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The literature on the relation between jump biomechanics and jumper's knee indicates that a jump with horizontal displacement poses a threat for developing jumper's knee. Subjects with jumper's knee have been shown to display a stiff landing pattern characterized by a small range of motion. However, up to now only crosssectional studies have been conducted. 6 teams from sports involving repetitive landing were followed prospectively for 2 years. At baseline athletes performed the Landing Error Scoring System jump and 3D kinematics and kinetics were obtained. A comparison was made between subjects who developed jumper's knee and those who did not develop it. 3 subjects developed jumper's knee during the study. Leg stiffness during landing was high compared to the mean of the healthy controls. No common kinematic patterns could be identified in these 3 subjects. The results suggest that athletes with high leg stiffness during landing might have an increased risk for developing jumper's knee, yet this conclusion is based on a very small sample. Subjects who develop jumper's knee do not show a common landing technique. Further research is needed to investigate whether leg stiffness can be used to identify athletes at risk and as a target variable to be used in prevention. [ABSTRACT FROM AUTHOR]

Patellar tendinopathy (jumper's knee) has a high prevalence in jumping athletes. Excessive load on the patellar tendon through high volumes of training and competition is an important risk factor. Structural changes in the tendon are related to a higher risk of developing patellar tendinopathy. The critical tendon load that affects tendon structure is unknown. The aim of this study was to investigate patellar tendon structure on each day of a 5-day volleyball tournament in an adolescent population (16-18 years). The right patellar tendon of 41 players in the Australian Volleyball Schools Cup was scanned with ultrasound tissue characterization ( UTC) on every day of the tournament ( Monday to Friday). UTC can quantify structure of a tendon into four echo types based on the stability of the echo pattern. Generalized estimating equations ( GEE) were used to test for change of echo type I and II over the tournament days. Participants played between eight and nine matches during the tournament. GEE analysis showed no significant change of echo type percentages of echo type I ( Wald chi-square = 4.603, d.f. = 4, P = 0.331) and echo type II ( Wald chi-square = 6.070, d.f. = 4, P = 0.194) over time. This study shows that patellar tendon structure of 16-18-year-old volleyball players is not affected during 5 days of cumulative loading during a volleyball tournament. [ABSTRACT FROM AUTHOR]

Patellar tendinopathy ( PT) is a common overuse injury of the patellar tendon in jumping athletes. In a recent large cross-sectional study from 2008 several factors were identified that may be associated with the etiology of PT. However, because of the study design no conclusions could be drawn about causal relations. The primary aim of the current study is to investigate whether the factors identified in the previous 2008 study can also be prospectively recognized as predictors of symptomatic PT in 2011. Nine hundred twenty-six Dutch elite and non-elite basketball and volleyball players from the previous study were invited again to complete an online survey about knee complaints and risk factors for PT in 2011. The logistic regression included 385 athletes of which 51 (13%) developed PT since 2008. Male gender [odds ratio ( OR) 2.0, 95% confidence interval ( CI) 1.1-3.5] was found to be a risk factor for developing PT. No sports-related variables could be identified to increase the risk of developing PT, but some evidence was found for performing heavy physically demanding work, like being a nurse or a physical education teacher ( OR 2.3, 95% CI 0.9-6.3). These findings indicate that, when considering preventive measures, it is important to take into account the total tendon load. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of conservative treatment (CT) on pain and function in patients with patellar tendinopathy (PT) compared with minimal (MI) or other invasive interventions (OI), or in addition to decline eccentric squat. Methods: Searches were performed in MEDLINE, Embase, Cochrane, PEDro, SPORTDiscus, CINAHL and AMED databases. All randomised trials that evaluated CT in individuals with PT were included. Two reviewers screened studies, extracted data, and assessed risk of bias of all included studies. Meta-analyses were conducted and we assessed certainty of the evidence using GRADE methodology. Results: When compared to MI, CT did not improve pain (mean difference = -0.2, 95% CI -1.5 to 1.1) or function (mean difference = -2.2, 95% CI -11.8 to 7.4) at medium/long-term followup. When compared with OI, CT did not improve pain (mean difference = -0.4, 95% CI -2.6 to 1.8) or function (mean difference = 5.9, 95% CI -17.1 to 29.0) at medium/long-term followup. No overall effects were found for combined CT (when a conservative intervention was added to decline eccentric squat) on pain (mean difference = -0.5, 95% CI -1.4 to 0.4) or function (mean difference = -2.3, 95% -9.1 to 4.6) at short-term followup. Single studies showed an effect on pain with iontophoresis at short-term follow-up (d=2.42) or dry-needling at medium/ long-term follow-up (d=1.17) and function with exercise intervention at medium/long-term follow-up (d=0.83). Conclusions: The estimates of treatment effect have only low-to very-low-certainty evidence to support them. Clinical implications: There is low to very low certainty evidence to support the short- and long-term effects of exercise, dry needling and iontophoresis as treatments for PT. This field of sports medicine/sports physiotherapy urgently needs larger, high quality studies with pain and function considered among the potential primary outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to investigate lower limb tendinopathy incidence over 3 seasons in Brazilian youth elite athletes., Design: Prospective epidemiological study., Methods: A prospective study was performed during 2015, 2016 and 2017 seasons, with a total of 1553 Brazilian youth athletes (1.195 male and 358 female) out of 6 sports (volleyball, basketball, judo, gymnastics, tennis and futsal). The mean age was 14.1 (11.2; 17.0) years, mean height was 1.75 (1.55; 1.95) meters and mean body mass was 59.4 (42.0; 76.4) kilograms. The diagnosis of lower limb tendinopathy (LLT) was made by an experienced sports physician based on a detailed history and clinical exam. The incidence of LLT was determined by number of injuries/total exposure hours x 1000., Results: In total, 100 LLT were recorded during the 3 seasons. The most frequent type of LLT was patellar (79%), adductor (12%) and Achilles (9%). The frequency of patellar tendinopathy was higher in male's volleyball, basketball and female volleyball (41%, 25%, 13%, respectively) and the frequency of Achilles tendinopathy was higher in basketball and female volleyball (33%,22%). The LLT incidence was 2.5/1000h in 2015, 4.2/1000h in 2016 and 2.1/1000h in 2017., Conclusion: Lower limb tendinopathies are relatively common in youth elite athletes. In 3-season, the most frequent type was patellar tendinopathy. A higher LLT incidence was observed in male volleyball athletes when compared to female volleyball athletes. Basketball athletes presented a higher frequency of patellar, adductor and Achilles tendinopathies in 3-seasons when compared to other sports., Competing Interests: Declaration of competing Interest None, (Copyright © 2024. Published by Elsevier Ltd.)

Objective: To systematically describe the next relevant aspects of tendotonometry in (1) its validity and reliability, (2) differences between populations, (3) the effect of interventions, and (4) differences between healthy and symptomatic Achilles tendon (AT) and patellar tendon (PT)., Data Sources: Three online databases (PubMed, Embase, and EBSCOhost) were systematically searched on the 10th of October 2023. All scientific literature concerning the use of tendotonometry in assessing tendon stiffness was collected. Articles were eligible if tendotonometry with a myotonometer digital palpation device was used to assess PT or AT stiffness in adults., Main Results: Thirty-four studies were included, which were categorized into studies regarding the (1a) reliability and (1b) validity of tendotonometry, (2) differences in stiffness between populations, (3) changes in stiffness due to interventions, (4) stiffness of healthy compared with injured tendons, and (5) other observational studies. The inter-rater and intrarater reliability of tendotonometry appeared to be good in assessing AT and PT stiffness, with only moderate evidence for the AT and inconclusive evidence for the PT. There is high certainty evidence that tendotonometry can detect differences in AT and PT stiffness after training interventions. Inconsistent results were found for the adequacy of tendotonometry to detect differences in AT and PT stiffness between populations., Conclusions: This review shows a potential role for tendotonometry in measuring tendon stiffness. However, more research is needed for validating the use of tendotonometry in AT and PT and its exact clinical interpretation., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This observational study aimed to evaluate the intra- and inter-operator reliability of a digital palpation device in measuring compressive stiffness of the patellar tendon at different knee angles in talent and elite volleyball players. Second aim was to examine differences in reliability when measuring at different knee angles, between dominant and non-dominant knees, between sexes, and with age. Two operators measured stiffness at the midpoint of the patellar tendon in 45 Dutch volleyball players at 0°, 45° and 90° knee flexion, on both the dominant and non-dominant side. We found excellent intra-operator reliability (ICC>0.979). For inter-operator reliability, significant differences were found in stiffness measured between operators (p<0.007). The coefficient of variance significantly decreased with increasing knee flexion (2.27% at 0°, 1.65% at 45° and 1.20% at 90°, p<0.001). In conclusion, the device appeared to be reliable when measuring compressive stiffness of the patellar tendon in elite volleyball players, especially at 90° knee flexion. Inter-operator reliability appeared to be questionable. More standardized positioning and measurement protocols seem necessary., Competing Interests: All authors affirm that they have no financial affiliation (including research funding) or involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript., (Copyright: © 2024 van Dam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: To better understand physical activity behavior and its health benefits in people living with health conditions, we studied people with and without 20 different self-reported health conditions with regard to (1) their physical activity levels, (2) factors correlated with these physical activity levels, and (3) the association between physical activity and all-cause mortality., Methods: We used a subsample (n = 88,659) of the Lifelines cohort study from the Netherlands. For people living with and without 20 different self-reported health conditions, we studied the aforementioned factors in relation to physical activity. Physical activity was assessed with the Short Questionnaire to Assess Health-Enhancing Physical Activity Questionnaire, and mortality data were obtained from the Dutch death register., Results: People with a reported health condition were less likely to meet physical activity guidelines than people without a reported health condition (odds ratios ranging from 0.55 to 0.89). Higher body mass index and sitting time, and lower self-rated health, physical functioning, and education levels were associated with lower odds of meeting physical activity guidelines across most health conditions. Finally, we found a protective association between physical activity and all-cause mortality in both people living with and without different health conditions., Conclusion: People living with different health conditions are generally less physically active compared with people living without a health condition. Both people living with and without self-reported health conditions share a number of key factors associated with physical activity levels. We also observed the expected protective association between physical activity and all-cause mortality.

Background: Biofeedback may alter the biomechanics of lower extremities in patients with chronic ankle instability (CAI). We aimed to systematically review the literature on the effect of gait-training and biofeedback on biomechanical parameters in individuals with CAI and conduct a meta-analysis., Methods: We searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 30th June 2022. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify those reporting the effect of biofeedback on biomechanical factors associated with CAI. Outcomes of interest were kinetics and kinematics. Two authors separately extracted data from included studies. Data of interest were study design, number of sessions, intervention, tools, outcomes, number, sex, age, height, and body mass of participants., Results: Thirteen studies with a total of 226 participants were included. Biofeedback was capable of shifting center of pressure (COP) and lateral plantar pressure medially and reducing foot inversion, adduction, propulsive vertical ground reaction force (vGRF), ankle joint contact force, peak pressure and pressure time integral in the lateral mid-foot and forefoot. Auditory biofeedback had agreater impact on modifying plantar pressure in individuals with CAI. The meta-analyses revealed that visual biofeedback reduces peak pressure in lateral mid-foot and pressure time integral at lateral and medial heel and pressure increases under the hallux., Conclusion: Biofeedback can alter pressure, vGRF, and foot inversion associated with CAI. Auditory biofeedback had greater impact on modifying plantar pressure in individuals with CAI. Further studies are required to assess the prolonged effect and clinical consequences of biofeedback or a combination of feedback on CAI in different age groups. Moreover, developing a low-cost and user-friendly device that can be evaluated in high quality RCTs is important prior to implementing the intervention in the clinical setting to reduce symptoms of CAI., (© 2023. The Author(s).)

Tendon problems of upper and lower extremity are common and can have impact on quality of life. The preferred terminology for load dependent tendon pain and loss of function is tendinopathy. The underlying pathophysiology of tendinopathy is complex and usually not a tendinitis. The Continuum of tendinopathy-model describes the role of load in 3 stages of tendinopathy which can be helpful in management of tendinopathy. Diagnosis of tendinopathy can be based on history and clinical examination. The role of imaging in diagnosis and prognosis is limited. Patient education, load management and progressive tendon loading exercises are the cornerstone of treatment. In case this approach fails there are several treatment options that can be considered, however there is only low or conflicting evidence on its effectiveness.

Objectives: Abdominal complaints (AC) during exercise are a common problem in runners. Nutrition is known to play a role in exercise-related AC, but information on the role of habitual dietary intake is limited. We assessed the prevalence of AC in a large cohort of runners, and investigated its association with potential risk factors, with a particular focus on nutritional factors in the habitual diet., Methods: A total of 1993 runners completed two online questionnaires: a general questionnaire on, among others, running habits and exercise-related AC and a Food Frequency Questionnaire. Runners with and without either upper AC (UAC) or lower AC (LAC) were compared regarding personal characteristics, running characteristics and habitual dietary intake., Results: 1139 runners (57%) reported AC during and/or up to 3 hours after running: 302 runners (15%) reported UAC, 1115 (56%) LAC and 278 (14%) both. In about one-third of runners with AC, these complaints negatively affected their running. Exercise-related AC were positively associated with female gender, younger age and more intense running. Most associations with nutritional factors were observed only for LAC in men, with a higher intake of energy, all macronutrients and grain products in men with LAC. In both men and women, a higher intake of tea and unhealthy choices were associated with AC., Conclusion: Exercise-related AC were quite prevalent, and in about one-third of the cases, AC impacted their running. Being female, having a younger age and running at higher intensity were positively associated with AC. Some aspects of the habitual diet were associated with AC. Most notable were positive associations for intake of fat, tea and unhealthy choices., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Lower limb tendinopathy (LLT) is highly prevalent in runners. Treatment can be challenging, and knowledge of risk factors may be valuable to develop preventive or treatment interventions for LLT. The aims of this study were (1) to assess the prevalence of three common LLTs (Achilles tendinopathy (AT), patellar tendinopathy and plantar fasciopathy) in a large cohort of Dutch and Belgian runners and (2) to investigate its association with potential risk factors, with a particular focus on nutritional factors in the habitual diet., Methods: A total of 1993 runners were included in the study. They completed two online questionnaires: a general questionnaire on running habits and injuries and a Food Frequency Questionnaire. Runners with and without LLT were compared regarding personal characteristics, running characteristics and nutritional factors., Results: The point prevalence for the three LLTs was 6%; 33% of the runners reported LLT in the past and 35% had either a current or past LLT. AT was the most prevalent type of LLT, and prevalence rates for all types of LLT were higher in men than women. Positive associations with LLT were observed for age and running years (men and women), running level and running distance (men). No associations between LLT and nutritional factors were observed., Conclusion: One-third of this population of runners had ever experienced an LLT. These tendinopathies were associated with gender, age and running load, but not with nutritional factors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Task-specific dystonia is a movement disorder of the central nervous system characterized by focal involuntary spasms and muscle contractions, which can negatively affect performance of a specific task. It can affect a wide range of fine motor skills, also in athletes. Current management of task-specific dystonia includes mainly prescribing drugs, exercise therapy or botulinum injections to the affected muscles. Psychological interventions for athletes suffering from task-specific dystonia have not been described extensively so far., Methods: We present a case-series of 4 different advanced skill-level athletes with suspected task-specific dystonia, which had a major impact on their performance. They all received treatment consisting of a combination of standardized behavioural therapy and relaxation techniques in the form of hypnosis in a total of 8 sessions in a 16-week time period., Results: After treatment, all athletes returned to their original high level of sport performance without further symptoms of their suspected task-specific dystonia., Discussion: Behavioural therapy in combination with a relaxation technique seems to be a safe and promising treatment for athletes with suspected task-specific dystonia. Further studies in a larger, preferably randomized controlled trial, are warranted to evaluate if this treatment strategy is effective in athletes with suspected task-specific dystonia., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Background: A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO., Methods: Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m 2 ) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up., Discussion: This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle., Trial Registration: ISRCTN ISRCTN13046877 . Registered 21 April 2022., (© 2023. The Author(s).)

Background: Tendinopathy is a painful condition that is prevalent in athletes as well as the general human population, and whose management is challenging., Objective: This systematic review aimed to evaluate the impact of nutrition on the prevention and treatment of tendinopathy., Methods: Searches were conducted in PubMed, EMBASE, Web of Science, and SPORTDiscus without restriction to year of publication. Studies examining the impact of exposure to nutrient intake in an adult human population on 1) prevalence/incidence of tendinopathy, 2) clinical outcomes of tendinopathy, 3) structural changes in the tendon by imaging modalities. Experimental and observational study designs written in English, Dutch, or German were eligible., Results: Nineteen studies met the inclusion criteria. The effects of the habitual diet were investigated in one study. Four studies examined the effects of exposure to alcohol. Alcohol consumption can be a potential risk factor associated with Achilles tendinopathy and rotator cuff tears, although findings were inconsistent. The use of dietary supplements was examined in fourteen studies. Among these, collagen-derived peptides were most often part of the supplements evaluated. Combining training and dietary supplements seems to induce better clinical and functional outcomes in tendinopathy., Conclusion: This review demonstrates the paucity of high-quality studies and a wide variety among studies regarding nutrients, tendon location, study population, and reported outcome measures. Individual studies showed promising clinical implications for the use of dietary supplements, particularly those containing collagen-derived peptides. However, giving any definitive dietary recommendations on the prevention and treatment of tendinopathy remains elusive., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)