Treatments for Achilles Tendinopathy — CJSM Blog Post Journal Club

We’re celebrating our 30th Anniversary!!! Take a look what’s beneath the new, sleek cover.

We are celebrating our 30th year of publication in 2020 and we could not be happier to ring this new year in than with the publication of our January 2020 issue, full of the sorts of offerings that make CJSM a special part of the sports medicine universe. From original research to systematic reviews to case reports, we have several new offerings that help clinicians bring the latest in evidence-based medicine to their patients on the pitch, in the training rooms, and in the clinics.

One of those studies reports research results reported by authors practicing in the UK and deals with a very common problem among athletes: Novel Inerventions for Recalcitrant Achilles Tendinopathy.

Dr. Zaremski & assistant take a break from their writing.

This prospective cohort study is the focus of our first blog post journal club of the year, with CJSM Associate Editor Jason Zaremski M.D. guiding us through the ins and outs of the study.  Take it away Dr. Zaremski!

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Introduction:  As we begin a new decade and say goodbye to 2019, the winter CJSM journal club will be focusing on an issue that is extremely common in all individuals, chronic Achilles tendon injury. As many individuals make New Year’s resolutions to exercise more and live healthier lifestyles, we as sports medicine and musculoskeletal experts must be prepared for an increase in overuse injuries such as tendinopathies.  These conditions can be difficult to treat, and new, novel approaches to these common conditions are always of interest. A new study by Wheeler and Tattersall is a timely publication to review in this new year: Novel Interventions for Recalcitrant Achilles Tendinopathy. Benefits Seen Following High-Volume Image-Guided Injection or Extracorporeal Shockwave Therapy—A Prospective Cohort Study.

Purpose: The authors of this study set out to compare the outcomes for patients with chronic non-insertional Achilles tendinopathy (CNIAT) following extracorporeal shockwave therapy (ESWT) versus high-volume image-guided injection (HVIGI). The results may provide practitioners greater information for patients and to improve patient care. Read more of this post

CJSM Blog Journal Club — is rESWT an effective therapy for chronic, distal biceps tendinopathy?

I’m pleased to welcome Jason Zaremski MD, one of our junior associate editors, who has contributed our first on-line journal club article.

Dr. Zaremski is a primary care sports medicine specialist who is board certified in Physical Medicine and Rehabilitation. He is an assistant professor at the University of Florida in the Department of Orthopaedics and Rehabilitation.

Dr. Zaremski is also a member of one of our affiliated societies, the American Medical Society for Sports Medicine, and was appointed last year as the AMSSM junior associate editor.  He’s been busy behind the scenes on many CJSM initiatives already; this is his first foray onto the blog, and we’ve been looking forward to his contribution.  Enjoy!

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Clinical Journal of Sports Medicine

Online Journal Club

Jason L Zaremski

Title: Furia JP, et al. Radial Extracorporeal Shock Wave Therapy Is Effective and Safe in Chronic Distal Biceps Tendinopathy. Clin J Sport Med 2017;27:430–437.

Introduction:

This is the first online Journal Club Commentary for the Clinical Journal of Sports Medicine’s new initiative for its Online Journal Club. Furia and colleagues sought to determine the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for chronic distal biceps tendinopathy (cDBT). This is a retrospective case control study with level three evidence. The specific aim of the study is to determine whether rESWT is safe and effective for the management of cDBT.

Methods:

This is a retrospective case control study Read more of this post

Isometric Contractions for In-Season Treatment of Patellar Tendinopathy

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Guest blogger Dr. Napolitano grinding it out on the water.

One of the great features of modern medical journals like CJSM is the ability to publish studies ahead of print – we call it “Published Online First.”

With the flexibility  allowed by the internet and emerging media, we are able to get studies that have gone through peer review and are in the queue for printing out to the reading public months before they otherwise would see the light of day.

We have one of our “Published Online First” studies burning things up on emerging media.  At CJSM we follow the Altmetrics on the studies in our pages, and this new one — Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain: An In-Season Randomized Clinical Trial — currently has a very hot rating of 107 (and climbing).

The treatment of such a common condition will be of inherent interest to those who practice sports medicine. Moreover, managing this nagging condition in mid-season can prove to be a Sisyphean task for the athlete and clinician.  This study has great promise to make a significant impact on your care of the athletes you see.

I asked the physician fellow working with me at NCH sports medicine, Jonathan Napolitano, MD, to do a guest post on this study authored by Rio et al.  Dr. Napolitano’s commentary, forthwith:

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Basketball season is upon us and our clinics have begun to fill with athletes ailing from patellar tendinopathy, seeking pain relief and a quick return to the hardwood.  As a sports medicine fellow with a residency background in physical medicine and rehabilitation I have used this time to step back and review the therapeutic exercises we prescribe for tendinopathies.  I have always paired the concept of eccentric strengthening with tendon repair.  However, various other types of muscle contraction and strengthening exercises can (and perhaps should be) prescribed as well.

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In between isotonic beer curls at World Series 2017 game (L – R): Drs. Stephen Cuff, Reno Ravindran, Jonathan Napolitano

As an educational exercise I would like to take a moment to review the types of muscle contractions.  Isometric contraction occurs without any movement of the joint on which the muscle acts.  Isokinetic contraction occurs at a constant speed across a joint range of motion with variable resistance.  Finally, isotonic exercises are performed through normal joint range of motion with a consistent resistance at variable speed.  Isotonic contractions are further divided into concentric (muscle shortening) and eccentric (muscle lengthening).

Tendon pain is a factor that limits participation and performance in athletes.  Eccentric strengthening has shown good clinical outcomes in the long-term; however, this intervention can lead to increased pain in the short-term, and in 2005 Visnes et al showed eccentric strengthening to be of no benefit for in-season athletes.

Recent research by Dr. Rio et al [including senior author Dr. Jill Cook] compared rehabilitation programs for in-season athletes with patellar tendon pain.  Read more of this post

Tip-off: The NBA Season is Set to Begin!

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“Kobe Bryant 61 NYK3,” by C.J. Iuzer.

The NBA regular season begins in a week, but there has been a lot happening already on the sports medicine front in the league.

From Paul George’s tib/fib fracture  to Kevin Durant’s ‘Jones fracture’  to Anthony Davis’ ‘wrist sprain,’  the athletic trainers, sideline physicians, and orthopaedic surgeons have had a busy ‘off season.’

And then, there is the question of Kobe.  He has been in the press a lot!

The NY Times recently had an interesting chat with the Kobe and Arianna Huffington, a unique friendship to say the least.  It seems Kobe is indeed looking at his future, however many seasons he may have in front of him.  And before he has even taken a shot in the regular season, pundits aplenty have shared their skepticism about his ability to perform on the court:  seems like a lot of folks are betting Kobe will be an albatross around the neck of the Lakers.

As most readers would know, Kobe Bryant ruptured his Achilles tendon at the end of the 2013 season. We blogged about it at the time (I’m reblogging the original post below) and discussed the pros/cons of operative vs. non-operative treatment of such injuries.  The issues of managing Achilles tendon pathology find their way frequently into the pages of CJSM.  Two such articles I would especially commend to the readers as being particularly relevant to the question of Kobe’s ability to recover:   “Complications after surgery or non-operative treatment for acute Achilles tendon rupture,”  and “Does accelerated functional rehabilitation after surgery improve outcomes in patients with acute Achilles tendon ruptures?”

Kobe, of course, went through operative treatment and an accelerated rehab.  His 2014 season was cut short because of a knee injury.  For the brief time he played, it would seem his Achilles held up quite well.  I suspect his knee injury was of the sort we saw after the NBA lockout, where a prolonged layoff from the sport can lead to higher rates of injury; that is, I think his knee injury was more linked to a prolonged absence from high-level running and jumping related to his prolonged recovery from Achilles tendon surgery.  A similar process was involved in Derek Jeter’s case, where a quick return from one injury (ankle fracture) led to a season-ending issue in another body part (quad strain).

I wouldn’t bet against Kobe, no sir.  He is as tough as they come, and throughout his career he has been at the forefront of athletes employing cutting-edge concepts in training and recovery.   I don’t know about the Lakers as a unit.  But I think Kobe can make some headlines that are not related to injury this season.  Draining 61 points at Madison Square Garden one more time in his career?  I think the Black Mamba may just have it in him.

Clinical Journal of Sport Medicine Blog

Image Kobe Bryant

I woke up this morning to hear very sad news that occurred in the NBA last night:  Kobe Bryant has ruptured his Achilles tendon.

Kobe, who turns 35 this year, is one of the most recognized athletes in the world (maybe one of the few things that China and the USA can agree on). He had been leading his team to crucial victories as they were making a playoff run when he succumbed to this not uncommon injury in the middle aged athlete. 

As he is quoted saying, he made a move he had executed a ‘million times’ when he felt like someone had kicked him in the leg, and he subsequently crumpled to the ground.  This is the classic history one might obtain when caring for an athlete with such an injury.  If you watch the video, you’ll see Kobe perform a classic…

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