Tendons in Ten Minutes Hold onto your hats…… Dr. Richard Collins MSK Physician
Tendons in Ten Minutes
Hold onto your hats……
Dr. Richard CollinsMSK Physician
Why tendons?
Sobrino et al. Orthop J Sports Med 2015Overuse injuries in Professional Ballet
• Anterior Knee Pain (likely included PT) 16%
• Patellar Tendinopathy 10.5%• Achilles Tendinopathy 8% Ramkumar et al. J Dance Med Sci
2016Injuries in a Professional Ballet Dance Company
• Foot & Ankle 38%• Sprain 10%• Achilles Tendinopathy 3%
• Back related 20% (most costly)
‘Many American ballet companies have taken to retaining in-house medical and training staff that, in one company of 70 dancers, demonstrated a $1.2 million savings over a 5-year period while simultaneously decreasing the injury incidence from 94% to 75%’
Ramkumar et alLower limb tendon care is a core need in Dance
Medicine
History in 30 seconds!
18 years ago….
7 years ago….
Now…
Tendinopathy
Causes
TreatmentDetection
Causes Collagen health• Systemic health• Pubertal development
Disordered Loading
• Biomechanics• Periodisation
Causes Collagen health• Systemic health• Pubertal
developmentDisordered
Loading• Biomechanics• Periodisation
Pubertal factors on overuse injuries J Dance Med Sci
2015The questions are being asked
Where does Collagen come into this?
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in pubertyThe Australians are on to this!
Detection Symptom screening
• Too subjective• Late presentation
UTC – new US technology
• Objective data• Good interobserver reproducibility (once
trained)• Links to developing research base
Detection Symptom screening
• Too subjective• Late presentation
UTC – new US technology
• Objective data• Good interobserver reproducibility (once
trained)• Links to developing research base
UTC – Ultrasound Tissue Characterisation
Dr. Lorenzo Masci hard at work
UTC – Ultrasound Tissue Characterisation
UTC – Ultrasound Tissue Characterisation
Adapted from JL Cook, C PurdumBr J Sports Med 2008
UTC – Ultrasound Tissue Characterisation
L Masci, H AlfredsonBr J Sports Med 2014
Treatment Intelligent
Loading• better models• activity specificInvasive
adjuncts• Injections• Surgery
Treatment Intelligent
Loading• better models• activity specificInvasive
adjuncts• Injections• Surgery
Intelligent Loading
JL Cook, SI DockingBr J Sports Med August 2015
Thank you!