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De jumper’s knee (patellatendinopathie) is een frequent voorkomende, lastig te behandelen blessure die gekenmerkt wordt door be lastingafhankelijke pijn ter plaatse van de apex patellae. De etiologie is multifactorieel: aanleg, overbelasting en verstoringen in de spierpeesfunctie en bewegingsketen lijken een belangrijke rol te spelen. Histopathologisch is er bij een chronische patellatendinopathie sprake van een gestoord regeneratieproces (tendinose) en niet zoals vaak gedacht werd een tendinits. Vasculoneurale ingroei is mogelijk de oorzaak van de pijn. Dit heeft consequenties voor de behandelstrategie. Die moet meer gericht zijn op het bevorderen van de regeneratie en niet zozeer op het bestrijden van een inflammatoir proces. Dit verklaart mogelijk waarom in de afgelopen decennia een grote diversiteit aan (anti-inflammatoire) behandelingen met weinig succes werd toegepast.Het revalidatieprogramma van een sporter met een patellatendinopathie is een langdurig proces (3-6 maanden) waarin aanpassen van de belasting, (excentrische) oefentherapie gericht op verbetering van de spier-peesfunctie en optimalisering van de bewegingsketen zeker aan bod moeten komen. Later dienen ook meer sportspecifieke oefeningen te worden ingebouwd. Extracorporele Shockwave Therapie (ESWT) kan mogelijk een additioneel therapeutisch effect hebben. Wanneer conservatieve behandeling faalt, is operatief ingrijpen nog een optie. De resultaten zijn echter wisselend en een operatie is zeker geen garantie om snel terug te keren op het oorspronkelijke sportniveau. Op het nieuwe histopathologisch inzicht gebaseerde experimentele behandelmethoden zoals scleroseren van de neovascularisaties en toepassing van groeifactoren lijken veelbelovend maar nader onderzoek is nodig alvorens zij in de klinische praktijk kunnen worden toegepast.

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Controversy regarding the aetiology and treatment of patients with chronic fatigue syndrome (CFS) continues to affect the medical professions. The Cochrane collaboration advises practitioners to implement graded exercise therapy for CFS sufferers using cognitive behavioural principles. In contrast there is evidence that exercise can induce symptom exacerbations in CFS where too vigorous exercise/activity promotes immune dysfunction, which in turn increases symptoms in patients with CFS. When designing and implementing an exercise programme it is important to be aware of both these seemingly opposing view points in order to deliver a programme without any detrimental effects on CFS pathophysiology. Using evidence from both the biological and clinical sciences, the present manuscript explains that graded exercise therapy for people with CFS can be safely undertaken without detrimental effects to the immune system. Exercise programs should be designed to cater for individual physical capabilities and should also account for the fluctuating nature of symptoms commonly reported by people with CFS. In line with cognitive behaviourally and graded exercise-based strategies, self-management for people with CFS involves encouraging the patients to pace their activities and respect their physical and mental limitations with the ultimate aim of improving their everyday function.

Jaarboek fysiotherapie met als thema psychosomatiek/psychologische benaderingen binnen de fysiotherapie

Introduction: Previous research has shown that patients with Chronic Fatigue Syndrome (CFS) present with an abnormal exercise response and exacerbation of symptoms after physical activity. Preliminary evidence for an association between the deregulation of the 2 ,5 -oligoadenylate (2-5A) synthetase/RNase (ribonuclease) L pathway and impairments of exercise capacity has been provided. This cross-sectional study aimed at examining the associations between the various components of the 2-5A synthetase/RNase L pathway and impairments of cardiorespiratory fi tness in CFS patients. Methods: Sixteen randomly allocated CFS underwent venous blood sampling and performed a maximally exercise stress test on a bicycle ergometer with continuous monitoring of cardiorespiratory parameters. The following blood parameters were assessed: the ratio of 37 kDa RNase L to the 83 kDa native RNase L (using a radiolabeled ligand/receptor assay), RNase L enzymatic activity (enzymatic assay), protein kinase R activity assay (comparison Western blot), elastase activity in monocytes and lymphocytes (enzymatic colorimetric assay), the number and % of monocytes and lymphocytes; and nitric oxide determination (for monocytes and lymphocytes; fl ow cytometry, live cell assay). Results: Forward stepwise multiple regression analysis revealed 1/ that the level of elastase was the only factor related to the reduction in oxygen uptake at a respiratory quotient (RQ) of 1.0 (regression model: R2=.53,F(1,14)=15.5,pactivity was the principle factor related to the reduction in workload at RQ=1.0 (R2=.77,F(6,9) =5.2,pL ratio pprinciple factor related to the reduction in % of target heart rate achieved (R2=.89,F(7,8)=9.5,p< .002; elastase pConclusion: These data provide evidence for an association between intracellular immune deregulation and impairments in cardiorespiratory fi tness in CFS. To establish a causal relationship, however, further studying of these interactions in a larger study sample and using a prospective longitudinal design is required.

Hip geometry and bone mineral density (BMD) have previously been shown to relate independently to hip fracture risk. Our objective was to determine by how much hip geometric data improved the identification of hip fracture. Lunar pencil beam scans of the proximal femur were obtained. Geometric and densitometric values from 800 female controls aged 60 years or more (from population samples which were participants in the European Prospective Osteoporosis Study. EPOS) were compared with data from 68 female hip fracture patients aged over 60 years who were scanned within 4 weeks of a contralateral hip fracture. We used Lunar DPX ‘beta’ versions of hip strength analysis (HSA) and hip axis length (HAL) applied to DPX(L) data. Compressive stress (Cstress), calculated by the HSA software to occur as a result of a typical fall on the greater trochanter. HAL, body mass index (BMI: weight/(height)) and age were considered alongside femoral neck BMD (FN-BMD, g/cm(2)) as potential predictors of fracture. Logistic regression was used to generate predictors of fracture initially from FN-BMD. Next age, Cstress (as the most discriminating HSA-derived parameter), HAL and BMI were added to the model as potentially independent predictors. It was not necessary to include both HAL and Cstress in the logistic models. so the entire data set was examined without excluding the subjects missing HAL measurements. Cstress combined with age and BMI provided significantly better prediction of fracture than FN-BMD used alone as is current practice, judged by comparing areas under receiver operating characteristic (ROC) curves (p

Hip geometry and bone mineral density (BMD) have been shown previously to relate, independently of each other, to risk of hip fracture. We used Lunar DPX “beta” versions of hip strength analysis (HSA) and hip axis length (HAL) software to analyze scans from ten representative age-stratified population samples in the European Prospective Osteoporosis Study (EPOS), All 1617 subjects were >50 years of age, and 1033 were women. The data were modeled with gender and center as categorical variables. The bone mineral density of the upper half of the femoral neck declined at a faster rate with age than that in the lower half, Femoral neck cross-sectional moment of inertia (CSMI), a measure of resistance to bending, showed no significant age reduction in either gender. However,height and weight effects on CSMI were significantly more beneficial in men than in women (0.002 < p < 0.012) and the weight effect appeared to be mediated by bone mineral content (BMC), Compressive stress (Cstress), defined as the stress in the femoral neck at its weakest cross section arising from a standardized fall, was higher in women. Although Cstress increased with body weight when BMC was held constant, in practice it fell through the association and statistical interaction of rising body weight with rising BMC, HAL, as expected, was strongly positively associated with male gender and also height (p < 0.0001). Hip strength-related indices were markedly center-dependent. Significant differences (p < 0.0001) were noted between the centers for all the variables investigated that related to hip geometry. Adjustment for femoral neck bone mineral content (totBMC) showed these center differences to account for >50% of center variation in hip strength, which remained highly significant (p < 0.0001). We conclude that there are substantial geographical differences in femoral neck geometry as well as in BMD, These geometric variations may contribute to the large variations in hip fracture risk across Europe. The effects of aging on hip strength need to be explored in longitudinal studies. (Bone 27:151-159; 2000) (C) 2000 by Elsevier Science Inc. All rights reserved.