independent studies with similar protocols were conducted by separate research groups. Each study-site evaluated left/right judgement performance for images of feet and hands using Recognise© software and compared performance between people with AT and healthy controls. Results from each study-site were independently collated, then combined in a meta-analysis.

Results: 126 participants (40 unilateral, 22 bilateral AT cases, 61 controls) were included. There were no differences between AT cases and controls for hand image accuracy and reaction time. Contrary to the hypothesis, there were no differences in performance between those with AT and controls for foot image reaction time, however there were conflicting findings for foot accuracy, based on four separate analyses. There were no differences between the affected and unaffected sides in people with unilateral AT.

Conclusions: Impairments in motor imagery performance for hands were not found in this study and we found inconsistent results for foot accuracy. This contrasts to studies in persistent pain of limbs, face and knee osteoarthritis, and suggests that differences in pathoaetiology or patient demographics may uniquely influence proprioceptive representation.
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http://dx.doi.org/10.1093/pm/pnab261DOI Listing
September 2021

Prevalence and pain distribution of anterior knee pain in college basketball players.

J Athl Train 2021 Jul 30. Epub 2021 Jul 30.

1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia.

Context: Causes of anterior knee pain (AKP) in jumping athletes include patellofemoral pain and patellar tendinopathy. Differential diagnosis of AKP is challenging, with variation in clinical presentations. No previous research has used pain location to describe AKP in basketball athletes.

Objectives: To describe the prevalence and pain distribution of AKP in college basketball. To report the prevalence of focal inferior pole pain using two outcome measures.

Design: Cross-sectional study Setting: University and college basketball facilities in Alberta, Canada.

Patients Or Other Participants: 242 collegiate basketball athletes Main Outcome Measure(s): The single leg decline squat test (SLDS) was used to capture pain location using pain mapping (dichotomised into focal/diffuse) and pain severity (numerical rating scale). The Oslo Sports Trauma Research Centre Knee questionnaire (OSTRC-Knee) and adapted version for patellar tendinopathy (OSTRC-P) were used to report the prevalence of anterior knee pain (AKP) and patellar tendinopathy respectively. Focal inferior pole pain during the SLDS was used to classify patellar tendinopathy.

Results: Of the 242 players (138 women, 104 men), 146 (60%) reported pain with the SLDS [unilateral n=64, (26%); bilateral n=82 (34%)]. 101 (43%) reported knee pain using the OSTRC-Knee. Pain mapping captured variability in pain location. Diffuse pain was more prevalent [left 70%; right 72%] than focal pain [left 30%; right 28%]. There was low prevalence of patellar tendinopathy with either outcome measure; OSTRC-P [n=21, 8.7%] and inferior pole pain during the SLDS [n=25, 10.3%] Conclusions: Diffuse AKP was common in Canadian basketball players, however pain mapped to the inferior pole of the patella was not. Few players reported tendinopathy using the OSTRC-P, suggesting that patellar tendinopathy was not a primary knee pain presentation in this jumping cohort. Pain location rather than presence or severity of pain alone may better describe the clinical presentations of AKP in jumping athletes.
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http://dx.doi.org/10.4085/1062-6050-0604.20DOI Listing
July 2021

Pelvic floor disorders stop women exercising: A survey of 4556 symptomatic women.

J Sci Med Sport 2021 Dec 17;24(12):1211-1217. Epub 2021 Jun 17.

Department of Physiotherapy, Monash University, Australia.

Objectives: To establish the impact of pelvic floor (PF) symptoms (urinary incontinence [UI], anal incontinence [AI] and pelvic organ prolapse [POP]) on exercise participation in women.

Design: Observational, cross-sectional survey.

Methods: Australian, 18- to 65-year-old women with self-identified PF symptoms during exercise (current, past or fear of) were included. This survey included validated questionnaires: Questionnaire for female Urinary Incontinence Diagnosis, Incontinence Severity Index, Pelvic Floor Bother Questionnaire, International Physical Activity Questionnaire and purpose-designed questions on the impact of PF symptoms on sport/exercise participation. Analysis utilised descriptive statistics. Chi-square tests for independence and t-tests were used to explore differences between groups.

Results: Of 4556 women, 46% stopped exercise they had previously participated in due to their PF symptoms. Urinary incontinence had the largest impact; 41% with UI, followed by 37% with POP and 26% with AI stopped at least one form of exercise. Forty-two percent of women who experienced symptoms in high-impact sports stopped participation (versus low-impact: 21%). Sports commonly ceased included volleyball (63%), racquet-sports (57%) and basketball (54%). Exercise cessation was reported amongst younger (18-25 years: 35%) and nulliparous women (31%). Common exercise modifications included lowering the intensity (58%) or frequency (34%) of participation or changing to a low-impact form of sport/exercise (45%).

Conclusions: Pelvic floor symptoms stop women of all ages and levels of participation from exercising. High-impact sports were most affected but low-impact sports were also ceased. Symptomatic women also modify exercise to less vigorous/frequent participation, which may place them at risk of physical inactivity, and chronic illness.
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http://dx.doi.org/10.1016/j.jsams.2021.06.003DOI Listing
December 2021

Deep hip external rotator muscle size in ballet dancers compared to non-dancing athletes, and associations to pain.

Phys Ther Sport 2021 Sep 29;51:58-64. Epub 2021 Jun 29.

The Australian Ballet, Southbank, Victoria, 3006, Australia; La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, 3086, Australia.

Objectives: To compare the deep hip external rotator (DHER) muscle (piriformis, gemelli, quadratus femoris (QF)) cross-sectional area (CSA) in dancers and athletes and evaluate the relationship between DHER size and hip pain.

Study Design: Cross-sectional study.

Setting: Elite ballet and sport.

Participants: 33 professional ballet dancers and 33 age and sex-matched athletes.

Main Outcome Measures: CSAs of piriformis, gemelli and QF on magnetic resonance imaging (MRI). Hip pain scored with the Copenhagen Hip and Groin Outcome Score (HAGOS): Hip pain was categorised as 'yes' if HAGOS pain score was <100, 'no' if HAGOS pain was = 100.

Results: Estimated marginal mean CSA of piriformis, gemelli and QF muscles was similar in athletes and dancers (p > 0.05), and CSAs were not associated with hip pain. Male and female dancers had similar sized DHER muscles. In athletes, CSA of piriformis was 55% (p = 0.02, Cohen's d(95%CI) = 0.98 (0.26,1.71)) and the gemelli were 34% (p = 0.03, Cohen's d(95%CI) = 0.98 (0.26,1.70)) larger in men than women; QF was 36% larger (p = 0.08, Cohen's d(95%CI) = 0.77 (0.06,1.48)).

Conclusion: Although ballet dancers perform in external rotation, their DHER are no larger than athletes and muscle size was not associated with hip pain.
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http://dx.doi.org/10.1016/j.ptsp.2021.06.010DOI Listing
September 2021

Nearly 40% of adolescent athletes report anterior knee pain regardless of maturation status, age, sex or sport played.

Phys Ther Sport 2021 Sep 27;51:29-35. Epub 2021 Jun 27.

La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia; Monash Department of Clinical Epidemiology, Cabrini Institute, Monash University, Clayton, VIC, Australia; Cabrini Institute, Cabrini Health, Malvern, VIC, Australia.

Objective: To report point prevalence of anterior knee pain (AKP) in adolescent athletes by (1) maturation status, (2) chronological age, (3) sex, and (4) primary sport.

Design: Cross-sectional.

Methods: Male and female participants aged 11-15 years were recruited from specialised sports programs for basketball, volleyball, Australian Rules Football and tennis. Standing height, sitting height, and body mass were measured and used to calculate maturity status. Past injury history, self-reported physical activity, and Victorian Institute of Sport Assessment Questionnaire Patellar Tendon (VISA-P) questionnaires were completed. Anterior knee pain was defined as any pain experienced on the anterior surface of the knee and recorded using a visual analogue scale (VAS). A single leg decline squat (SLDS) was performed for provocation of AKP.

Results: Two hundred and seventeen male and female adolescent athletes participated in this study. Twenty participants were excluded from data analysis. Point prevalence of AKP was 39% (N = 76). Average self-reported physical activity/week was 7.9 ± 4.1 h of their specialised sport and 2.0 ± 2.0 h of other physical activity/week. Maturation status, chronological age, sex nor primary sporting program was statistically significant in explaining the presence or absence of AKP.

Conclusion: Due to the right-skewed maturation sample, the authors cannot state conclusively that maturation status was not associated with AKP. Nearly 40% of this cohort reported AKP during a pain provocation test. The presence of AKP was not explained by maturation status, age, sex or primary sport program. Given the chronic nature of AKP and future morbidity reported, this high prevalence provides rationale for intervention or prevention studies targeting younger athletes.
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http://dx.doi.org/10.1016/j.ptsp.2021.06.005DOI Listing
September 2021

Magnetic resonance imaging findings associated with posterior ankle impingement syndrome are prevalent in elite ballet dancers and athletes.

Skeletal Radiol 2021 Dec 19;50(12):2423-2431. Epub 2021 May 19.

La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, 3086, Australia.

Objective: To report the prevalence of MRI features commonly associated with posterior ankle impingement syndrome in elite ballet dancers and athletes and to compare findings between groups.

Materials And Methods: Thirty-eight professional ballet dancers (47.4% women) were age- and sex-matched to 38 elite soccer or cricket fast bowler athletes. All participants were training, playing, and performing at full workload and underwent 3.0-T standardised magnetic resonance imaging of one ankle. De-identified images were assessed by one senior musculoskeletal radiologist for findings associated with posterior ankle impingement syndrome (os trigonum, Stieda process, posterior talocrural and subtalar joint effusion-synovitis, flexor hallucis longus tendon pathology and tenosynovitis, and posterior ankle bone marrow oedema). Imaging scoring reliability testing was performed.

Results: Posterior talocrural effusion-synovitis (90.8%) and subtalar joint effusion-synovitis (93.4%) were common in both groups, as well as the presence of either an os trigonum or Stieda process (61.8%). Athletes had a higher prevalence of either os trigonum or Stieda process than dancers (74%, 50% respectively, P = 0.03). Male athletes had a higher prevalence of either os trigonum or Stieda process than male dancers (90%, 50% respectively, P = 0.01), or female athletes (56%, P = 0.02). Posterior subtalar joint effusion-synovitis size was larger in dancers than athletes (P = 0.02). Male and female dancers had similar imaging findings. There was at least moderate interobserver and intraobserver agreement for most MRI findings.

Conclusion: Imaging features associated with posterior impingement were prevalent in all groups. The high prevalence of os trigonum or Stieda process in male athletes suggests that this is a typical finding in this population.
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http://dx.doi.org/10.1007/s00256-021-03811-xDOI Listing
December 2021

Association Between COL5a1, COL11a1, and COL11a2 Gene Variations and Rotator Cuff Tendinopathy in Young Athletes.

Clin J Sport Med 2021 May 7. Epub 2021 May 7.

Department of Physiotherapy, University of Valencia, Valencia, Spain; La Trobe Sport and Exercise Medicine Research Centre, Faculty of Health Science, La Trobe University, Victoria, Australia; Department of Physiotherapy, Faculty of Health, European University, Valencia, Spain; Physical and Sports Education Department, Faculty of Physical Activity and Sport Sciences, University of Valencia, Valencia, Spain; Department of Physiology, University de Valencia, Valencia, Spain; and Center for Translational Research in Physiotherapy, Department of Pathology and Surgery, Physiotherapy Area, Miguel Hernandez University, San Juan, Alicante, Spain.

Objective: Tendinopathy is a prevalent condition in young athletes and in older nonathletic people. Recent tendinopathy research has shown a growing interest in the role played by genetic factors, basically genes involved in collagen synthesis and regulation, in view of collagen disorganization typically present in tendon pathologies.

Design: A case-control, genotype-phenotype association study.

Setting: La Ribera Hospital, Valencia, Spain.

Participants: A group of 137 young athletes (49 with rotator cuff tendon pathology and 88 healthy counterparts) who played upper-limb-loading sports were clinically and ultrasound (US) assessed for rotator cuff tendinopathy were included.

Intervention: Genetic analysis was performed to determine whether there was a relationship between rotator cuff pathology and the genotype.

Main Outcome Measures: We hypothesized that the following single nucleotide polymorphisms: COL5a1 rs12722, COL11a1 rs3753841, COL11a1 rs1676486, and COL11a2 rs1799907 would be associated with rotator cuff tendinopathy.

Results: A direct relationship between CC genotype and bilateral US pathological images was statistically significant (χ2 = 0.0051) and confirmed by the Fisher test, with a correlation coefficient of 0.345 and a Cramer's v of 0.26.

Conclusion: A significant association was found between COL5a1 rs12722 genotype and rotator cuff pathology, with the CC genotype conferring increased risk of tendon abnormalities and being associated with rotator cuff pathology.
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http://dx.doi.org/10.1097/JSM.0000000000000937DOI Listing
May 2021

Effect of Pelvic Floor Symptoms on Women's Participation in Exercise: A Mixed-Methods Systematic Review With Meta-analysis.

J Orthop Sports Phys Ther 2021 07 10;51(7):345-361. Epub 2021 May 10.

Objective: To (1) review the effect of pelvic floor (PF) symptoms (urinary incontinence [UI], pelvic organ prolapse, and anal incontinence) on exercise participation in women, and (2) explore PF symptoms as a barrier to exercising.

Design: Mixed-methods systematic review with meta-analysis.

Literature Search: Eight databases were systematically searched up to September 2020.

Study Selection Criteria: We included full-text, peer-reviewed observational, experimental, or qualitative studies in adult, community-dwelling women with PF symptoms. Outcomes included the participant-reported effect on exercise or the perception of PF symptoms as an exercise barrier. Study quality was assessed using a modified version of the Mixed Methods Appraisal Tool.

Data Synthesis: Meta-analysis was performed where possible. Deductive and inductive content analysis was used to synthesize qualitative data. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework and the GRADE-Confidence in the Evidence from Reviews of Qualitative research (CERQual) guided interpretation of the certainty of evidence.

Results: Thirty-three studies were included. In 47% (95% confidence interval [CI]: 37%, 56%; I = 98.6%) of women with past, current, or fear of PF symptoms, UI symptoms adversely affected exercise participation (21 studies, n = 14 836 women). Thirty-nine percent (95% CI: 22%, 57%; I = 93.0%; 6 studies, n = 426) reported a moderate or great effect on exercise. Pelvic organ prolapse affected exercise for 28% of women (95% CI: 24%, 33%; I = 0.0%; 2 studies, n = 406). There were no quantitative studies of anal incontinence.

Conclusion: For 1 in 2 women, UI symptoms negatively affect exercise participation. Half of women with UI reported either stopping or modifying exercise due to their symptoms. Limited data on pelvic organ prolapse also demonstrated adverse exercise effect. .
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http://dx.doi.org/10.2519/jospt.2021.10200DOI Listing
July 2021

Chronic Plantar Heel Pain Is Principally Associated With Waist Girth (Systemic) and Pain (Central) Factors, Not Foot Factors: A Case-Control Study.

J Orthop Sports Phys Ther 2021 Sep 7;51(9):449-458. Epub 2021 May 7.

Objective: To determine the independent associations of potential clinical, symptom, physical activity, and psychological factors with chronic plantar heel pain.

Design: Case-control.

Methods: We investigated associations by comparing 220 participants with chronic (more than 3 months in duration) plantar heel pain to 100 age- and sex-matched controls, who were recruited randomly from the electoral roll. Exposures measured were waist girth, body mass index, body composition, clinical measures of foot and leg function, physical activity via accelerometry, depression and pain catastrophizing, symptoms of prolonged morning stiffness anywhere in the body, and multisite pain. Data were analyzed using multivariable conditional logistic regression.

Results: Waist girth (centimeters) (odds ratio [OR] = 1.06; 95% confidence interval [CI]: 1.03, 1.09), ankle plantar flexor strength (kilograms) (OR = 0.98; 95% CI: 0.97, 0.99), pain at multiple sites (pain at 1 other site: OR = 2.76; 95% CI: 1.29, 5.91; pain at 4 or more other sites: OR = 10.45; 95% CI: 3.66, 29.81), and pain catastrophizing status (none, some, or catastrophizer) (some: OR = 2.91; 95% CI: 1.33, 6.37; catastrophizer: OR = 6.79; 95% CI: 1.91, 24.11) were independently associated with chronic plantar heel pain. There were univariable but not independent associations with morning stiffness, first metatarsophalangeal joint extension range of motion, depression, and body mass index. There were no significant associations with physical activity or body composition (bioelectrical impedance analysis).

Conclusion: Waist girth, ankle plantar flexor strength, multisite pain, and pain catastrophizing, but not foot-specific factors, were independently associated with chronic plantar heel pain. Of these 4 factors, 3 (waist girth, multisite pain, and pain catastrophizing) were central or systemic associations. .
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http://dx.doi.org/10.2519/jospt.2021.10018DOI Listing
September 2021

Differences in Biomechanical Loading Magnitude During a Landing Task in Male Athletes with and without Patellar Tendinopathy.

J Athl Train 2021 Apr 22. Epub 2021 Apr 22.

2Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.

Context: Prior research has not established if overloading or underloading movement profiles are present in symptomatic and asymptomatic athletes with patellar tendon structural abnormality (PTA) compared to healthy athletes.

Objective: The purpose was to compare involved limb landing biomechanics between male athletes with and without patellar tendinopathy.

Design: Cross-sectional study Setting: Laboratory Patients or Other Participants: 43 males were grouped based on patellar tendon pain & ultrasound imaging of the proximal patellar tendon: symptomatic with PTA (SYM-PTA; n=13; 20±2yrs; 1.8±0.1m; 84±5kg), asymptomatic with PTA (ASYM-PTA; n=15; 21±2yrs; 1.8±0.1m; 82±13kg), and healthy control (CON; n=15; 20±2yrs; 1.8±0.1m; 79±12kg).

Main Outcome Measures: 3D biomechanics were collected during double-limb jump-landing. Kinematic (knee flexion angle (KF)) and kinetic (vertical ground reaction force (VGRF); internal knee extension moment (KEM); patellar tendon force (FPT)) variables were analyzed as continuous waveforms during the stance phase for the involved limb. Mean values were calculated for each 1% of stance, normalized over 202 data points (0-100%), and plotted with 95% confidence intervals. Statistical significance was defined as a lack of 95% CI overlap for ≥ 6 consecutive data points.

Results: SYM-PTA had lesser KF than CON throughout the stance phase. ASYM-PTA had lesser KF than CON in the early and late stance phase. SYM-PTA group had lesser KEM and FPT than CON in early stance, as well as ASYM-PTA in mid-stance.

Conclusions: Male athletes with SYM-PTA demonstrated a patellar tendon load-avoidance profile compared to ASYM-PTA and CON athletes. ASYM-PTA did not show evidence of overloading compared to CON. Our findings support the need for individualized treatments for athletes with tendinopathy to maximize load-capacity.

Trial Registry: ClinicalTrials.gov (#XXX).
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http://dx.doi.org/10.4085/1062-6050-0548.20DOI Listing
April 2021

Associations between clinical and imaging findings in posterior ankle impingement syndrome: a systematic review.

Acta Radiol 2021 Apr 19:2841851211008389. Epub 2021 Apr 19.

La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia.

Background: Posterior ankle impingement syndrome (PAIS) is a common and debilitating condition, commonly affecting people who participate in activities that involve repetitive ankle plantarflexion. The relationship between clinical and imaging findings in PAIS has not been established.

Purpose: To investigate the relationship between clinical and imaging features in PAIS by reviewing the literature comparing symptomatic patients to asymptomatic controls.

Material And Methods: A systematic literature search was performed to identify all English-language articles that compared imaging features in patients diagnosed with PAIS to imaging in an asymptomatic control group.

Results: A total of 8394 articles were evaluated by title and abstract, and 156 articles were read in full text. No articles compared imaging findings to an asymptomatic control group, thus no articles met the inclusion criteria.

Conclusion: This systematic review found no published research that compared the imaging findings of people diagnosed with PAIS to asymptomatic people. Until this information is available, imaging features in people with posterior ankle impingement should be interpreted with caution.
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http://dx.doi.org/10.1177/02841851211008389DOI Listing
April 2021

Wellness Monitoring for Professional Ballet Dancers - A Pilot Study.

J Dance Med Sci 2021 Jun 29;25(2):80-85. Epub 2021 Mar 29.

Self-report wellness measures are used extensively in elite sport as valid indicators of the adaptive responses to training and performance of an athlete. Wellness parameters such as quality and quantity of sleep, muscle soreness, fatigue, and stress are monitored in professional sport via Athlete Management Systems (AMS) and self-report monitoring applications (App). However, the use of a monitoring App specifically for professional classical ballet dancers has not been tested. This study piloted a self-report App to measure wellness constructs in a professional ballet company. Three male and two female dancers volunteered to take part in the mixed-method study, entering daily wellness data, frequency of work-related activities, and injury status into an App on their smart phones. Via a focus group interview session, perceptions of wellness and experiences using the App were found to be favorable, with dancers reporting that the App enhanced awareness of their well-being. To further develop monitoring tools in professional ballet companies, it is recommended that the App be made specific to the wellness needs of dancers.
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http://dx.doi.org/10.12678/1089-313X.061521bDOI Listing
June 2021

Physical Activity and Investigation With Magnetic Resonance Imaging Partly Explain Variability in the Prevalence of Patellar Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals.

J Orthop Sports Phys Ther 2021 05 28;51(5):216-231. Epub 2021 Mar 28.

Objective: To estimate the pooled prevalence of, and factors associated with, the presence of patellar tendon abnormalities observed on imaging in people without symptoms.

Design: Systematic review with stratified meta-analysis and meta-regression.

Literature Search: We searched Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science from 1980 to August 2020.

Study Selection Criteria: We included studies that reported the prevalence of asymptomatic patellar tendon abnormalities on imaging. We excluded studies of participants with current tendon pain, a history of tendon pain, or other systemic conditions.

Data Synthesis: Stratification and meta-regression of studies based on study-level descriptive statistics (mean age, body mass index, proportion of female participants, physical activity participation, imaging modality) were performed using a random-effects model to account for between-study heterogeneity. Risk of bias was assessed using the modified Newcastle-Ottawa scale.

Results: Meta-analysis of 64 studies (7125 limbs from 4616 participants) found significant between-study heterogeneity (I≥90%, <.01), which precluded a summary prevalence estimate. Heterogeneity was partially explained by studies that included participants who were physically active and studies that assessed tendon abnormalities using magnetic resonance imaging compared to ultrasound (<.05). Mean age, body mass index, proportion of female participants, and sample size did not explain the remaining heterogeneity.

Conclusion: There was substantial variability in the reported prevalence of asymptomatic patellar tendon abnormalities. A clear and valid method is needed to assess and report the presence of patellar tendon abnormalities to increase research capacity and establish the clinical value of imaging the patellar tendon. .
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http://dx.doi.org/10.2519/jospt.2021.10054DOI Listing
May 2021

Explaining Variability in the Prevalence of Achilles Tendon Abnormalities: A Systematic Review With Meta-analysis of Imaging Studies in Asymptomatic Individuals.

J Orthop Sports Phys Ther 2021 05 28;51(5):232-252. Epub 2021 Mar 28.

Objective: To estimate the prevalence of, and factors associated with, Achilles tendon abnormalities observed on imaging in asymptomatic individuals.

Design: Systematic review with stratified meta-analysis and meta-regression.

Literature Search: Embase, Scopus, MEDLINE, CINAHL, SPORTDiscus, and Web of Science were searched from 1980 to August 2020.

Study Selection Criteria: We included studies that reported the prevalence of Achilles tendon abnormalities, observed with any imaging modality, in an asymptomatic population. We excluded studies if participant mean age was younger than 12 years or if participants had current/previous lower-limb tendon injuries/symptoms or other systemic conditions.

Data Synthesis: Random-effects proportion meta-analysis was used to estimate prevalence. We used meta-regression for continuous variables (mean age and body mass index [BMI], sample size, proportion of female participants) and stratified categorical variables (imaging modality and participation in physical activity) to explain between-study heterogeneity.

Results: We included 91 studies (10 156 limbs, 5841 participants). The prevalence of Achilles tendon abnormalities on imaging ranged from 0% to 80% per participant. Between-study heterogeneity was high (I>90%, <.001), precluding data pooling. Between-study heterogeneity was partly explained by participant mean BMI (slope, 2.8% per 1-unit increase in BMI; 95% confidence interval: 0.57%, 5.03%; = .015) and participation in physical activity per limb, and mean age of 40 years old or older ( = .022) per participant.

Conclusion: There was substantial variability in the prevalence of Achilles tendon abnormalities on imaging in asymptomatic individuals. Higher prevalence of abnormalities was associated with older age (40 years old or older), higher BMI, and participation in physical activity. A large proportion of heterogeneity remains unaccounted for, likely due to variations in abnormality definitions and study design. .
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http://dx.doi.org/10.2519/jospt.2021.9970DOI Listing
May 2021

Assessment of trunk lateral flexion range of movement using a novel method in first class cricket players.

J Athl Train 2021 Mar 3. Epub 2021 Mar 3.

La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia

Objectives: Lateral flexion range of movement (LF ROM) is used to assess and monitor recovery of side strain injury in athletes. This study established a reliable and pragmatic measure of LF ROM and investigated the stability of the measure over time in athletes.

Design: 1) Cross-sectional reliability study and 2) Cohort longitudinal study.

Setting: Elite cricket teams in COUNTRY-AAA and COUNTRY-BBB Participants: Cricket players Methods: 1) The intra- and inter-rater reliability of two methods of measuring LF ROM were assessed (distance to the floor or distance to fibular head). Ten healthy first-class cricket bowlers were tested by three experienced physiotherapists. Intra-class correlations (2,1) were calculated for absolute agreement for all 3 testers. 2) Professional cricket fast bowlers were recruited from COUNTRY-AAA and COUNTRY-BBB domestic and international competitions. Lateral flexion range of movement was measured monthly during the pre- and competitive season. A one-way repeated measures analysis of variance was performed to identify difference within the pre-season, within the competitive season, and between competitive seasons.

Main Outcome Measures: Lateral flexion range of movement towards and away from the bowling arm.

Results: Both methods had good intra- and inter-test reliability (ICC>0.84). As LF ROM to the floor was easier for clinicians it was used for the longitudinal study. Lateral flexion range of movement did not significantly alter throughout the pre- and competitive season or between seasons (p>0.05).

Conclusions: This new method of describing LF ROM demonstrates good intra- and inter-rater reliability and stability over time and can be used as an outcome measure in side-strain injury.
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http://dx.doi.org/10.4085/564-20DOI Listing
March 2021

Sensory Processing in People With and Without Tendinopathy: A Systematic Review With Meta-analysis of Local, Regional, and Remote Sites in Upper- and Lower-Limb Conditions.

J Orthop Sports Phys Ther 2021 01;51(1):12-26

Objective: To synthesize results of somatosensory processing tests in people with upper- and lower-limb tendinopathy, compared to controls.

Design: Systematic review with meta-analysis.

Literature Search: Four electronic databases (MEDLINE, CINAHL Plus, SPORTDiscus, and Embase) were searched.

Study Selection Criteria: Included studies measured a domain of sensory processing and compared a tendinopathy group to a healthy control group.

Data Synthesis: Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Upper- and lower-limb conditions were compared and outcomes were examined by measurement site (local, regional, or remote to location of pain).

Results: Of the 30 studies included, 18 investigated lateral elbow tendinopathy. The most commonly assessed outcome measures were pressure pain threshold (PPT) and thermal pain threshold. There was moderate evidence for local and regional reduction of PPT in upper-limb tendinopathies, but not at remote sites. In lower-limb tendinopathies, there was conflicting evidence regarding reduced PPT at local sites and limited evidence of normal PPT at remote sites. There was moderate evidence of sensitization of thermal pain threshold at local sites in upper-limb tendinopathies and limited evidence of no difference in thermal pain threshold in lower-limb tendinopathies. Findings across other domains were variable.

Conclusion: Sensory processing was different between upper-limb tendinopathy and lower-limb tendinopathy. Upper-limb tendinopathies showed signs consistent with primary and secondary hyperalgesia, but lower-limb tendinopathies did not. There was mixed evidence for primary hyperalgesia and limited evidence against secondary hyperalgesia. .
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http://dx.doi.org/10.2519/jospt.2021.9417DOI Listing
January 2021

Self-Reported Wellness in Training and Performance: A Comparison of Professional Ballet Dancers and Professional Athletes.

Med Probl Perform Art 2020 Dec;35(4):196-201

School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, 3086 VIC, Australia. Tel +61 (0) 3 9479 3526.

Objective: In high-performance sport, the use of self-report measures is expanding. The exploration of wellness states in response to training and performance requires further investigation for professional ballet dancers and athletes. This study therefore aimed to: compare wellness scores between professional ballet dancers and athletes in training and performance; report frequency of self-reported modified participation during training and performance; and report frequency of self-reported inability to participate due to pain and illness in dancers and athletes.

Methods: Fourteen professional ballet dancers (mean 26 yrs, SD 2.6) and 14 sex- and age-matched professional athletes (mean 27.7 yrs, SD 2.9) recorded daily wellness (fatigue, stress, sleep quality and quantity), participation (full, rest, modified, or unable to participate) and activity (performance, training) into a wellness application on their smart phone over a 4-month period. Mixed factorial ANOVAs were conducted to assess the interaction between group (ballet dancers and athletes) and activity (performance and training) on the dependent variables (stress, fatigue, sleep quality, and sleep quantity).

Results: Stress and fatigue levels were higher for both dancers and athletes during performance compared to training periods. Dancers recorded lower sleep quantity than athletes, with no difference in sleep quality. Modified participation appears more common in dancers compared to athletes. Dancers and athletes were rarely unable to train or perform/compete over the 4 months.

Conclusion: Self-reported wellness scores appear sensitive to activity type and can provide valuable information to guide intervention and recovery strategies. Further research on the impact of poor wellness on performance, illness, and injury in professional ballet is warranted.
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http://dx.doi.org/10.21091/mppa.2020.4028DOI Listing
December 2020

Joint Hypermobility Does Not Increase the Risk of Developing Hip Pain, Cartilage Defects, or Retirement in Professional Ballet Dancers Over 5 years.

Clin J Sport Med 2021 11;31(6):e342-e346

School of Allied Health, La Trobe University, Bundoora, Victoria, Australia; and.

Objective: This study aimed to evaluate the risk of developing hip pain, cartilage defects, and retirement in hypermobile ballet dancers over 5 years.

Design: Prospective cohort study.

Setting: Professional Ballet Company.

Participants: Forty ballet dancers (57.5% women) were assessed at baseline and 21 dancers at 5 years.

Independent Variable: Baseline evaluation of generalised joint hypermobility (GJH) (GJH = Beighton score ≥5/9).

Outcome Measures: Cartilage defects on hip 3T magnetic resonance imaging and pain (the Copenhagen Hip and Groin Outcome Score: HAGOS) at baseline and follow-up, hip-related injury incidence, and retirement over 5 years.

Results: Twelve dancers retired by follow-up, none due to hip injury or GJH. At baseline, 17 (42.5%) dancers were hypermobile, 18 (45%) had cartilage defects, and 15 (37.5%) reported hip pain (HAGOS pain <100). Cartilage defect prevalence was lower in GJH (n = 1) than non-GJH dancers (n = 17, P < 0.001). Beighton scores <5/9 were predictive of cartilage defect presence at baseline, independent of age and sex (P = 0.006). At follow-up, cartilage defects progressed in 2 dancers, one was hypermobile. Baseline and follow-up HAGOS pain scores were similar in GJH and non-GJH dancers (P > 0.05 for all). Hip-related injury over 5 years was reported by a similar number of GJH (n = 7) and non-GJH dancers (n = 6, P = 0.7). Hypermobility was more prevalent in active dancers (n = 12) than dancers who retired (n = 2), independent of age, rank, and sex (P = 0.03).

Conclusions: Hypermobile dancers are at no greater risk of reporting hip pain and injury or retirement over 5 years, and cartilage defect prevalence was much lower in GJH than non-GJH dancers.
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November 2021

Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players.

Am J Sports Med 2020 11 8;48(13):3306-3315. Epub 2020 Oct 8.

La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.

Background: Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited.

Purpose: To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI.

Study Design: Case-control study; Level of evidence, 3.

Methods: Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury.

Results: Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; = .001) and a history of ankle injury (AHR, 3.9; = .032). Older age (AHR, 1.1; = .013) and a history of CMSI (AHR, 6.7; = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence.

Conclusion: A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.
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http://dx.doi.org/10.1177/0363546520959327DOI Listing
November 2020

Landing biomechanics are not immediately altered by a single-dose patellar tendon isometric exercise protocol in male athletes with patellar tendinopathy: A single-blinded randomized cross-over trial.

Phys Ther Sport 2020 Nov 12;46:177-185. Epub 2020 Sep 12.

Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Objectives: To a) determine the acute effects of a single-dose patellar tendon isometric exercise protocol on involved limb landing biomechanics in individuals with patellar tendinopathy and asymptomatic patellar tendon pathology, and b) determine if individuals with patellar tendinopathy demonstrated changes in pain following a single-dose patellar tendon isometric exercise protocol.

Design: Single-blinded randomized cross-over trial.

Setting: Laboratory; PARTICIPANTS: 28 young male athletes with symptomatic (n = 13, age: 19.62 ± 1.61) and asymptomatic (n = 15, age: 21.13 ± 1.88) patellar tendinopathy.

Main Outcome Measures: Participants completed a single-dose patellar tendon isometric exercise protocol and a sham-TENS protocol, randomized and separated by 7-10 days. Pain-levels during a single-limb decline squat (SLDS) and three-dimensional biomechanics were collected during a double-limb jump-landing task before and after each intervention protocol. A mixed-model repeated measures ANOVA was conducted to compare change scores for all dependent variables.

Results: There were no group × intervention interactions for change in pain (F = 0.555, p = 0.463). There was one significant group × intervention interaction for vertical ground reaction force (VGRF) (F = 5.33, p = 0.029). However, post-hoc testing with Bonferroni correction demonstrated no statistical significance for group (SYM: t = -1.679, p = 0.119; ASYM: t = -1.7, p = 0.107) or intervention condition (isometric: t = -2.58, p = 0.016; sham-TENS: 0.72, p = 0.460). There were no further significant group × intervention interactions (p > 0.05).

Conclusions: A single-dose patellar tendon isometric exercise protocol did not have acute effects on landing biomechanics or pain levels in male athletes with patellar tendinopathy or asymptomatic patellar tendon pathology.
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http://dx.doi.org/10.1016/j.ptsp.2020.09.003DOI Listing
November 2020

Letters to the Editor.

Clin J Sport Med 2020 07;30(4):e118-e119

Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia.

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http://dx.doi.org/10.1097/JSM.0000000000000656DOI Listing
July 2020

Hip Joint Effusion-Synovitis Is Associated With Hip Pain and Sports/Recreation Function in Female Professional Ballet Dancers.

Clin J Sport Med 2020 07;30(4):341-347

School of Allied Health, La Trobe University, Bundoora, Victoria, Australia.

Objective: To compare hip joint effusion-synovitis prevalence in professional ballet dancers with nondancing athletes and to evaluate the relationship between effusion-synovitis and clinical measures and cartilage defects.

Design: Case-control study.

Setting: Elite ballet and sport.

Participants: Forty-nine professional ballet dancers and 49 age-matched and sex-matched athletes.

Independent Variables: Group (dancers/athletes), sex, age, years of training, Copenhagen Hip and Groin Outcome Scores (HAGOSs), hip rotation range of motion (ROM), generalized joint hypermobility (GJH), and hip cartilage defect scores.

Main Outcome Measures: Hip joint effusion-synovitis (absent, grade 1 = 2-4 mm, grade 2 = >4 mm) scored with 3-Tesla magnetic resonance imaging.

Results: Hip joint effusion-synovitis was found in 22 (45%) dancers and 13 (26.5%) athletes (P = 0.06). Grade 2 effusion-synovitis was only found in dancers (n = 8, r = 0.31, P = 0.009). The prevalence of effusion-synovitis was similar in men (n = 11, 26%) and women (n = 24, 43%, P = 0.09). Female dancers with effusion-synovitis had lower HAGOS pain (r = 0.63, P = 0.001) and sports/recreation scores (r = 0.66, P = 0.001) compared with those without effusion-synovitis. The HAGOS scores were not related to effusion-synovitis in male dancers or female and male athletes (P > 0.01 for all). Effusion-synovitis was not related to hip ROM, GJH, or cartilage defect scores (P > 0.05 for all).

Conclusions: Hip joint effusion-synovitis was related to higher levels of pain and lower sports/recreation function in female ballet dancers. Effusion-synovitis was not related to hip rotation ROM, GJH or cartilage defects. Larger sized joint effusion-synovitis was exclusively found in dancers.
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http://dx.doi.org/10.1097/JSM.0000000000000595DOI Listing
July 2020

Influence of genetic factors in elbow tendon pathology: a case-control study.

Sci Rep 2020 04 16;10(1):6503. Epub 2020 Apr 16.

Center for Translational Research in Physiotherapy. Physiotherapy area. Miguel Hernandez University, Elche, Spain.

Elbow tendinopathy is a common pathology of the upper extremity that impacts both athletes and workers. Some research has examined the genetic component as a risk factor for tendinopathy, mainly in the lower limbs. A case-control study was designed to test for a relationship between certain collagen gene single nucleotide polymorphisms (SNPs) and elbow tendon pathology. A sample of 137 young adult athletes whose sports participation involves loading of the upper limb were examined for the presence of structural abnormalities indicative of pathology in the tendons of the lateral and medial elbow using ultrasound imaging and genotyped for the following SNPs: COL5A1 rs12722, COL11A1 rs3753841, COL11A1 rs1676486, and COL11A2 rs1799907. Anthropometric measurements and data on participants' elbow pain and dysfunction were collected using the Disabilities of the Arm, Shoulder and Hand and the Mayo Clinic Performance Index for the Elbow questionnaires. Results showed that participants in the structural abnormality group had significantly higher scores in pain and dysfunction. A significant relationship between COL11A1 rs3753841 genotype and elbow tendon pathology was found (p = 0.024), with the CT variant associated with increased risk of pathology.
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http://dx.doi.org/10.1038/s41598-020-63030-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162873PMC
April 2020

Self-reported jumpers' knee is common in elite basketball athletes - But is it all patellar tendinopathy?

Phys Ther Sport 2020 May 23;43:58-64. Epub 2020 Jan 23.

La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Australia. Electronic address:

Objectives: To describe the prevalence and pain location of self-reported patellar tendinopathy and patellar tendon abnormality in a male elite basketball population.

Design: Cross-sectional.

Setting: Pre-season tournament.

Participants: Sixty male athletes from the Australian National Basketball League.

Main Outcome Measures: Self-reported patellar tendinopathy (PT) using the Oslo Sports Trauma Research Centre Overuse Questionnaire (OSTRC). Pain location using pain mapping (dichotomised: focal/diffuse) and severity during the single leg decline squat. Ultrasound tissue characterisation scans of both patellar tendons.

Results: Thirteen participants (22.7%) self-reported PT. Only 3 who reported PT had localised inferior pole pain. Thirty athletes reported pain during the decline squat, 15 described focal pain; 10 diffuse pain (5 missing data). Those with diffuse pain had greater years played [Md = 21 (13-24), n = 10 than focal pain (Md = 12 (7-26), n = 15), p = 0.042, r = 0.3]. Bilateral tendon abnormality was found in 45% of athletes and 15% had unilateral tendon abnormality.

Conclusion: Elite male basketball athletes self-reporting PT had heterogeneity in pain location. When focal pain with loading was used as a primary definition of PT, 'jumpers' knee' was not common in this cohort. This study found that abnormality of the patellar tendon was common and did not correlate with symptoms.
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http://dx.doi.org/10.1016/j.ptsp.2020.01.012DOI Listing
May 2020

Hip Joint Cartilage Defects in Professional Ballet Dancers: A 5-year Longitudinal Study.

Clin J Sport Med 2021 11;31(6):e335-e341

School of Allied Health, La Trobe University, Bundoora, Victoria, Australia; and.

Objective: A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years.

Design: Longitudinal.

Setting: Professional ballet company.

Participants: Twenty-one professional ballet dancers (52% men).

Independent Variables: Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS-pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI).

Main Outcome Measure: Change in cartilage defect score on MRI between baseline and 5-year follow-up.

Results: Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores <100 at follow-up. There were no time-loss hip injuries over 5 years. Two (33%) dancers with cartilage defects recorded hip-related pain (one reported minor training modification). Femoral neck-shaft angles (NSAs) were lower in men with cartilage defects [129.3 degrees (3.4 degrees)] compared with those without cartilage defects [138.4 degrees (4.5 degrees); P = 0.004].

Conclusions: Elite level ballet did not negatively affect cartilage health over 5 years. Cartilage defects were related to low femoral NSAs. Most cartilage defects did not progress and there was minimal impact on dance participation and pain levels. Longer follow-up is required to determine the long-term sequelae for those with cartilage defects.

Level Of Evidence: 1b.
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http://dx.doi.org/10.1097/JSM.0000000000000818DOI Listing
November 2021

Landing Biomechanics, But Not Physical Activity, Differ in Young Male Athletes With and Without Patellar Tendinopathy.

J Orthop Sports Phys Ther 2020 Mar 6;50(3):158-166. Epub 2020 Jan 6.

Objective: To examine differences in biomechanical and physical activity load in young male athletes with and without patellar tendinopathy.

Design: Cross-sectional cohort study.

Methods: Forty-one young male athletes (15-28 years of age) were categorized into 3 distinct groups: symptomatic athletes with patellar tendon abnormalities (PTA) (n = 13), asymptomatic athletes with PTA (n = 14), and a control group of asymptomatic athletes without PTA (n = 14). Participants underwent a laboratory biomechanical jump-landing assessment and wore an accelerometer for 1 week of physical activity monitoring.

Results: The symptomatic group demonstrated significantly less patellar tendon force loading impulse in the involved limb compared with both the control and asymptomatic groups (<.05), with large effects ( = 0.91-1.40). There were no differences in physical activity between the 3 groups (>.05).

Conclusion: Young male athletes with symptomatic patellar tendinopathy demonstrated smaller magnitudes of patellar tendon force loading impulse during landing compared to both asymptomatic athletes with patellar tendinopathy and healthy control participants. However, these 3 distinct groups did not differ in general measures of physical activity. Future investigations should examine whether comprehensively monitoring various loading metrics may be valuable to avoid both underloading and overloading patterns in athletes with patellar tendinopathy. .
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http://dx.doi.org/10.2519/jospt.2020.9065DOI Listing
March 2020

High-energy dose of therapeutic ultrasound in the treatment of patellar tendinopathy: protocol of a randomized placebo-controlled clinical trial.

BMC Musculoskelet Disord 2019 Dec 27;20(1):624. Epub 2019 Dec 27.

Physical Agents and Rehabilitation Research Group GPRAE, Universidade Federal de São Paulo - UNIFESP, campus Baixada Santista, Santos, SP, 11015-029, Brazil.

Background: Patellar tendinopathy is an extremely debilitating condition and its treatment usually requires a combination of clinical approaches. Therapeutic ultrasound (TUS) is one of the most available electrophysical agent in rehabilitation settings; however, there is also a lack of high-quality studies that test different dosimetric aspects of TUS. Thus, the purpose of this study is to evaluate the short-, medium-, and long-term effects of the combination of high-energy TUS with a rehabilitation program for patellar tendinopathy.

Methods: This will be a randomized, placebo-controlled trial with blinding of patients, assessors, and therapist. The setting is an outpatient physical therapy clinic. We will recruit 66 participants (male and female) aged between 18 and 40 years and presenting with patellar tendinopathy. A treatment combining high-energy dose TUS and a rehabilitation program for patellar tendinopathy will be delivered twice a week for 8 weeks. The control group will receive the same treatment, but with a placebo TUS. The effectiveness of the intervention will be measured at the beginning (baseline), midpoint (4 weeks), and end of treatment (8 weeks), as well as at 3- and 6-months post-treatment. Primary outcomes will be pain intensity (visual analogue scale, VAS), and VISA-P questionnaire and primary time points will be baseline (T0) and the end of the program (T2). Also, IPAQ-short form questionnaire, muscle strength (manual dynamometry), 2D kinematics, pain pressure threshold (PPT) algometry, thermography, and magnetic resonance imaging (MRI) will be collected.

Discussion: TUS will be applied in an attempt to enhance the results obtained with the rehabilitation program proposed in this study, as well as stimulate some repair responses in individuals undergoing treatment for patellar tendinopathy, which in turn may optimize and improve treatment programs for patellar tendinopathy as well as to establish new guidelines for the application of TUS.

Trial Registration: This study was prospectively registered at April-3rd-2018 and updated at September-1st-2019 in the Brazilian Registry of Clinical Trials (REBEC) under the registration number: RBR-658n6w.
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http://dx.doi.org/10.1186/s12891-019-2993-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6933732PMC
December 2019

Muscle Size and Quality of the Gluteal Muscles and Tensor Fasciae Latae in Women with Greater Trochanteric Pain Syndrome.

Clin Anat 2020 Oct 24;33(7):1082-1090. Epub 2019 Nov 24.

La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, Australia.

Greater trochanteric pain syndrome (GTPS) is prevalent in women and severely impacts quality of life. A key muscle group demonstrating reduced strength are the hip abductors. An understanding of specific muscles affected will help guide targeted rehabilitation. Objectives of this case-control study were to compare gluteal and tensor fasciae latae (TFL) muscle size and quality (fatty infiltration) in women with symptomatic GTPS to asymptomatic age-matched female controls. Magnetic resonance imaging of 16 women with GTPS (mean age 55.75 years, range 23-69) and 15 asymptomatic controls (mean age 55.60 years, range 31-66) was undertaken. Muscle volumes of the gluteus maximus, gluteus medius, gluteus minimus, and TFL were calculated. Fatty infiltration was rated using the Goutallier classification system for all muscles in their entirety, as well as anterior and posterior segments of gluteus medius and minimus. Muscle volumes and fatty infiltration were compared between groups. Significantly smaller muscle volumes were identified in the symptomatic group for the upper (P = 0.01) and lower (P = 0.04) portions of gluteus maximus, gluteus medius (P = 0.03), and gluteus minimus (P = 0.02). There was no difference in TFL (P = 0.18). Symptomatic participants displayed significantly greater fatty infiltration in gluteus maximus upper (P = 0.021) and lower (P = 0.049) when adjusted for BMI, and gluteus minimus (P = 0.018), particularly in the posterior portion (P = 0.04). Anterior gluteus minimus demonstrated high amounts of fatty infiltration in both groups. Gluteal muscle atrophy and fatty infiltration in women with GTPS suggests gluteus maximus and minimus may be an important target for rehabilitation. Clin. Anat., 33:1082-1090, 2020. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.23510DOI Listing
October 2020

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.

Br J Sports Med 2020 Apr 4;54(8):444-451. Epub 2019 Nov 4.

Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

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 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 ' 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 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).
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http://dx.doi.org/10.1136/bjsports-2019-100894DOI Listing
April 2020
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