The pathology of tendinopathy has been described as degenerative or failed healing. Neither of these descriptions fully explains the heterogeneity of presentation. This review proposes, and provides evidence for, a continuum of pathology. This model of pathology allows rational placement of treatments along the continuum.
A new model of tendinopathy and thoughtful treatment implementation may improve outcomes for those with tendinopathy. This model is presented for evaluation by clinicians and researchers.
]]>The combined positioning of the trunk and knee in the coronal and sagittal planes during non-contact anterior cruciate ligament (ACL) injury has not been previously reported.
During ACL injury female athletes demonstrate greater lateral trunk and knee abduction angles than ACL-injured male athletes and uninjured female athletes.
Cross-section control-cohort design.
Analyses of still captures from 23 coronal (10 female and 7 male ACL-injured players and 6 female controls) or 28 sagittal plane videos performing similar landing and cutting tasks. Significance was set at p<=0.05.
Lateral trunk and knee abduction angles were higher in female compared to male athletes during ACL injury (p<=0.05) and trended toward being greater than female controls (p = 0.16, 0.13, respectively). Female ACL-injured athletes showed less forward trunk lean than female controls (mean (SD) initial contact (IC): 1.6 (9.3)° vs 14.0 (7.3)°, p<=0.01).
Female athletes landed with greater lateral trunk motion and knee abduction during ACL injury than did male athletes or control females during similar landing and cutting tasks.
Lateral trunk and knee abduction motion are important components of the ACL injury mechanism in female athletes as observed from video evidence of ACL injury.
The purpose of this study was to identify changes in clinical outcome and lower extremity biomechanics during walking and hopping in ACL-injured subjects before and after a 20-session neuromuscular and strength training programme.
Pre and post experimental design.
Outpatient clinic, primary care.
32 subjects with unilateral ACL injury, mean 60 (SD 35) days after injury, with a mean age of 26.2 (5.4) years.
The rehabilitation programme consisted of neuromuscular and strength exercises.
Outcome measurements assessed before and after a 20-session rehabilitation programme were: self-assessment questionnaires (KOS-ADL, IKDC2000, Global function), four single-leg hop tests, and isokinetic muscle strength tests. Lower extremity kinematics and kinetics were captured during the stance phase of gait and landing after a single leg hop, synchronised with three force plates.
These ACL-injured individuals significantly improved their clinical outcome after rehabilitation. Gait analysis disclosed a significantly improved knee extension moment after rehabilitation, but no change in hip or knee excursions. During landing after hop no change in knee excursion or knee moment was recorded.
After rehabilitation the ACL-injured subjects showed a significantly improved clinical outcome, but lower extremity biomechanics were still significantly impaired during both walking and hopping. The rehabilitation programme influenced knee joint loading during walking, but not during hopping. Longer rehabilitation should be considered before ACL-injured individuals return to jumping activities.
To determine if a heart rate-based protocol for bronchial provocation testing ensures sufficient exercise intensity for inducing exercise-induced bronchial obstruction.
100 clinically healthy non-asthmatic sports students.
Subjects underwent an exercise challenge test (ECT) on a treadmill ergometer for bronchial provocation according to the guidelines of the American Thoracic Society (ATS). Heart rate (HR), forced expiratory volume in 1 second (FEV1), pH (pH) and lactate concentration were measured before and after exercise.
After exercise in 56% of the examined subjects lactate concentrations were <6 mmol/l. A highly significant decrease in FEV1 (mean –4.41 (SD 1.5%)) was found at concentrations of >6 mmol/l, whereas at concentrations <6.48 mmol/l, no participant showed an impairment of lung function (FEV1 values <=90%). In five subjects, a bronchial obstruction was found, as shown by decreases in FEV1 of –10 to –47% after exercise. The lactate concentrations in these individuals were between 6.48 and 11.7 mmol/l, indicating a predominantly anaerobic metabolic response to exercise.
These results show that the ATS standard protocol, using a heart rate formula for assessing the exercise intensity, is not sufficient to cause predominantly anaerobic lactate metabolism and hence exercise-induced hyperventilation. Therefore, a potential bronchial obstruction could not be induced in 56% of the subjects. For a sensitive study design, exercise intensities demanding anaerobic lactate metabolism should always be ensured. A more precise protocol is required.
To find the individual intensity for aerobic endurance training, the lactate minimum test (LMT) seems to be a promising method. LMTs described in the literature consist of speed or work rate-based protocols, but for training prescription in daily practice mostly heart rate is used. The aim of the present study was to investigate the reproducibility of a new heart rate-based LMT protocol.
20 subjects each underwent four LMTs on a cycle ergometer. The LMT consisted of a first part (Conconi test) to induce lactate accumulation and a second part (incremental protocol) with stages of 5 min starting beyond the aerobic threshold. During these stages work rate was adjusted to reach predetermined heart rates, which were calculated for every single test from heart rate (HR) at rest and maximum HR. Lactate was measured after each stage to define the lactate minimum (LM) and the corresponding HR.
Institute of Sports Medicine.
20 healthy and endurance-trained individuals (13 men, seven women).
Reproducibility of heart rate at LM.
The reproducibility of heart rate at LM was high (coefficient of variation (CV) = 2.1%). The reproducibility of work rate at LM was good (CV = 6.7%). CV for lactate concentrations at LM was 17.4%. High interindividual differences at LM were found in heart rate (range 149–178 beats/min) and lactate levels (range 1.2–6.8 mmol/l).
The LMT using a heart rate-based protocol is a reproducible method of assessing HR at an exercise intensity where an equilibrium exists between blood lactate accumulation and elimination.
To investigate the influence of anthropometric parameters on race performance in ultra-endurance triathletes.
Descriptive field study.
The Triple Iron Triathlon Germany 2006 in Lensahn over 11.6 km swimming, 540 km cycling and 126.6 km running.
17 male Caucasian triathletes (mean (SD) 39.2 (7.5) years, 80.7 (8.9) kg, 178 (5) cm, BMI 25.4 (2.4) kg/m2).
None.
Determination of body mass, body height, skin fold thicknesses, circumferences of extremities, as well as calculation of body mass index (BMI), skeletal muscle mass (SM), per cent SM (%SM) and per cent body fat (%BF) in order to correlate measured and calculated anthropometric parameters with race performance.
Body mass, body height, skin fold thicknesses, circumferences of extremities, BMI, %SM and %BF had no effect (p>0.05) on race performance. No significant correlation (p>0.05) was observed between total race time and any of the directly measured and calculated anthropometric properties. A significant correlation (p<0.05) was observed between total race time and both running time (r2 = 0.87) and cycling time (r2 = 0.62). In contrast, no significant correlation (p>0.05) was shown between swimming time and total race time.
There is no significant association between anthropometric parameters and race performance in ultra-endurance triathletes. Running performance rather than cycling performance seems to be the most important factor in order to be successful in a Triple Iron Triathlon. Swimming performance seems to be of low importance.
To assess physical activity (PA) levels measured objectively using accelerometers in community-dwelling older people and to examine the associations with health, disability, anthropometric measures and psychosocial factors.
Cross-sectional survey.
Single general practice (primary care centre), United Kingdom.
Random selection of 560 community-dwelling older people at least 65 years old, registered with the practice. 43% (238/560) participated.
Participants completed a questionnaire assessing health, disability, psychosocial factors and PA levels; underwent anthropometric assessment; and wore an accelerometer (Actigraph) for 7 days.
Average daily accelerometer step-counts and time spent in different PA levels. Associations between step-counts and other factors were examined using linear regression.
Average daily step-count was 6443 (95% CI 6032 to 6853). Men achieved 754 (84 to 1424) more steps daily than women. Step-count declined steadily with age. Independent predictors of average daily step-count were: age; general health; disability; diabetes; body mass index; exercise self-efficacy; and perceived exercise control. Activities associated independently with higher step-counts included number of long walks and dog-walking. Only 2.5% (6/238) of participants achieved the recommended 150 minutes weekly of at least moderate-intensity activity in >=10 minute bouts; 62% (147/238) achieved none.
This is the first population-based sample of older people with objective PA and anthropometric measures. PA levels in older people are well below recommended levels, emphasising the need to increase PA in this age group, particularly in those who are overweight/obese or have diabetes. The independent effects of exercise self-efficacy and exercise control on PA levels highlight their role as potential mediators for intervention studies.
The paper proposes a novel educational system based on patho-anatomic concepts. Anatomical reference points were selected to form a diagnostic triangle, which provides the discriminative power to restrict the differential diagnosis, and form the basis of ensuing investigation.
This paper forms part of a series addressing the three dimensional nature of proximal lower limb pathology. The 3G approach (groin, gluteal and greater trochanter triangles) acknowledges this, permitting the clinician to move throughout the region, considering pathologies appropriately. These papers should be read in conjunction with one another in order to fully understand the conceptual approach.
]]>