tendons in ten minutes
TRANSCRIPT
Tendons in Ten Minutes
Hold onto your hats……
Dr. Richard CollinsMSK Physician
Why tendons?
Sobrino et al. Orthop J Sports Med 2015Overuse injuries in Professional Ballet
• Anterior Knee Pain (likely included PT) 16%
• Patellar Tendinopathy 10.5%• Achilles Tendinopathy 8% Ramkumar et al. J Dance Med Sci
2016Injuries in a Professional Ballet Dance Company
• Foot & Ankle 38%• Sprain 10%• Achilles Tendinopathy 3%
• Back related 20% (most costly)
‘Many American ballet companies have taken to retaining in-house medical and training staff that, in one company of 70 dancers, demonstrated a $1.2 million savings over a 5-year period while simultaneously decreasing the injury incidence from 94% to 75%’
Ramkumar et alLower limb tendon care is a core need in Dance
Medicine
History in 30 seconds!
18 years ago….
7 years ago….
Now…
Tendinopathy
Causes
TreatmentDetection
Causes Collagen health• Systemic health• Pubertal development
Disordered Loading
• Biomechanics• Periodisation
Causes Collagen health• Systemic health• Pubertal
developmentDisordered
Loading• Biomechanics• Periodisation
Pubertal factors on overuse injuries J Dance Med Sci
2015The questions are being asked
Where does Collagen come into this?
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in puberty
• Life-time tendon collagen is synthesised by age 17• Puberty is a critical period of collagen synthesis• Lower Limb tendon development connected to growth• Tendon collagen is potentially as susceptible to RED-S as
bone collagen
Collagen synthesis in pubertyThe Australians are on to this!
Detection Symptom screening
• Too subjective• Late presentation
UTC – new US technology
• Objective data• Good interobserver reproducibility (once
trained)• Links to developing research base
Detection Symptom screening
• Too subjective• Late presentation
UTC – new US technology
• Objective data• Good interobserver reproducibility (once
trained)• Links to developing research base
UTC – Ultrasound Tissue Characterisation
Dr. Lorenzo Masci hard at work
UTC – Ultrasound Tissue Characterisation
UTC – Ultrasound Tissue Characterisation
Adapted from JL Cook, C PurdumBr J Sports Med 2008
UTC – Ultrasound Tissue Characterisation
L Masci, H AlfredsonBr J Sports Med 2014
Treatment Intelligent
Loading• better models• activity specificInvasive
adjuncts• Injections• Surgery
Treatment Intelligent
Loading• better models• activity specificInvasive
adjuncts• Injections• Surgery
Intelligent Loading
JL Cook, SI DockingBr J Sports Med August 2015
Thank you!