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ObjectiveTo assess the effectiveness of low tendon compression rehabilitation (LTCR) versus high tendon compression rehabilitation (HTCR) for treating patients with insertional Achilles tendinopathy.MethodsIn an investigator-blinded, stratified randomised trial, 42 sport-active patients (30 males and 12 females; age 45.8±8.2 years) with chronic (> 3 months) insertional Achilles tendinopathy were allocated in a 1:1 ratio to receive LTCR or HTCR. Both rehabilitation protocols consisted of a progressive 4-stage tendon-loading programme, including isometric, isotonic, energy-storage and release and sport-specific exercises. The LTCR programme was designed to control Achilles tendon compression by limiting ankle dorsiflexion during exercise, eliminating calf stretching and incorporating heel lifts. The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 12 and 24 weeks, which measures tendon pain and function and was analysed on an intention-to-treat basis using a linear mixed model. Significance was accepted when p<0.05.Results20 patients were randomised to the LTCR group and 22 to the HTCR group. Improvement in VISA-A score was significantly greater for LTCR compared with HTCR after 12 weeks (LTCR=24.4; HTCR=12.2; mean between-group difference=12.9 (95% CI: 6.2 to 19.6); p<0.001) and after 24 weeks (LTCR=29.0; HTCR=19.3; mean between-group difference=10.4 (95% CI: 3.7 to 17.1); p<0.001). These differences exceeded the minimal clinically important difference of 10.ConclusionsIn sport-active patients with insertional Achilles tendinopathy, LTCR was more effective than HTCR in improving tendon pain and function at 12 and 24 weeks. Consequently, LTCR should be considered in the treatment of insertional Achilles tendinopathy.Trial registration numberClinicalTrials.gov (ID: NCT05456620).

RCT. Lateral elbow tendinopathy is a common clinical condition. eccentric exercises. eccentric-concentric loading and, isometric exercises are indicated to reduce and manage tendon pain. To compare the effectiveness of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. A randomized clinical trial was carried out in a rheumatology and rehabilitation center. A group of 34 patients with later elbow tendinopathy was randomly allocated to Group A (n = 11) who underwent eccentric training, Group B had eccentric-concentric and Group C who had eccentric-concentric and isometric training. All patients received 5 treatments per week for 4 weeks. Pain was evaluated using a visual analog scale and function using a visual analog scale and pain-free grip strength at the end of the 4-week course of treatment (week 4) and 1 month (week 8) after the end of treatment. The eccentric-concentric training combined with isomentric contractions produced the largest effect in the reduction of pain and improvement of function at the end of the treatment (P < .05) and at any of the follow-up time points (P < .05). The eccentric-concentric training combined with isomentric contractions was the most effective treatment. Future well-designed studies are needed to confirm the results of the present trial. III.

To evaluate the effectiveness of adding Dynamic Tape® to a progressive load exercise program in patients with patellar tendinopathy. Randomized controlled trial. University research. Forty-eight subjects with patellar tendinopathy. Participants were divided into two groups: dynamic group, which received progressive load exercises and Dynamic Tape®, and sham group, which received progressive load exercises and sham taping. The intervention was conducted three times per week over 12 weeks. The pain during decline squatting was assessed using a visual analog scale. The severity of patellar tendinopathy was measured using the Victorian Institute of Sport Assessment-Patella (VISA-P). There was no effect of group-time interaction for the pain (Z = 0.844, p = 0.472) or severity (Z = 1.275, p = 0.286) of patellar tendinopathy. Reduced pain and severity were observed over time (p < 0.05), however there was no between-group differences (p > 0.05). Dynamic Tape® does not provide additional benefits when combined with a progressive load exercise program for reducing pain and severity in patellar tendinopathy. •Adding Dynamic Tape® had no effect on patellar tendinopathy severity or pain.•Progressive tendon-loading exercises improved pain and function in both groups.•Improvement over time was observed, regardless of Dynamic Tape® use.

To assess physiotherapist delivery fidelity and identify factors optimising delivery fidelity of an intervention based on recommended guidelines for Achilles tendinopathy. A prospective repeated-measures observational study of physiotherapist delivery fidelity with carefully defined exercise and physical activity advice. An inter-disciplinary clinic in Melbourne, Australia, embedded in a randomised controlled trial. Two physiotherapists delivering the intervention to five participants each, at three timepoints. All participants were expected to receive the same intervention. Feedback at timepoint one, guided boost-training to optimise delivery fidelity. Proportion of exercise and physical activity advice components delivered as intended (high ≥80%; moderate 51–79%; low≤50%), with relationships between variables analysed using chi-square tests. Physiotherapist delivery fidelity improved significantly between timepoint one and two (χ2 = 83.3, p < 0.001), then sustained at timepoint three. At timepoint one, seven (70%) of intervention components were delivered with high fidelity, one (10%) with moderate fidelity and two (20%) with low fidelity. At timepoint two, after boost-training, nine (90%) were delivered with high fidelity and one (10%) with moderate fidelity. At timepoint three, all intervention components (100%) were delivered with high fidelity by both physiotherapists. Physiotherapist delivery fidelity can be optimised with feedback, collaboration and boost-training. •Assessing physiotherapist delivery fidelity can provide opportunity for improving delivery of rehabilitation as intended.•Physiotherapist delivery fidelity can be optimised with feedback and boost-training.•Boost-training consisted of clarifications, cross-permeation, and collaboration.

It has been suggested that the reduction in subacromial space during arm elevation is one of the potential mechanisms in the etiology of Rotator cuff tendinopathy. While it is known that Kinesio taping reduces the narrowing of the acromiohumeral distance (AHD) during arm elevation, the effect of Dynamic taping remains unknown. This study aimed to compare the immediate effects of Kinesio taping and Dynamic taping on AHD in individuals with symptomatic Rotator Cuff Tendinopathy. Two group pre-post-test repeated measures design was used. Thirty-two participants were randomly assigned to two groups: Kinesio taping group (n = 16) and Dynamic taping group (n = 16). AHD measurements were taken via ultrasound at 0° (rest) and 60° shoulder abduction both before and immediately after taping. Repeated measures ANOVAs were used for statistical analyses. The study demonstrated that both taping methods led to a significant increase in AHD at both neutral and 60° abduction. However, the increase in AHD with Dynamic taping was statistically greater than with Kinesio taping in both neutral (p < 0.05) and 60° abduction (p < 0.001). The findings of this study suggest that Dynamic taping techniques may be a more effective approach for improving AHD for symptomatic patients. Therefore, Dynamic taping has the potential to be clinically beneficial before engaging in exercises. •Kinesio taping led to an immediate increase in acromiohumeral distance (AHD) in both the neutral position and at 60° of shoulder abduction.•Dynamic taping also resulted in an immediate increase in AHD in both the neutral position and at 60° of shoulder abduction.•Dynamic taping, especially when employing the \"upper limb offload\" technique, exhibited a greater immediate increase in AHD compared to Kinesio taping.

IntroductionPatellar tendinopathy (PT) rehabilitation programmes frequently incorporate eccentric exercise (EE), where participants have limited control over the range of motion, speed, force production and load. Newly developed training protocols that employ visual feedback with specialised devices offer controlled management of loads, speeds and forces across the full range of motion, potentially providing greater benefits.ObjectiveThis protocol outlines a randomised controlled trial designed to compare the effects of a visuomotor torque feedback (TF) protocol with a traditional EE protocol on the rehabilitation of PT over a 6-week period. Our primary objective is to evaluate whether the TF protocol reduces pain and disability more effectively than the EE protocol in individuals with PT. Secondary objectives include analysing structural and architectural changes in the patellar tendon and quadriceps femoris muscles, as well as examining motor unit discharge dynamics in response to EE and TF training. Lastly, we aim to compare these dynamics and structural changes between healthy controls and individuals with PT.MethodsThirty two individuals with PT and twenty six healthy controls will be recruited. The PT group will be subdivided into an EE group, and a TF group, with both groups undergoing a 6-week training programme. The EE group will perform their exercises two times per day, while the TF group will do so 2–3 times a week. In individuals with PT, the primary outcomes will be the Victorian Institute of Sport-Patella (VISA-P) questionnaire to measure disability/physical function, and pain with a Numerical Rating Scale (NRS). To gain insights on mechanisms of action for potential improvements, motor unit discharge characteristics of the quadriceps femoris muscles will be assessed with high-density surface electromyography. Additionally, we will measure structural/architectural changes to the patellar tendon and quadriceps femoris muscles using B-mode ultrasonography and shear-wave elastography.Ethics and disseminationThis study was approved by the Science, Technology, Engineering and Mathematics Ethical Review Committee from the University of Birmingham (ERN_2257-Jun2024). The results of this study will be disseminated in peer-reviewed journals and at international conferences.Trial registration numberISRCTN15821610.

Qualitative study. Adherence is paramount to the successful outcome of exercise-based treatment. The barriers and enablers to adherence to a home- and class-based exercise program were explored in this qualitative study. Semi-structured interviews were carried out to establish common themes relating to the participants' experiences during a year-long randomized controlled trial. Twelve participants were interviewed. The main enablers to exercise were highlighted as equipment, perceived benefit from the exercises, and longer and more intensive monitoring. Barriers included the lack of motivation, lack of equipment, and pain. Implications for practice are incorporating enablers and addressing barriers including self-discharge from classes; the importance of longer term follow-up and the benefits of adopting exercise into a well-established routine may provide potential benefits. N/A.

Background Midportion Achilles tendinopathy (AT) is a common overuse injury, usually requiring several months of rehabilitation. Exercise therapy of the ankle plantar flexors (i.e. tendon loading) is considered crucial during conservative rehabilitation. Alfredson’s isolated eccentric and Silbernagel’s combined concentric-eccentric exercise programs have both shown beneficial results, but it is unknown whether any of these programs is superior for use in clinical practice. Therefore, the primary objective of this study is to compare the effectiveness of both programs on clinical symptoms. Secondary objectives are to compare the effectiveness of both programs on quality of life and functional outcome measures, to investigate the prognostic value of baseline characteristics, to investigate differences in cost-effectiveness. Methods/Design Eighty-six recreational athletes (21–60 years of age) with unilateral chronic midportion AT (i.e. ≥ 3 months) will be included in this multicenter assessor blinded randomized controlled trial. They will be randomly allocated to either a group performing the Alfredson isolated eccentric training program ( n  = 43), or a group performing the Silbernagel combined concentric-eccentric program ( n  = 43). In the Alfredson group, participants will perform eccentric heel-drops on their injured side, twice daily for 12 weeks, whereas in the Silbernagel group, participants perform various concentric-eccentric heel-raise exercises, once daily for 12 weeks. Primary outcome measure will be the Victorian Institute of Sport Assessment – Achilles (VISA-A) questionnaire. Secondary outcomes will be a visual analogue scale (VAS) for pain during daily activities and sports, duration of morning stiffness, global perceived effect, the 12-item Short Form Health Survey and the Euroqol instrument, and functional performance measured with the heel-raise test and the countermovement jump. Additionally, alongside the RCT, a cost-effectiveness analysis will be performed. Assessments will be performed at baseline and after 12, 26, and 52 weeks. Discussion This study is the first to directly compare the Alfredson and the Silbernagel exercise program in a randomized trial. The results can further enlarge the evidence base for choosing the most appropriate exercise program for patients with midportion AT. Trial registration Dutch Trial register: NTR5638 . Date of registration: 7 January 2016.

Objective: To compare the efficacy and safety of two eccentric rehabilitation protocols for patients with symptomatic patellar tendinopathy. A new eccentric overload training device was compared with the present standard eccentric rehabilitation programme on a decline board. Design: Prospective, randomised clinical trial. Setting: Sports rehabilitation clinic, university sports laboratory, supplemented with home exercises. Patients: 20 competitive and recreational athletes, all with clinical diagnosis of patellar tendinopathy, verified by MRI or ultrasound imaging. Interventions: A 12-week rehabilitation period, either with bilateral eccentric overload strength training using the Bromsman device twice a week or with unilateral eccentric body load training using a decline board twice a week, supplemented with daily home exercises. Outcome measures: The primary outcome was pain and function, assessed by the Swedish Victorian Institute of Sport Assessment for Patella (VISA-P) score. Secondary outcome measures were isokinetic muscle torque, dynamic function and muscle flexibility, as well as pain level estimations using visual analogue scale (VAS). Side effects were registered. Results: Both treatment groups improved in the short term according to the VISA-P scores during the 12-week rehabilitation period. However, there were no significant differences between the groups in terms of pain and function. After a 3-month rehabilitation period, most patients could be regarded as improved enough to be able to return to training and sports. No serious side effects were detected in either group. Conclusion: In patients with patellar tendinopathy pain, two-legged eccentric overload training twice per week, using the new device (Bromsman), was as efficient and safe as the present standard daily eccentric one-legged rehabilitation-training regimen using a decline board.

Our purpose was to investigate the effect of creatine (Cr) supplementation on regeneration periods in tendon overuse injury rehabilitation of adolescent fin swimmers. The participants of this study were injured adolescent competitive fin swimmers (n = 18). The subjects were randomly assigned the creatine (CR) or placebo (PL) groups with a double-blind research design. The subjects were given Cr supplementation or received the placebo as part of the conservative treatment of the tendinopathy. We measured the segmental lean mass (SLM;kg), the ankle plantar flexion peak torque (PFT;N·m), the pain intensity (NRS;values), prior to immobilization, after immobilization (R2) and after the 2nd (R4) and 4th (R6) weeks of the rehabilitation period of the injured limb. The creatine kinase (CK; U/L) enzyme levels were measured before immobilization, and then every 24 hours for four days. There was a significant decrease in SLM (CR by 5.6% vs. PL by 8.9%; p < 0.03) after two weeks of immobilization in both groups (p < 0.001). After four weeks rehabilitation the SLM significantly increased in both groups (CR by 5.5% vs. PL by 3.8%; p < 0.01). The percent changes in PFT after supplementation in R4 (p < 0.001) and R6 (p < 0.03) were significantly different between groups. There was a significant percent increase measured in the CR group (R4 by 10.4%; p < 0.001; R6 by 16.8%; p < 0.001), whereas significant, but lower growth found in the PL group also took place (R4 by 7.1%; p < 0.001; R6 by 14.7%; p < 0.001) after four weeks of rehabilitation. Significantly faster decrease were found in NRS of CR versus PL group during treatment (p < 0.02). We detected significantly lower CK levels increase at the CR group compared to the PL group. The results of this study indicate that Cr supplementation combined with therapeutic strategy effectively supports the rehabilitation of tendon overuse injury of adolescent fin swimmers.