TY - JOUR
A1 - Risch, Lucie
A1 - Cassel, Michael
A1 - Mayer, Frank
T1 - Acute effect of running exercise on physiological Achilles tendon blood flow
JF - Scandinavian journal of medicine & science in sports
N2 - Sonographically detectable intratendinous blood flow (IBF) is found in 50%-88% of Achilles tendinopathy patients as well as in up to 35% of asymptomatic Achilles tendons (AT). Although IBF is frequently associated with tendon pathology, it may also represent a physiological regulation, for example, due to increased blood flow in response to exercise. Therefore, this study aimed to investigate the acute effects of a standardized running exercise protocol on IBF assessed with Doppler ultrasound (DU) Advanced dynamic flow in healthy ATs. 10 recreationally active adults (5 f, 5m; 29 +/- 3years, 1.72 +/- 0.12m, 68 +/- 16kg, physical activity 206 +/- 145minute/wk) with no history of AT pain and inconspicious tendon structure performed 3 treadmill running tasks on separate days (M1-3) with DU examinations directly before and 5, 30, 60, and 120minutes after exercise. At M1, an incremental exercise test was used to determine the individual anaerobic threshold (IAT). At M2 and M3, participants performed 30-minute submaximal constant load tests (CL1/CL2) with an intensity 5% below IAT. IBF in each tendon was quantified by counting the number of vessels. IBF increased in five ATs from no vessels at baseline to one to four vessels solely detectable 5minutes after CL1 or CL2. One AT had persisting IBF (three vessels) throughout all examinations. Fourteen ATs revealed no IBF at all. Prolonged running led to a physiological, temporary appearance of IBF in 25% of asymptomatic ATs. To avoid exercise-induced IBF in clinical practice, DU examinations should be performed after 30minutes of rest.
KW - advanced dynamic flow
KW - doppler ultrasound
KW - hyperemia
KW - neovascularization
KW - sonography
Y1 - 2017
U6 - https://doi.org/10.1111/sms.12874
SN - 0905-7188
SN - 1600-0838
VL - 28
IS - 1
SP - 138
EP - 143
PB - Wiley
CY - Hoboken
ER -
TY - JOUR
A1 - Risch, Lucie
A1 - Wochatz, Monique
A1 - Messerschmidt, Janin
A1 - Engel, Tilman
A1 - Mayer, Frank
A1 - Cassel, Michael
T1 - Reliability of evaluating achilles tendon vascularization assessed with doppler ultrasound advanced dynamic flow
JF - Journal of ultrasound in medicine
N2 - The reliability of quantifying intratendinous vascularization by high-sensitivity Doppler ultrasound advanced dynamic flow has not been examined yet. Therefore, this study aimed to investigate the intraobserver and interobserver reliability of evaluating Achilles tendon vascularization by advanced dynamic flow using established scoring systems. Methods-Three investigators evaluated vascularization in 67 recordings in a test-retest design, applying the Ohberg score, a modified Ohberg score, and a counting score. Intraobserver and interobserver agreement for the Ohberg score and modified Ohberg score was analyzed by the Cohen kappa and Fleiss kappa coefficients (absolute), Kendall tau b coefficient, and Kendall coefficient of concordance (W; relative). The reliability of the counting score was analyzed by intraclass correlation coefficients (ICC) 2.1 and 3.1, the standard error of measurement (SEM), and Bland-Altman analysis (bias and limits of agreement [LoA]). Results-Intraobserver and interobserver agreement (absolute/relative) ranged from 0.61 to 0.87/0.87 to 0.95 and 0.11 to 0.66/0.76 to 0.89 for the Ohberg score and from 0.81 to 0.87/0.92 to 0.95 and 0.64 to 0.80/0.88 to 0.93 for the modified Ohberg score, respectively. The counting score revealed an intraobserver ICC of 0.94 to 0.97 (SEM, 1.0-1.5; bias, -1; and LoA, 3-4 vessels). The interobserver ICC for the counting score ranged from 0.91 to 0.98 (SEM, 1.0-1.9; bias, 0; and LoA, 3-5 vessels). Conclusions-The modified Ohberg score and counting score showed excellent reliability and seem convenient for research and clinical practice. The Ohberg score revealed decent intraobserver but unexpected low interobserver reliability and therefore cannot be recommended.
KW - advanced dynamic flow
KW - intratendinous blood flow
KW - musculoskeletal
KW - reliability
KW - ultrasound
Y1 - 2017
U6 - https://doi.org/10.1002/jum.14414
SN - 0278-4297
SN - 1550-9613
VL - 37
IS - 3
SP - 737
EP - 744
PB - Wiley
CY - Hoboken
ER -
TY - GEN
A1 - Cassel, Michael
A1 - Intziegianni, Konstantina
A1 - Risch, Lucie
A1 - Müller, Steffen
A1 - Engel, Tilman
A1 - Mayer, Frank
T1 - Physiological Tendon Thickness Adaptation in Adolescent Elite Athletes
BT - A Longitudinal Study
N2 - Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 ± 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean ± SD) and statistical testing for group differences was performed (α = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 ± 0.7 mm/5.6 ± 0.7 mm) nor in controls (4.8 ± 0.4 mm/4.9 ± 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (M1: 3.5 ± 0.5 mm, M2: 3.8 ± 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p ≤ 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.
T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 355
KW - Achilles and patellar tendon
KW - non-athletes
KW - sonography
KW - training adaptation
KW - young athletes
Y1 - 2017
U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-403823
ER -
TY - JOUR
A1 - Cassel, Michael
A1 - Intziegianni, Konstantina
A1 - Risch, Lucie
A1 - Mueller, Steffen
A1 - Engel, Tilman
A1 - Mayer, Frank
T1 - Physiological Tendon Thickness Adaptation in Adolescent Elite Athletes: A Longitudinal Study
JF - Frontiers in physiology
N2 - Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 +/- 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean SD) and statistical testing for group differences was performed (cy = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 +/- 0.7 mm/5.6 +/- 0.7 mm) nor in controls (4.8 +/- 0.4 mm/4.9 +/- 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (Ml: 3.5 +/- 0.5 mm, M2: 3.8 +/- 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p <= 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.
KW - Achilles and patellar tendon
KW - training adaptation
KW - sonography
KW - young athletes
KW - non-athletes
Y1 - 2017
U6 - https://doi.org/10.3389/fphys.2017.00795
SN - 1664-042X
VL - 8
SP - 599
EP - 611
PB - Frontiers Research Foundation
CY - Lausanne
ER -
TY - GEN
A1 - Risch, Lucie
A1 - Mayer, Frank
A1 - Cassel, Michael
T1 - Doppler flow response following running exercise differs between healthy and tendinopathic Achilles tendons
T2 - Postprints der Universität Potsdam : Humanwissenschaftliche Reihe
N2 - Background: The relationship between exercise-induced intratendinous blood flow (IBF) and tendon pathology or training exposure is unclear.
Objective: This study investigates the acute effect of running exercise on sonographic detectable IBF in healthy and tendinopathic Achilles tendons (ATs) of runners and recreational participants.
Methods: 48 participants (43 ± 13 years, 176 ± 9 cm, 75 ± 11 kg) performed a standardized submaximal 30-min constant load treadmill run with Doppler ultrasound “Advanced dynamic flow” examinations before (Upre) and 5, 30, 60, and 120 min (U5-U120) afterward. Included were runners (>30 km/week) and recreational participants (<10 km/week) with healthy (Hrun, n = 10; Hrec, n = 15) or tendinopathic (Trun, n = 13; Trec, n = 10) ATs. IBF was assessed by counting number [n] of intratendinous vessels. IBF data are presented descriptively (%, median [minimum to maximum range] for baseline-IBF and IBF-difference post-exercise). Statistical differences for group and time point IBF and IBF changes were analyzed with Friedman and Kruskal-Wallis ANOVA (α = 0.05).
Results: At baseline, IBF was detected in 40% (3 [1–6]) of Hrun, in 53% (4 [1–5]) of Hrec, in 85% (3 [1–25]) of Trun, and 70% (10 [2–30]) of Trec. At U5 IBF responded to exercise in 30% (3 [−1–9]) of Hrun, in 53% (4 [−2–6]) of Hrec, in 70% (4 [−10–10]) of Trun, and in 80% (5 [1–10]) of Trec. While IBF in 80% of healthy responding ATs returned to baseline at U30, IBF remained elevated until U120 in 60% of tendinopathic ATs. Within groups, IBF changes from Upre-U120 were significant for Hrec (p < 0.01), Trun (p = 0.05), and Trec (p < 0.01). Between groups, IBF changes in consecutive examinations were not significantly different (p > 0.05) but IBF-level was significantly higher at all measurement time points in tendinopathic versus healthy ATs (p < 0.05).
Conclusion: Irrespective of training status and tendon pathology, running leads to an immediate increase of IBF in responding tendons. This increase occurs shortly in healthy and prolonged in tendinopathic ATs. Training exposure does not alter IBF occurrence, but IBF level is elevated in tendon pathology. While an immediate exercise-induced IBF increase is a physiological response, prolonged IBF is considered a pathological finding associated with Achilles tendinopathy.
T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 715
KW - neovascularization
KW - tendinopathy
KW - Doppler ultrasound
KW - Advanced Dynamic Flow
KW - athlete
KW - sonography
Y1 - 2021
U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-521367
SN - 1866-8364
ER -
TY - GEN
A1 - Risch, Lucie
A1 - Stoll, Josefine
A1 - Schomöller, Anne
A1 - Engel, Tilman
A1 - Mayer, Frank
A1 - Cassel, Michael
T1 - Intraindividual Doppler Flow Response to Exercise Differs Between Symptomatic and Asymptomatic Achilles Tendons
T2 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe
N2 - Objective: This study investigated intraindividual differences of intratendinous blood flow (IBF) in response to running exercise in participants with Achilles tendinopathy.
Design: This is a cross-sectional study.
Setting: The study was conducted at the University Outpatient Clinic.
Participants: Sonographic detectable intratendinous blood flow was examined in symptomatic and contralateral asymptomatic Achilles tendons of 19 participants (42 ± 13 years, 178 ± 10 cm, 76 ± 12 kg, VISA-A 75 ± 16) with clinically diagnosed unilateral Achilles tendinopathy and sonographic evident tendinosis.
Intervention: IBF was assessed using Doppler ultrasound “Advanced Dynamic Flow” before (Upre) and 5, 30, 60, and 120 min (U5–U120) after a standardized submaximal constant load run.
Main Outcome Measure: IBF was quantified by counting the number (n) of vessels in each tendon.
Results: At Upre, IBF was higher in symptomatic compared with asymptomatic tendons [mean 6.3 (95% CI: 2.8–9.9) and 1.7 (0.4–2.9), p < 0.01]. Overall, 63% of symptomatic and 47% of asymptomatic Achilles tendons responded to exercise, whereas 16 and 11% showed persisting IBF and 21 and 42% remained avascular throughout the investigation. At U5, IBF increased in both symptomatic and asymptomatic tendons [difference to baseline: 2.4 (0.3–4.5) and 0.9 (0.5–1.4), p = 0.05]. At U30 to U120, IBF was still increased in symptomatic but not in asymptomatic tendons [mean difference to baseline: 1.9 (0.8–2.9) and 0.1 (-0.9 to 1.2), p < 0.01].
Conclusion: Irrespective of pathology, 47–63% of Achilles tendons responded to exercise with an immediate acute physiological IBF increase by an average of one to two vessels (“responders”). A higher amount of baseline IBF (approximately five vessels) and a prolonged exercise-induced IBF response found in symptomatic ATs indicate a pain-associated altered intratendinous “neovascularization.”
T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 746
KW - achilles tendinopathy
KW - tendinosis
KW - neovascularization
KW - ultrasound
KW - advanced dynamic flow
KW - sonography
Y1 - 2022
U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-542865
SN - 1866-8364
SP - 1
EP - 8
PB - Universitätsverlag Potsdam
CY - Potsdam
ER -
TY - GEN
A1 - Engel, Tilman
A1 - Schraplau, Anne
A1 - Wochatz, Monique
A1 - Kopinski, Stephan
A1 - Sonnenburg, Dominik
A1 - Schomöller, Anne
A1 - Risch, Lucie
A1 - Kaplick, Hannes
A1 - Mayer, Frank
T1 - Feasability of An Eccentric Isokinetic Protocol to Induce Trunk Muscle Damage: A Pilot Study
T2 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe
N2 - Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 773
KW - exercise
KW - eccentric
KW - muscle fatigue
KW - trunk muscles
KW - isokinetics
KW - repeated bout effect
KW - inflammation
KW - exercise induced muscle damage
KW - interleukin-6
KW - internleukin-10
KW - tumor necrosis factor-α
Y1 - 2022
U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-557409
SN - 1866-8364
SP - E9
EP - E17
PB - Universitätsverlag Potsdam
CY - Potsdam
ER -
TY - CHAP
A1 - Risch, Lucie
A1 - Cassel, Michael
A1 - Messerschmidt, Janin
A1 - Intziegianni, Konstantina
A1 - Mayer, Frank
T1 - Consistency and reliability of examining intratendinous blood flow in Achilles tendinopathy patients using doppler ultrasonography
T2 - Medicine and science in sports and exercise : official journal of the American College of Sports Medicine
Y1 - 2014
SN - 0195-9131
SN - 1530-0315
VL - 46
IS - 5
SP - 46
EP - 46
PB - Lippincott Williams & Wilkins
CY - Philadelphia
ER -
TY - JOUR
A1 - Engel, Tilman
A1 - Schraplau, Anne
A1 - Wochatz, Monique
A1 - Kopinski, Stephan
A1 - Sonnenburg, Dominik
A1 - Schomöller, Anne
A1 - Risch, Lucie
A1 - Kaplick, Hannes
A1 - Mayer, Frank
T1 - Feasability of An Eccentric Isokinetic Protocol to Induce Trunk Muscle Damage: A Pilot Study
JF - Sports Medicine International Open
N2 - Eccentric exercise is discussed as a treatment option for clinical populations, but specific responses in terms of muscle damage and systemic inflammation after repeated loading of large muscle groups have not been conclusively characterized. Therefore, this study tested the feasibility of an isokinetic protocol for repeated maximum eccentric loading of the trunk muscles. Nine asymptomatic participants (5 f/4 m; 34±6 yrs; 175±13 cm; 76±17 kg) performed three isokinetic 2-minute all-out trunk strength tests (1x concentric (CON), 2x eccentric (ECC1, ECC2), 2 weeks apart; flexion/extension, 60°/s, ROM 55°). Outcomes were peak torque, torque decline, total work, and indicators of muscle damage and inflammation (over 168 h). Statistics were done using the Friedman test (Dunn’s post-test). For ECC1 and ECC2, peak torque and total work were increased and torque decline reduced compared to CON. Repeated ECC bouts yielded unaltered torque and work outcomes. Muscle damage markers were highest after ECC1 (soreness 48 h, creatine kinase 72 h; p<0.05). Their overall responses (area under the curve) were abolished post-ECC2 compared to post-ECC1 (p<0.05). Interleukin-6 was higher post-ECC1 than CON, and attenuated post-ECC2 (p>0.05). Interleukin-10 and tumor necrosis factor-α were not detectable. All markers showed high inter-individual variability. The protocol was feasible to induce muscle damage indicators after exercising a large muscle group, but the pilot results indicated only weak systemic inflammatory responses in asymptomatic adults.
KW - exercise
KW - eccentric
KW - muscle fatigue
KW - trunk muscles
KW - isokinetics
KW - repeated bout effect
KW - inflammation
KW - exercise induced muscle damage
KW - interleukin-6
KW - internleukin-10
KW - tumor necrosis factor-α
Y1 - 2021
U6 - https://doi.org/10.1055/a-1757-6724
SN - 2367-1890
VL - 6
SP - E9
EP - E17
PB - Thieme
CY - Stuttgart
ET - 1
ER -
TY - JOUR
A1 - Cassel, Michael
A1 - Risch, Lucie
A1 - Intziegianni, Konstantina
A1 - Mueller, Juliane
A1 - Stoll, Josefine
A1 - Brecht, Pia
A1 - Mayer, Frank
T1 - Incidence of achilles and patellar tendinopathy in adolescent elite athletes
JF - International journal of sports medicine
N2 - The study investigated the incidence of Achilles and patellar tendinopathy in adolescent elite athletes and non-athletic controls. Furthermore, predictive and associated factors for tendinopathy development were analyzed. The prospective study consisted of two measurement days (M1/M2) with an interval of 3.2 +/- 0.9 years. 157 athletes (12.1 +/- 0.7 years) and 25 controls (13.3 +/- 0.6 years) without Achilles/patellar tendinopathy were included at Ml. Clinical and ultrasound examinations of both Achilles (AT) and patellar tendons (PT) were performed. Main outcome measures were incidence tendinopathy and structural intratendinous alterations (hypo-/hyperechogenicity, vascularization) at M2 [%]. Incidence of Achilles tendinopathy was 1% in athletes and 0% in controls. Patellar tendinopathy was more frequent in athletes (13 %)than in controls (4%). Incidence of intratendinous alterations in ATs was 1-2% in athletes and 0 % in controls, whereas in PTs it was 4-6 % in both groups (p >0.05). Intratendinous alterations at M2 were associated with patellar tendinopathy in athletes (p <= 0.01). Intratendinous alterations at M1, anthropometric data, training amount, sports or sex did not predict tendinopathy development (p>0.05). Incidence often dinopathy and intratendinous alterations in adolescent athletes is low in ATs and more common in PTs. Development of intratendinous alterations in PT is associated with tend in opathy. However, predictive factors could not be identified.
KW - epidemiology
KW - young athletes
KW - sonography
KW - vascularization
KW - hypoechogenicities
Y1 - 2018
U6 - https://doi.org/10.1055/a-0633-9098
SN - 0172-4622
SN - 1439-3964
VL - 39
IS - 9
SP - 726
EP - 732
PB - Thieme
CY - Stuttgart
ER -
TY - GEN
A1 - Schraplau, Anne
A1 - Sonnenburg, Dominik
A1 - Wochatz, Monique
A1 - Engel, Tilman
A1 - Schomöller, Anne
A1 - Risch, Lucie
A1 - Kaplick, Hannes
A1 - Mayer, Frank
T1 - Characterization of muscle damage and inflammation following repeated maximal eccentric loading of the trunk
T2 - Medicine and science in sports and exercise : official journal of the American College of Sports Medicine
N2 - Eccentric exercises (ECC) induce reversible muscle damage, delayed-onset muscle soreness and an inflammatory reaction that is often followed by a systemic anti-inflammatory response. Thus, ECC might be beneficial for treatment of metabolic disorders which are frequently accompanied by a low-grade systemic inflammation. However, extent and time course of a systemic immune response after repeated ECC bouts are poorly characterized.
PURPOSE: To analyze the (anti-)inflammatory response after repeated ECC loading of the trunk.
METHODS: Ten healthy participants (33 ± 6 y; 173 ± 14 cm; 74 ± 16 kg) performed three isokinetic strength measurements of the trunk (concentric (CON), ECC1, ECC2, each 2 wks apart; flexion/extension, velocity 60°/s, 120s MVC). Pre- and 4, 24, 48, 72, 168h post-exercise, muscle soreness (numeric rating scale, NRS) was assessed and blood samples were taken and analyzed [Creatine kinase (CK), C-reactive protein (CRP), Interleukin-6 (IL-6), IL-10, Tumor necrosis factor-α (TNF-α)]. Statistics were done by Friedman‘s test with Dunn‘s post hoc test (α=.05).
RESULTS: Mean peak torque was higher during ECC1 (319 ± 142 Nm) than during CON (268 ± 108 Nm; p<.05) and not different between ECC1 and ECC2 (297 ± 126 Nm; p>.05). Markers of muscle damage (peaks post-ECC1: NRS 48h, 4.4±2.9; CK 72h, 14407 ± 19991 U/l) were higher after ECC1 than after CON and ECC2 (p<.05). The responses over 72h (stated as Area under the Curve, AUC) were abolished after ECC2 compared to ECC1 (p<.05) indicating the presence of the repeated bout effect. CRP levels were not changed. IL-6 levels increased 2-fold post-ECC1 (pre: 0.5 ± 0.4 vs. 72h: 1.0 ± 0.8 pg/ml). The IL-6 response was enhanced after ECC1 (AUC 61 ± 37 pg/ml*72h) compared to CON (AUC 33 ± 31 pg/ml*72h; p<.05). After ECC2, the IL-6 response (AUC 43 ± 25 pg/ml*72h) remained lower than post-ECC1, but the difference was not statistically significant. Serum levels of TNF-α and of the anti-inflammatory cytokine IL-10 were below detection limits. Overall, markers of muscle damage and immune response showed high inter-individual variability.
CONCLUSION: Despite maximal ECC loading of a large muscle group, no anti-inflammatory and just weak inflammatory responses were detected in healthy adults. Whether ECC elicits a different reaction in inflammatory clinical conditions is unclear.
Y1 - 2020
U6 - https://doi.org/10.1249/01.mss.0000679532.65880.af
SN - 0195-9131
SN - 1530-0315
VL - 52
IS - 7S
SP - 497
EP - 497
PB - Lippincott Williams & Wilkins
CY - Philadelphia
ER -
TY - GEN
A1 - Schomöller, Anne
A1 - Risch, Lucie
A1 - Kaplick, Hannes
A1 - Schraplau, Anne
A1 - Wochatz, Monique
A1 - Engel, Tilman
A1 - Sonnenburg, Dominik
A1 - Mayer, Frank
T1 - Changes in paraspinal muscle T2 times and creatine kinase after a bout of eccentric exercise
T2 - Medicine and science in sports and exercise : official journal of the American College of Sports Medicine
N2 - Eccentric (ECC) exercises might cause muscle damage, characterized by delayed-onset muscle soreness, elevated creatine kinase (CK) levels and local muscle oedema, shown by elevated T2 times in magnet resonance imaging (MRI) scans. Previous research suggests a high inter-individual difference regarding these systemic and local responses to eccentric workload. PURPOSE: To analyze ECC exercise-induced muscle damage in lumbar paraspinal muscles assessed via MRI. METHODS: Ten participants (3f/7m; 33±6y; 174±8cm; 71±12kg) were included in the study. Quantitative paraspinal muscle constitution of M. erector spinae and M. multifidius were assessed in supine position before and 72h after an intense eccentric trunk exercise bout in a mobile 1.5 tesla MRI device. MRI scans were recorded on spinal level L3 (T2-weighted TSE echo sequences, 11 slices, 2mm slice thickness, 3mm gap, echo times: 20, 40, 60, 80, 100ms, TR time: 2500ms). Muscle T2 times were calculated for manually traced regions of interest of the respective muscles with an imaging software. The exercise protocol was performed in an isokinetic device and consisted of 120sec alternating ECC trunk flexion-extension with maximal effort. Venous blood samples were taken before and 72h after the ECC exercise. Descriptive statistics (mean±SD) and t-testing for pre-post ECC exercises were performed. RESULTS: T2 times increased from pre- to post-ECC MRI measurements from 55±3ms to 79±28ms in M. erector spinae and from 62±5ms to 78±24ms in M. multifidius (p<0.001). CK increased from 126±97 U/L to 1447±20579 U/L. High SDs of T2 time and CK in post-ECC measures could be due to inter-individual reactions to ECC exercises. 3 participants showed high local and systemic reactions (HR) with T2 time increases of 120±24% (M. erector spinae) and 73±50% (M. multifidius). In comparison, the remaining 7 participants showed increases of 11±12% (M. erector spinae) and 7±9% (M. multifidius) in T2 time. Mean CK increased 9.5-fold in the 3 HR subjects compared with the remaining 7 subjects. CONCLUSIONS: The 120sec maximal ECC trunk flexion-extension protocol induced high amounts of muscle damage in 3 participants. Moderate to low responses were found in the remaining 7 subjects, assuming that inter-individual predictors play a role regarding physiological responses to ECC workload.
Y1 - 2020
U6 - https://doi.org/10.1249/01.mss.0000685648.68626.f1
SN - 0195-9131
SN - 1530-0315
SN - 0025-7990
VL - 52
IS - 17
SP - 929
EP - 929
PB - Lippincott Williams & Wilkins
CY - Philadelphia
ER -
TY - JOUR
A1 - Cassel, Michael
A1 - Risch, Lucie
A1 - Mayer, Frank
A1 - Kaplick, Hannes
A1 - Engel, Aaron
A1 - Kulig, Kornelia
A1 - Bashford, Greg
T1 - Achilles tendon morphology assessed using image based spatial frequency analysis is altered among healthy elite adolescent athletes compared to recreationally active controls
JF - Journal of science and medicine in sport : official journal of Sports Medicine Australia
N2 - Objectives: Although expected, tendon adaptations in adolescent elite athletes have been underreported. Morphologically, adaptations may occur by an increase in collagen fiber density and/or organization. These characteristics can be captured using spatial frequency parameters extracted from ultrasound images. This study aims to compare Achilles tendon (AT) morphology among sports-specific cohorts of elite adolescent athletes and to compare these findings to recreationally active controls by use of spatial frequency analysis. Design: Cross-sectional observational study. Method: In total, 334 healthy adolescent athletes from four sport categories (ball, combat, endurance, explosive strength) and 35 healthy controls were included. Longitudinal ultrasound scans were performed at the AT insertion and midportion. Intra-tendinous-morphology was quantified by performing spatial frequency analysis assessing eight parameters at standardized ROls. Increased values in five parameters suggest a higher structural organization, and in two parameters higher fiber density. One parameter represents a quotient combining both organization and fiber density. Results: Among athletes, only ball sport athletes exhibited an increase in one summative parameter at pre-insertion site compared to athletes from other sport categories. When compared to athletes, controls had significantly higher values of four parameters at pre-insertion and three parameters at midportion site reflecting differences in both, fiber organization and density. Conclusions: Intra-tendinous-morphology was similar in all groups of adolescent athletes. Higher values found in non-athletes might suggest higher AT fiber density and organization. It is yet unclear whether the lesser structural organization in young athletes represents initial AT pathology, or a physiological adaptive response at the fiber cross-linking level. (C) 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
KW - Tendon structure
KW - Adaptation
KW - Ultrasound
KW - Athletic loading
KW - Tendinopathy
Y1 - 2019
U6 - https://doi.org/10.1016/j.jsams.2019.03.011
SN - 1440-2440
SN - 1878-1861
VL - 22
IS - 8
SP - 882
EP - 886
PB - Elsevier
CY - Oxford
ER -
TY - CHAP
A1 - Risch, Lucie
A1 - Bashford, Greg
A1 - Kulig, Kornelia
A1 - Kaplick, Hannes
A1 - Mayer, Frank
A1 - Cassel, Michael
T1 - Spatial frequency analysis identifies altered local Micromorphology in adolescent athletes with Achilles tendinopathy
T2 - Medicine and science in sports and exercise : MSSE ; official journal of the American College of Sports Medicine
Y1 - 2020
U6 - https://doi.org/10.1249/01.mss.0000670932.99564.57
SN - 0195-9131
SN - 1530-0315
VL - 52
SP - 82
EP - 82
PB - Lippincott Williams & Wilkins
CY - Philadelphia
ER -
TY - JOUR
A1 - Risch, Lucie
A1 - Stoll, Josefine
A1 - Schomöller, Anne
A1 - Engel, Tilman
A1 - Mayer, Frank
A1 - Cassel, Michael
T1 - Intraindividual Doppler Flow Response to Exercise Differs Between Symptomatic and Asymptomatic Achilles Tendons
JF - Frontiers in physiology
N2 - Objective: This study investigated intraindividual differences of intratendinous blood flow (IBF) in response to running exercise in participants with Achilles tendinopathy.
Design: This is a cross-sectional study.
Setting: The study was conducted at the University Outpatient Clinic.
Participants: Sonographic detectable intratendinous blood flow was examined in symptomatic and contralateral asymptomatic Achilles tendons of 19 participants (42 ± 13 years, 178 ± 10 cm, 76 ± 12 kg, VISA-A 75 ± 16) with clinically diagnosed unilateral Achilles tendinopathy and sonographic evident tendinosis.
Intervention: IBF was assessed using Doppler ultrasound “Advanced Dynamic Flow” before (Upre) and 5, 30, 60, and 120 min (U5–U120) after a standardized submaximal constant load run.
Main Outcome Measure: IBF was quantified by counting the number (n) of vessels in each tendon.
Results: At Upre, IBF was higher in symptomatic compared with asymptomatic tendons [mean 6.3 (95% CI: 2.8–9.9) and 1.7 (0.4–2.9), p < 0.01]. Overall, 63% of symptomatic and 47% of asymptomatic Achilles tendons responded to exercise, whereas 16 and 11% showed persisting IBF and 21 and 42% remained avascular throughout the investigation. At U5, IBF increased in both symptomatic and asymptomatic tendons [difference to baseline: 2.4 (0.3–4.5) and 0.9 (0.5–1.4), p = 0.05]. At U30 to U120, IBF was still increased in symptomatic but not in asymptomatic tendons [mean difference to baseline: 1.9 (0.8–2.9) and 0.1 (-0.9 to 1.2), p < 0.01].
Conclusion: Irrespective of pathology, 47–63% of Achilles tendons responded to exercise with an immediate acute physiological IBF increase by an average of one to two vessels (“responders”). A higher amount of baseline IBF (approximately five vessels) and a prolonged exercise-induced IBF response found in symptomatic ATs indicate a pain-associated altered intratendinous “neovascularization.”
KW - achilles tendinopathy
KW - tendinosis
KW - neovascularization
KW - ultrasound
KW - advanced dynamic flow
KW - sonography
Y1 - 2021
U6 - https://doi.org/10.3389/fphys.2021.617497
SN - 1664-042X
VL - 12
SP - 1
EP - 8
PB - Frontiers Research Foundation
CY - Lausanne, Schweiz
ER -
TY - JOUR
A1 - Risch, Lucie
A1 - Mayer, Frank
A1 - Cassel, Michael
T1 - Doppler flow response following running exercise differs between healthy and tendinopathic Achilles tendons
JF - Frontiers in Physiology
N2 - Background: The relationship between exercise-induced intratendinous blood flow (IBF) and tendon pathology or training exposure is unclear.
Objective: This study investigates the acute effect of running exercise on sonographic detectable IBF in healthy and tendinopathic Achilles tendons (ATs) of runners and recreational participants.
Methods: 48 participants (43 ± 13 years, 176 ± 9 cm, 75 ± 11 kg) performed a standardized submaximal 30-min constant load treadmill run with Doppler ultrasound “Advanced dynamic flow” examinations before (Upre) and 5, 30, 60, and 120 min (U5-U120) afterward. Included were runners (>30 km/week) and recreational participants (<10 km/week) with healthy (Hrun, n = 10; Hrec, n = 15) or tendinopathic (Trun, n = 13; Trec, n = 10) ATs. IBF was assessed by counting number [n] of intratendinous vessels. IBF data are presented descriptively (%, median [minimum to maximum range] for baseline-IBF and IBF-difference post-exercise). Statistical differences for group and time point IBF and IBF changes were analyzed with Friedman and Kruskal-Wallis ANOVA (α = 0.05).
Results: At baseline, IBF was detected in 40% (3 [1–6]) of Hrun, in 53% (4 [1–5]) of Hrec, in 85% (3 [1–25]) of Trun, and 70% (10 [2–30]) of Trec. At U5 IBF responded to exercise in 30% (3 [−1–9]) of Hrun, in 53% (4 [−2–6]) of Hrec, in 70% (4 [−10–10]) of Trun, and in 80% (5 [1–10]) of Trec. While IBF in 80% of healthy responding ATs returned to baseline at U30, IBF remained elevated until U120 in 60% of tendinopathic ATs. Within groups, IBF changes from Upre-U120 were significant for Hrec (p < 0.01), Trun (p = 0.05), and Trec (p < 0.01). Between groups, IBF changes in consecutive examinations were not significantly different (p > 0.05) but IBF-level was significantly higher at all measurement time points in tendinopathic versus healthy ATs (p < 0.05).
Conclusion: Irrespective of training status and tendon pathology, running leads to an immediate increase of IBF in responding tendons. This increase occurs shortly in healthy and prolonged in tendinopathic ATs. Training exposure does not alter IBF occurrence, but IBF level is elevated in tendon pathology. While an immediate exercise-induced IBF increase is a physiological response, prolonged IBF is considered a pathological finding associated with Achilles tendinopathy.
KW - neovascularization
KW - tendinopathy
KW - Doppler ultrasound
KW - Advanced Dynamic Flow
KW - athlete
KW - sonography
Y1 - 2021
U6 - https://doi.org/10.3389/fphys.2021.650507
SN - 1664-042X
VL - 12
PB - Frontiers Research Foundation
CY - Lausanne
ER -
TY - JOUR
A1 - Cassel, Michael
A1 - Intziegianni, Konstantina
A1 - Risch, Lucie
A1 - Müller, Steffen
A1 - Engel, Tilman
A1 - Mayer, Frank
T1 - Physiological Tendon Thickness Adaptation in Adolescent Elite Athletes
BT - A Longitudinal Study
JF - Frontiers in physiology
N2 - Increased Achilles (AT) and Patellar tendon (PT) thickness in adolescent athletes compared to non-athletes could be shown. However, it is unclear, if changes are of pathological or physiological origin due to training. The aim of this study was to determine physiological AT and PT thickness adaptation in adolescent elite athletes compared to non-athletes, considering sex and sport. In a longitudinal study design with two measurement days (M1/M2) within an interval of 3.2 ± 0.8 years, 131 healthy adolescent elite athletes (m/f: 90/41) out of 13 different sports and 24 recreationally active controls (m/f: 6/18) were included. Both ATs and PTs were measured at standardized reference points. Athletes were divided into 4 sport categories [ball (B), combat (C), endurance (E) and explosive strength sports (S)]. Descriptive analysis (mean ± SD) and statistical testing for group differences was performed (α = 0.05). AT thickness did not differ significantly between measurement days, neither in athletes (5.6 ± 0.7 mm/5.6 ± 0.7 mm) nor in controls (4.8 ± 0.4 mm/4.9 ± 0.5 mm, p > 0.05). For PTs, athletes presented increased thickness at M2 (M1: 3.5 ± 0.5 mm, M2: 3.8 ± 0.5 mm, p < 0.001). In general, males had thicker ATs and PTs than females (p < 0.05). Considering sex and sports, only male athletes from B, C, and S showed significant higher PT-thickness at M2 compared to controls (p ≤ 0.01). Sport-specific adaptation regarding tendon thickness in adolescent elite athletes can be detected in PTs among male athletes participating in certain sports with high repetitive jumping and strength components. Sonographic microstructural analysis might provide an enhanced insight into tendon material properties enabling the differentiation of sex and influence of different sports.
KW - Achilles and patellar tendon
KW - training adaptation
KW - sonography
KW - young athletes
KW - non-athletes
Y1 - 2017
U6 - https://doi.org/10.3389/fphys.2017.00795
SN - 1664-042X
VL - 8
SP - 1
EP - 8
PB - Frontiers
CY - Lausanne
ER -
TY - JOUR
A1 - Schomöller, Anne
A1 - Risch, Lucie
A1 - Kaplick, Hannes
A1 - Wochatz, Monique
A1 - Engel, Tilman
A1 - Schraplau, Anne
A1 - Sonnenburg, Dominik
A1 - Huppertz, Alexander
A1 - Mayer, Frank
T1 - Inter-rater and inter-session reliability of lumbar paraspinal muscle composition in a mobile MRI device
JF - BJR : an international journal of radiology, radiation oncology and all related sciences / British Institute of Radiology
N2 - Objective: To assess the reliability of measurements of paraspinal muscle transverse relaxation times (T2 times) between two observers and within one observer on different time points.
Methods: 14 participants (9f/5m, 33 +/- 5 years, 176 +/- 10 cm, 73 +/- 12 kg) underwent 2 consecutive MRI scans (M1,M2) on the same day, followed by 1 MRI scan 13-14 days later (M3) in a mobile 1.5 Tesla MRI. T2 times were calculated in T-2 weighted turbo spin- echo-sequences at the spinal level of the third lumbar vertebrae (11 slices, 2 mm slice thickness, 1 mm interslice gap, echo times: 20, 40, 60, 80, 100 ms) for M. erector spinae (ES) and M. multifidius (MF). The following reliability parameter were calculated for the agreement of T2 times between two different investigators (OBS1 & OBS2) on the same MRI (inter rater reliability, IR) and by one investigator between different MRI of the same participant (intersession variability, IS): Test-Retest Variability (TRV, Differences/Mean*100); Coefficient of Variation (CV, Standard deviation/Mean*100); Bland-Altman Analysis (systematic bias = Mean of the Differences; Upper/Lower Limits of Agreement = Bias+/-1.96*SD); Intraclass Correlation Coefficient 3.1 (ICC) with absolute agreement, as well as its 95% confidence interval.
Results: Mean TRV for IR was 2.6% for ES and 4.2% for MF. Mean TRV for IS was 3.5% (ES) and 5.1% (MF). Mean CV for IR was 1.9 (ES) and 3.0 (MF). Mean CV for IS was 2.5% (ES) and 3.6% (MF). A systematic bias of 1.3 ms (ES) and 2.1 ms (MF) were detected for IR and a systematic bias of 0.4 ms (ES) and 0.07 ms (MF) for IS. ICC for IR was 0.94 (ES) and 0.87 (MF). ICC for IS was 0.88 (ES) and 0.82 (MF).
Conclusion: Reliable assessment of paraspinal muscle T2 time justifies its use for scientific purposes. The applied technique could be recommended to use for future studies that aim to assess changes of T2 times, e.g. after an intense bout of eccentric exercises.
Y1 - 2021
U6 - https://doi.org/10.1259/bjr.20210141
SN - 0007-1285
SN - 1748-880X
VL - 94
IS - 1127
PB - Wiley
CY - Bognor Regis
ER -