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 - 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 - THES A1 - Müller, Steffen T1 - Die belastungsspezifische neuromuskuläre Antwort bei Athleten mit Tendinopathie der Achilles- oder Patellarsehne : Analysen der funktionalen und therapeutischen Effekte eines sensomotorischen Trainings T1 - Neuromuscular response to physical stress in athletes with tendinopathie of the achilles- or patellartendon : funktional and therapeutic effects of an sensorimotor training N2 - Tendinopathien der Achilles- oder Patellarsehne sind häufig in Sportarten mit zahlreichen repetitiven Belastungen im Dehnungs-Verkürzungs-Zyklus der unteren Extremität zu finden. Sowohl eine möglicherweise alterierte belastungsspezifische neuromuskuläre Antwort (NMA), als auch funktional begründete Therapiemaßnahmen mit möglichen positiven Effekten sind aktuell ungeklärt. Ziel der Arbeit war deshalb die Untersuchung der belastungsspezifischen neuromuskulären Antwort bei Athleten mit Tendinopathie der Achilles- oder Patellarsehne im Vergleich zu beschwerdefreien Athleten. Zusätzlich sollten mögliche funktionale und therapeutische Effekte eines sensomotorischen Trainings im randomisierten, kontrollierten und prospektiven Studiendesign überprüft werden. 51 Sportler mit unilateraler Tendinopathie (Achilles-/Patellarsehne n = 35/16) und 33 gesunde Sportler wurden zur Beurteilung der belastungsspezifischen neuromuskulären Antwort eingeschlossen. Zur Klärung der Effekte eines sensomotorischen Trainings im Längsschnitt konnten 26 Sportler mit Tendinopathie randomisiert zu einer Kontrollgruppe (n = 14) und einer Therapiegruppe mit sensomotorischem Training (n = 12) zugeordnet werden. Nach einer ersten biomechanischen Messung M1 (Belastungssituationen: Lauf-, Stabilisations-, Kraftbelastung) und der Erhebung der subjektiven Schmerzsymptomatik folgte eine 8-wöchige Therapiephase mit einer abschließenden Re-Test-Messung M2 identisch zu M1. Das sensomotorische Training war auf die gesamte untere Extremität ausgerichtet und wurde nach Einweisung regelmäßig kontrolliert. Die Erfassung der NMA erfolgte über die Quantifizierung der muskulären Aktivität (EMG). Zusätzlich wurde die Kinetik (z.B. Maximalkraft) belastungsspezifisch erfasst. Eine reduzierte NMA konnte für die Sportler mit Tendinopathie über veränderte EMG-Zeit- und Amplitudenmessgrößen, eine reduzierte aktive Stabilisationsfähigkeit und Maximalkraft (p < 0,05) nachgewiesen werden. In Abhängigkeit der Lokalisation (Achilles-/Patellarsehen) bzw. der Seite (Beschwerdeseite/gesunde Seite) ergaben sich keine relevanten Differenzen. Das sensomotorische Training zeigte eine Optimierung der NMA (z.B. erhöhte Maximalkraft) bei Tendinopathie der Achilles- oder Patellarsehne. Die Überprüfung der Beschwerdesymptomatik wies in allen Schmerz-Scores nach der Therapie reduzierte Werte und damit einen positiven therapeutischen Effekt gegenüber der Kontrollgruppe auf. Zusammenfassend kann eine systematisch reduzierte NMA bei Lauf-, Stabilisations- und Kraftbelastung der Sportler mit Tendinopathie nachgewiesen werden. Das sensomotorische Training ist funktional und therapeutisch als effiziente Therapiemaßnahme zu erachten. N2 - Tendinopathies of the achilles- or patellartendon are common overuse unjuries in sports including high numbers of repetitive stretch-shortening-cycles of the lower limb. Possible alterations of the neuromuscular response (NMR) to physical stress and functionally justified therapies with potential positive effects are currently unknown. The aim of the study was therefore the analysis of the neuromuscular response in situations with physical stress in athletes with tendinopathie of the achilles or patellartendon compared to symptom free athletes. In addition, possible functional and therapeutic effects of a sensorimotor training were studied in a prospective, randomized and controlled study. 51 athletes with unilateral tendinopathy (achilles-/patellartendon n = 35/16) and 33 healthy athletes were included to assess the stress related neuromuscular response (NMR). To clarify the effects of a sensorimotor training 26 athletes with tendinopathy were randomized to a control group (n = 14) and a therapy group with sensorimotor training (n = 12). After initial biomechanical measurements M1 (situations: running, active postural stability and maximum strength test) and the collection of subjective complaints (pain) an 8-week treatment phase followed with a final re-test M2 measure identical to M1. The sensorimotor training was arranged for the entire lower extremity, and was checked after an initial briefing on a regular basis. The assessment of the NMR was quantified by muscle activity (EMG). In addition, the kinetics (e.g. maximum force) was acquired in the stabilization and maximum strength test. A reduced NMR could be proven for athletes with tendinopathy with changed EMG time and amplitude measurements, a reduced active postural stabilization ability and reduced maximum strength (p <0.05). No relevant differences could be observed in comparing localization (achilles-/patellartendon) and side (leg with complains/healthy leg). The sensorimotor training showed an optimization of NMR (e.g. increased maximum strength) for patient with tendinopathy of the achilles- or patellartendon. The examination of the complaints showed reduced values in all pain scores after therapy. The treatment had therefore positive therapeutic effects compared to the control group. In summary, a systematically reduced NMR in running, stabilization and strength tests are evident for athletes with tendinopathy. The sensorimotor training can be considered as an efficient treatment with functional and therapeutic effects. KW - Tendinopathie KW - neuromuskuläre Kontrolle KW - sensomotorisches Training KW - Reliabilität KW - tendinopathy KW - neuromuscular control KW - sensorimotor training KW - reproducibility Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus-16454 SN - 978-3-940793-18-8 PB - Universitätsverlag Potsdam CY - Potsdam ER - TY - JOUR A1 - Intziegianni, Konstantina A1 - Cassel, Michael A1 - Rauf, S. A1 - White, S. A1 - Rector, Michael V. A1 - Kaplick, Hannes A1 - Wahmkow, Gunnar A1 - Kratzenstein, S. A1 - Mayer, Frank T1 - Influence of Age and Pathology on Achilles Tendon Properties During a Single-leg Jump JF - International journal of sports medicine N2 - Prevalence of Achilles tendinopathy increases with age leading to a weaker tendon with predisposition to rupture. Conclusive evidence of the influence of age and pathology on Achilles tendon (AT) properties remains limited, as previous studies are based on standardized isometric conditions. The study investigates the influence of age and pathology on AT properties during single-leg vertical jump (SLVJ). 10 children (C), 10 asymptomatic adults (A), and 10 tendinopathic patients (T) were included. AT elongation [mm] from rest to maximal displacement during a SLVJ on a force-plate was sonographically assessed. AT compliance [mm/N]) and strain [%] was calculated by dividing elongation by peak ground reaction force [N] and length, respectively. One-way ANOVA followed by Bonferroni post-hoc correction (=0.05) were used to compare C with A and A with T. AT elongation (p=0.004), compliance (p=0.001), and strain were found to be statistically significant higher in C (27 +/- 3mm, 0.026 +/- 0.006[mm/N], 13 +/- 2%) compared to A (21 +/- 4mm, 0.017 +/- 0.005[mm/N], 10 +/- 2%). No statistically significant differences (p0.05) was found between A and T (25 +/- 5mm, 0.019 +/- 0.004[mm/N], 12 +/- 3%). During SLVJ, tendon responded differently in regards to age and pathology with children having the most compliant AT. Higher compliance found in healthy tendons might be considered as a protective factor against load-related injuries. KW - children KW - tendinopathy KW - compliance KW - dynamic KW - ultrasonography Y1 - 2016 U6 - https://doi.org/10.1055/s-0042-108198 SN - 0172-4622 SN - 1439-3964 VL - 37 SP - 973 EP - 978 PB - Thieme CY - Stuttgart ER - TY - THES A1 - Intziegianni, Konstantina T1 - Influence of age and pathology on Achilles tendon properties under functional tasks T1 - Einfluss von Alter und Pathologie auf Eigenschaften der Achillessehne während funktionaler Aufgaben N2 - Prevalence of Achilles tendinopathy increases with age, leading to a weaker tendon with predisposition to rupture. Previous studies, investigating Achilles tendon (AT) properties, are restricted to standardized isometric conditions. Knowledge regarding the influence of age and pa-thology on AT response under functional tasks remains limited. Therefore, the aim of the thesis was to investigate the influence of age and pathology on AT properties during a single-leg vertical jump. Healthy children, asymptomatic adults and patients with Achilles tendinopathy participated. Ultrasonography was used to assess AT-length, AT-cross-sectional area and AT-elongation. The reliability of the methodology used was evaluated both Intra- and inter-rater at rest and at maximal isometric plantar-flexion contraction and was further implemented to investigate tendon properties during functional task. During the functional task a single-leg vertical jump on a force plate was performed while simultaneously AT elongation and vertical ground reaction forces were recorded. AT compliance [mm/N] (elongation/force) and AT strain [%] (elongation/length) were calculated. Differences between groups were evaluated with respect to age (children vs. adults) and pathology (asymptomatic adults vs. patients). Good to excellent reliability with low levels of variability was achieved in the assessment of AT properties. During the jumps AT elongation was found to be statistical significant higher in children. However, no statistical significant difference was found for force among the groups. AT compliance and strain were found to be statistical significant higher only in children. No significant differences were found between asymptomatic adults and patients with tendinopathy. The methodology used to assess AT properties is reliable, allowing its implementation into further investigations. Higher AT-compliance in children might be considered as a protective factor against load-related injuries. During functional task, when higher forces are acting on the AT, tendinopathy does not result in a weaker tendon. N2 - Die Prävalenz der Achillessehenentendinopathie steigt mit zunehmendem Alter, was zu einer geschwächten Sehnenstruktur mit Prädisposition zur Ruptur führt. Frühere Studien, welche Achillesssehnen(AS)-Eigenschaften untersuchten, beschränkten sich auf standardisierte isometrische Bedingungen. Der Einfluss von Alter und Pathologie auf das AS-Verhalten während funktioneller Bewegungen ist unklar. Das die Ziel der vorliegenden Arbeit war es daher, den Einfluss des Alters und Pathologie auf AS-Eigenschaften während einen einbeinigen vertikalen Sprung zu untersuchen. Es wurden gesunde Kinder, asymptomatische Erwachsene und Patienten mit Achillessehnene-ndinopathie eingeschlossen. Sonographisch wurden AS-Länge, -Querschnittsfläche (cross-sectional area) und -Dehnung gemessen. Intra- und inter-rater Reliabilität der genutzten Methoden wurden sowohl in Ruhe als auch unter maximaler isometrischer Plantarflexion bestimmt und nachfolgend zur Untersuchung der funktionellen AS-Eigenschaften implementiert. Hierzu wurde ein einbeiniger vertikaler Sprung auf einer Kraftmessplatte absolviert und zeitgleich AS-Compliance sowie vertikale Bodenreaktionskräfte regsitriert. AS-Compliance [mm/N] (Dehnung/Kraft) und AS-Verformung [%] (Dehnung/Länge) wurden kalkuliert. Die Gruppenunterschiede wurden in Bezug auf Alter (Kinder vs. Erwachsene) und Pathologie (Erwachsene vs. Patienten) evaluiert. Bei der Bewertung der verwendeten Methode wurde eine gute bis sehr gute Reliabilität mit geringer Variabilität zur Beurteilung der AS-Eigenschaften erreicht. Während der einbeinigen Sprünge zeigte sich eine statistisch signifikant höhere AS-Dehnung bei Kindern verglichen zu Erwachsenen. Ein statistisch signifikanter Kraft-Unterschied bestand zwischen den Gruppen nicht. AS-Compliance und –Verformung waren ausschließlich statistisch signifikant höher bei den Kindern. Keine signifikanten Unterschiede zwischen Erwachsenen und Patienten wurden gefunden. Die Methodik zur Bestimmung der AS-Eigenschaften ist zuverlässig, was deren Implementierung in weitere funktionelle Untersuchungen ermöglicht. Die höhere funktionelle AS-Compliance bei Kindern kann als Schutz vor Überlastungsschäden diskutiert werden. Während funktioneller Aufgaben, bei denen höhere Kräfte auf die AS wirken, ging das Vorhandensein einer Tendinopathie nicht mit einer schwächeren Sehne einher. KW - Achilles tendon KW - tendinopathy KW - age KW - reliability KW - tendon mechanical properties KW - Achillessehne KW - Tendinopathie KW - Alter KW - Sehnen mechanische Eigenschaften Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-398732 ER - TY - JOUR A1 - Cassel, Michael A1 - Baur, Heiner A1 - Hirschmueller, Anja A1 - Carlsohn, Anja A1 - Fröhlich, Katja A1 - Mayer, Frank T1 - Prevalence of Achilles and patellar tendinopathy and their association to intratendinous changes in adolescent athletes JF - Scandinavian journal of medicine & science in sports N2 - Achilles (AT) and patellar tendons (PT) are commonly affected by tendinopathy in adult athletes but prevalence of symptoms and morphological changes in adolescents is unclear. The study aimed to determine prevalence of tendinopathy and intratendinous changes in ATs and PTs of adolescent athletes. A total of 760 adolescent athletes (13.0 +/- 1.9 years; 160 +/- 13cm; 50 +/- 14kg) were examined. History, local clinical examination, and longitudinal Doppler ultrasound analysis for both ATs and PTs were performed including identification of intratendinous echoic changes and vascularization. Diagnosis of tendinopathy was complied clinically in case of positive history of tendon pain and tendon pain on palpation. Achilles tendinopathy was diagnosed in 1.8% and patellar tendinopathy in 5.8%. Vascularizations were visible in 3.0% of ATs and 11.4% of PTs, hypoechogenicities in 0.7% and 3.2% as well as hyperechogenicities in 0% and 0.3%, respectively. Vascularizations and hypoechogenicities were statistically significantly more often in males than in females (P0.02). Subjects with patellar tendinopathy had higher prevalence of structural intratendinous changes than those without PT symptoms (P0.001). In adolescent athletes, patellar tendinopathy is three times more frequent compared with Achilles tendinopathy. Longitudinal studies are necessary to investigate physiological or pathological origin of vascularizations and its predictive value in development of tendinopathy. KW - Prevalence KW - tendinopathy KW - sonography KW - Doppler ultrasound KW - vascularization KW - hypoechogenicities KW - hyperechogenicities KW - adolescent athletes Y1 - 2015 U6 - https://doi.org/10.1111/sms.12318 SN - 0905-7188 SN - 1600-0838 VL - 25 IS - 3 SP - e310 EP - e318 PB - Wiley-Blackwell CY - Hoboken ER -