Etiologic Factors Associated with Symptomatic Achilles Tendinopathy

Holmes, George B.; Lin, Jui-Wei

doi:10.1177/107110070602701115

Cited by 247 publications

(180 citation statements)

References 43 publications

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“…Tendinopathy has an increased incidence with age and the male gender [11,89] and with obesity [36,47]. Excessive long-distance running, intensity, and hill work are risk factors for acute Achilles tendinopathy [60,70,95]; distance and excessive time spent swimming are associated with supraspinatus tendinopathy [98].…”

Section: Common Intrinsic and Extrinsic Associationsmentioning

confidence: 99%

“…Excessive long-distance running, intensity, and hill work are risk factors for acute Achilles tendinopathy [60,70,95]; distance and excessive time spent swimming are associated with supraspinatus tendinopathy [98]. There is also an association between tendinopathy and hormone replacement therapy and oral contraceptives in women [47].…”

Section: Common Intrinsic and Extrinsic Associationsmentioning

confidence: 99%

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The Basic Science of Tendinopathy

Murrell

2008

Clinical Orthopaedics &Amp; Related Research

314

254

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Tendinopathy is a common clinical problem with athletes and in many occupational settings. Tendinopathy can occur in any tendon, often near its insertion or enthesis where there is an area of stress concentration, and is directly related to the volume of repetitive load to which the tendon is exposed. Recent studies indicate tendinopathy is more likely to occur in situations that increase the ''dose'' of load to the tendon enthesis -including increased activity, weight, advancing age, and genetic factors. The cells in tendinopathic tendon are rounder, more numerous, and show evidence of oxidative damage and more apoptosis. These cells also produce a matrix that is thicker and weaker with more water, more immature and cartilage-like matrix proteins, and less organization. There is now evidence of a population of regenerating stem cells within tendon. These studies suggest prevention of tendinopathy should be directed at reducing the volume of repetitive loads to below that which induces oxidative-induced apoptosis and cartilage-like genes. The management strategies might involve agents or cells that induce tendon stem cell proliferation, repair and restoration of matrix integrity.

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Section: Common Intrinsic and Extrinsic Associationsmentioning

confidence: 99%

Section: Common Intrinsic and Extrinsic Associationsmentioning

confidence: 99%

The Basic Science of Tendinopathy

Murrell

2008

Clinical Orthopaedics &Amp; Related Research

314

254

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“…45,59 The less active are not immune as a minority of cases have been reported in sedentary groups. 43,107 Although runners appear to be the most commonly affected cohort, 59,60,62,98 Achilles disorders have been reported in a wide variety of sports. 32,33,59,60,134 It was noted that athletes are more likely to become symptomatic when training as opposed to during competitive events.…”

Section: Prevalencementioning

confidence: 99%

“…43 It has been suggested that these diseases diminish the blood flow that may ultimately reach the Achilles tendon. 43 These disease processes in part explain the prevalence of this disorder in the sedentary population. Interestingly, Achilles tendinopathy has been reported in 6% of cases after taking the antibiotic fluoroquinolone.…”

Section: Pronationmentioning

confidence: 99%

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Carcia

Martin²,

Houck³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

119

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The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010:40(9):A1–A26. doi:10.2519/jospt.2010.0305

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“…These results indicate a pivotal role for estradiol in maintaining homeostasis of female connective tissue. connective tissue; tendon fibrils; insulin-like growth factor-I; extracellular matrix; bone CROSS-SECTIONAL FINDINGS INDICATE that sex hormones influence tendon biomechanical properties (36), extracellular matrix adaptability in response to mechanical loading (11,21,36,41,59), and the risk of sustaining soft tissue injuries (11,24,25).…”

mentioning

confidence: 99%

Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

Hansen

Kongsgaard²,

Holm³

et al. 2009

Journal of Applied Physiology

121

114

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Flyvbjerg A, Langberg H, Kjaer M. Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women. J Appl Physiol 106: 1385-1393, 2009. First published October 16, 2009 doi:10.1152/japplphysiol.90935.2008.-The knowledge about the effect of estradiol on tendon connective tissue is limited. Therefore, we studied the influence of estradiol on tendon synthesis, structure, and biomechanical properties in postmenopausal women. Nonusers (control, n ϭ 10) or habitual users of oral estradiol replacement therapy (ERT, n ϭ 10) were studied at rest and in response to one-legged resistance exercise. Synthesis of tendon collagen was determined by stable isotope incorporation [fractional synthesis rate (FSR)] and microdialysis technique (NH2-terminal propeptide of type I collagen synthesis). Tendon area and fibril characteristics were determined by MRI and transmission electron microscopy, whereas tendon biomechanical properties were measured during isometric maximal voluntary contraction by ultrasound recording. Tendon FSR was markedly higher in ERT users (P Ͻ 0.001), whereas no group difference was seen in tendon NH2-terminal propeptide of type I collagen synthesis (P ϭ 0.32). In ERT users, positive correlations between serum estradiol (sestradiol) and tendon synthesis were observed, whereas change in tendon synthesis from rest to exercise was negatively correlated to s-estradiol. Tendon area, fibril density, fibril volume fraction, and fibril mean area did not differ between groups. However, the percentage of medium-sized fibrils was higher in ERT users (P Ͻ 0.05), whereas the percentage of large fibrils tended to be greater in control (P ϭ 0.10). A lower Young's modulus (GPa/%) was found in ERT users (P Ͻ 0.05). In conclusion, estradiol administration was associated with higher tendon FSR and a higher relative number of smaller fibrils. Whereas this indicates stimulated collagen turnover in the resting state, collagen responses to exercise were negatively associated with s-estradiol. These results indicate a pivotal role for estradiol in maintaining homeostasis of female connective tissue. connective tissue; tendon fibrils; insulin-like growth factor-I; extracellular matrix; bone CROSS-SECTIONAL FINDINGS INDICATE that sex hormones influence tendon biomechanical properties (36), extracellular matrix adaptability in response to mechanical loading (11,21,36,41,59), and the risk of sustaining soft tissue injuries (11,24,25).Estrogen receptors have been localized in ligaments (32, 33), and tendons express transcripts for estrogen receptors (23). Nevertheless, the effect of estrogen on tendon and ligament turnover is not clarified. Thus an inhibiting effect (34, 60), no effect (51), and a stimulating effect (32) on collagen synthesis and fibroblast proliferation in vitro have been observed in anterior cruciate ligament (ACL) tissue samples. These contrasting findings are probably related to the variation between animal species and the applied methods. This ...

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Etiologic Factors Associated with Symptomatic Achilles Tendinopathy

Abstract: Obesity, hypertension, and steroids have as their end-organ effect a diminution of local microvascularity. The significant correlation of these factors with Achilles tendinopathy suggests the importance of their effect on microvascularity in the development of Achilles tendinopathy.

Cited by 247 publications

References 43 publications

The Basic Science of Tendinopathy

The Basic Science of Tendinopathy

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

Effect of estrogen on tendon collagen synthesis, tendon structural characteristics, and biomechanical properties in postmenopausal women

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