1 Muscle, tendon and bone injuries Håvard Moksnes, PT PhD Br J Sports Med 2009;43:247–251. http://bjsm.bmj.com/content/43/4/247 Podcast: http://bjsm.bmj.com/site/podcasts/ How does load stimulate the tendon? Mechanotransduction refers to the process by which the body converts mechanical loading into cellular responses. These cellular responses, in turn, promote structural change. A classic example of mechanotransduction in action is bone adapting to load. Khan & Scott; Br J Sports Med 2009;43:4 247-252 Cell communication in mechanotherapy Khan & Scott BJSM 2009;43(4):247-52.
34
Embed
Muscle, tendon and bone injuries · change. A classic example of mechanotransduction in action is bone adapting to load. ... tendon healing Maintain muscle activation Maintain physical
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
Muscle, tendon and
bone injuries
Håvard Moksnes, PT PhD
Br J Sports Med 2009;43:247–251.
http://bjsm.bmj.com/content/43/4/247
Podcast: http://bjsm.bmj.com/site/podcasts/
How does load stimulate the tendon?
Mechanotransduction refers to the process by which the
body converts mechanical loading into cellular
responses.
These cellular responses, in turn, promote structural
change.
A classic example of mechanotransduction in action is
Effect of Corticosteroid Injection, Physiotherapy,
or Both on Clinical Outcomes in Patients With
Unilateral Lateral Epicondylalgia A RCT
Conclusion and Relevance
Among patients with chronic unilateral lateral
epicondylalgia, the use of corticosteroid injection vs
placebo injection resulted in worse clinical outcomes
after 1 year, and physiotherapy did not result in any
significant differences
Coombes et al JAMA 2013
11
Take home messages RTP with
overuse injuries
✓ Assess and tweak total load
✓ Include the parents and coaches
✓ Removal from play may be necessary
✓ Agree on a structured progression plan
Hamstring injuries
- injury types and rehabilitation
Håvard Moksnes
Sports Physiotherapist
Hamstring muscle group
Semitendinosu
s
Semimembrano
sus
Biceps
Femoris
Biceps
Femoris –
short head
12
Hamstring injuries
Different types of injuries
High-speed running
Slow-speed stretching
High-speed stretching
Overuse (proximal)
Askling 2007,
Heiderschneit 2010
Two distinct acute injuries
van der
Made et al
2016
van der
Made et al
2016
13
Hamstring muscle group
Semitendinosu
s
Semimembrano
sus
Biceps
Femoris
Biceps
Femoris –
short head
van der Made et al
2016
van der
Made et al
2016
Muscle injuries in football
Hamstring 37%
Adductor 23%
Quadriceps 19%
Calf 13%
Ekstrand et al 2011
14
Le Meur
2016
Hamstring injuries
Rehabilitation exercises matter
✓ Lengthening exercises are more effective
than conventional exercises!
Br J Sports Med
2013;47:953-959
Gjennomsnittlig 23
dager å vinne ved
å velge riktige
rehabiliteringsøvel
ser;
28 dager vs 51
dager for retur til
full trening
Br J Sports Med
2013;47:953-959
15
Ivolvement of the
proximal tendon
significantly increases
time to return to
sport
Br J Sports Med
2013;47:953-959
Do not forget apophyseal avulsions !
Prediction RTS with MRI
Grade I
➢ Mean 18 days (±19)
➢ 70% = 0 -> 37 days
➢ 95% = 0 -> 56 days
Grade III
➢ Mean 24 days (±13)
➢ 70% = 11 -> 37 days
➢ 95% = 0 -> 50 days
16
Hamstring muscle group
Semitendinosu
s
Semimembrano
sus
Biceps
Femoris
Biceps
Femoris –
short head
Sprinting type injury
Long head of biceps femoris
Askling
2007
Sprinting type injury
Askling
2007
PMT
J
PT
Sprinting type injury
Long head of biceps femoris
Intramuscular tendon involvement
Yes = longer recovery time
Secondary problems
Biceps femoris short head
Askling
2007
17
The intramuscular tendon
Reurink
2016
Stretching type injury
Semimem
.
n.ischiadicu
s.
Quadratus
femoris.
Askling
2007
Hamstring muscle group
Semitendinosu
s
Semimembrano
sus
Biceps
Femoris
Biceps
Femoris –
short head
18
Proximal Hamstring Tendinopathy:
A Real Pain in The Butt For Runners!
Pain during high intensity running
Pain with prolonged sitting
Pain with increased stide length
Pain during uphill running
Must reduce running volume!
Le Meur
2016
Sport specific RTS
19
The Extender
Askling, BJSM 2013
The Diver
Askling, BJSM 2013
The Glider
Askling, BJSM 2013
Advanced lengthening exercise
20
Norges idrettsforbund og olympiske og paralympiske komité
Rehabilitering og testing etter akillesseneruptur
Side 81
The results of the present study demonstrate that
stable surgical repair with accelerated tendon
loading could be performed in all (n = 49) patients without reruptures and major soft tissue–related
complications.
Olsson et al AJSM 2013 Side 82 Olsson et al AJSM 2013
21
Side 83 Olsson et al AJSM 2013
TREATMENT PROTOCOL – ACHILLES
TENDON RUPTURE NON-SURGICALLY
TREATED
Week 0
✓ Treatment: Walker brace with 3 heel pads, weight-bearing through the heel as tolerated, use of 2 crutches. Referral to orthopedic technician for shoe heel-lift (use shoe with heel-lift on the healthy side).
✓ Walker brace: Allowed to take off the walker brace for washing and aerating the foot. When the walker brace is removed, no weight-bearing or dorsal extension of the foot is allowed. Wearing the walker brace while sleeping.
✓ Exercise program: home exercises daily wearing the walker brace – move the toes several times a day
After 2 weeks:
✓ Treatment: Walker brace with 2 heel pads (take off the upper pad), full weight-bearing, use of 2 crutches if needed.
✓ Exercise program: home exercises as described above.
After 4 weeks:
✓ Treatment: Walker brace with 1 heel pad, full weight-bearing
✓ Exercise program: home exercises daily as described above
After 6 weeks
✓ Treatment: Walker brace without heel pad, full weight-bearing
✓ Exercise program: home exercises daily as described above
After 8 weeks
✓ Visit orthopaedic surgeon
✓ Treatment: Wean off walker brace. Use of shoes with heel-lift (until 14 weeks after injury), compression stocking to prevent swelling.
✓ Exercise program: Important that all exercises are performed slowly and carefully
Side 84
The first 6-8 weeks
✓Biological healing
✓No stretching!
✓Controlled loading in plantar flexion to stimulatetendon healing