Is Achilles tendon blood flow related to foot pronation?

In the etiology of Achilles tendinopathy (AT), it is frequently suggested that excessive pronation causes a vascular constriction of the Achilles tendon, described as the "whipping phenomenon" (Clement et al., 1984). Although previous studies focused on the association between pronation and AT, it is striking that the underlying association between foot pronation and blood flow has not been studied yet. Therefore, the aim of this study was to investigate whether the amount of pronation during running influences the Achilles tendon blood flow. Twenty-five experienced runners, aged 34.5±10.2 years, participated in this study. 2D-lower limb kinematics during barefoot and shod running in both frontal and sagittal plane were assessed. Blood flow of the Achilles tendon was measured before and after barefoot and shod running, using the oxygen-to-see device. The results of this study showed a significant effect of eversion excursion on the increase in Achilles tendon blood flow after shod running. More specifically, the more the eversion excursion observed, the lower the increase in blood flow (P=.013). We therefore suggest, in individuals with increased inversion at touchdown and increased eversion around midstance during shod running, that antipronation measures could be useful in both preventing and managing Achilles tendinopathy.

What does normal tendon structure look like? New insights into tissue characterization in the Achilles tendon.

Recently, ultrasound tissue characterization (UTC) was introduced as a reliable method for quantification of tendon structure. Despite increasing publications on the use of UTC, it is striking that there is a lack of normative data in active adolescents. Therefore, the aim of this study was to provide normative values of the Achilles tendon as quantified by UTC. Seventy physiotherapy students (26 male and 44 female students) with no history of Achilles tendon injuries were recruited. The Achilles tendons were scanned with UTC to characterize tendon structure. This study demonstrated that Achilles tendons of active, healthy adolescents contained 54.6% echo type I, 42.8% echo type II, 2.2% echo type III, and 0.3% echo type IV at midportion. The comparison between insertion and midportion of the tendon showed more echo type II at insertion (P < 0.001). Furthermore, female tendons contained significantly more echo type II, in both insertion and midportion compared with male tendons (P = 0.004 and P = 0.003, respectively). The results of this study, with respect to the MDC (minimum detectable change), highlight differences in the UTC echopattern in the normal population (sex and regional location), which are important considerations for future studies.

Arguments for an increasing differentiation towards fibrocartilaginous components in midportion Achilles tendinopathy.

PURPOSE: The objective of this study was to investigate the fibrocartilaginous differentiation occurring in midportion Achilles tendinopathy. METHODS: Tendon samples were retrospectively collected from 23 patients, who had undergone surgery for midportion Achilles tendinopathy resistant to conservative treatment. Based on histological scores, the biopts were subdivided into three categories: a light, moderate and severe histopathological stage. Throughout these stages, immunohistochemical staining was performed against biglycan, aggrecan and collagen type II, components characteristic for fibrocartilage. Staining of these components was evaluated using a semi-quantitative scoring method. RESULTS: The immunohistochemical scores of biglycan and aggrecan were statistically significant between the histopathological stages (P < 0.001). The immunohistochemical scores were positively correlated with the increasing histopathological stages [Spearman's correlation coefficient = 0.93 for biglycan and 0.78 for aggrecan (P < 0.001)]. Staining for collagen type II remained negative throughout these stages. CONCLUSION: Immunohistochemical staining of the fibrocartilaginous components biglycan and aggrecan showed a progressive increase, correlated with a further evolved histopathological stage. This observation gave arguments for an increased differentiation towards fibrocartilaginous components at protein level in midportion Achilles tendinopathy.

Blood flow of the Achilles tendon during military training.

The purpose of this study was to evaluate the vascular response of the Achilles tendon as indicated by power Doppler activity during a military training program of 6 weeks. 49 male military recruits (98 tendons) volunteered for this study. Before and during the military training program, the Achilles tendons were screened with gray-scale ultrasonography and power Doppler US. Reactive tendinopathies of the Achilles tendons were registered by means of a clinical examination, VAS-scores and VISA-A scores. The US examination, the clinical examination, VAS-scores and VISA-A scores showed that 13/98 tendons developed a reactive tendinopathy. 3 of these 13 symptomatic tendons showed intratendinous Doppler activity. In these tendons, pain was always present before the vascular response of the Achilles tendon. Both pain and hypervascularisation remained visible till the end of the basic military training. In 5 asymptomatic tendons with no structural changes of the tendon, a vascular response was seen during one single measurement. It can be hypothesized that there is no relationship between the vascular response of the Achilles tendon and the pain in a reactive tendinopathy. In a reactive tendinopathy, other pain mechanisms must be investigated in future research.

Effect of proprioceptive neuromuscular facilitation stretching on the plantar flexor muscle-tendon tissue properties.

Proprioceptive neuromuscular facilitation (PNF) stretching programs have been shown to be the most effective stretching technique to increase the range of motion (ROM). The objective of this study was to examine the mechanism of effect of PNF stretching on changes in the ROM. Sixty-two healthy subjects were randomized into two groups: a PNF stretching group and a control group. The PNF group performed a 6-week stretching program for the calf muscles. Before and after this period, all subjects were evaluated for dorsiflexion ROM, passive resistive torque (PRT) of the plantar flexors and stiffness of the Achilles tendon. The results of the study revealed that the dorsiflexion ROM was significantly increased in the PNF group (DeltaROMext: 5.97+/-0.671 degrees ; DeltaROMflex: 5.697+/-0.788 degrees ). The PRT of the plantar flexors and the stiffness of the Achilles tendon did not change significantly after 6 weeks of PNF stretching. These findings provide evidence that PNF stretching results in an increased ankle dorsiflexion. However, this increase in ROM could not be explained by a decrease of the PRT or by a change in stiffness of the Achilles tendon, and therefore can be explained by an increase in stretch tolerance.

Assessment of chemical and biochemical stabilization of organic C in soils from the long-term experiments at Rothamsted (UK).

Biological and chemical stabilization of organic C was assessed in soils sampled from the long-term experiments at Rothamsted (UK), representing a wide range of carbon inputs and managements by extracting labile, non-humified organic matter (NH) and humic substances (HS). Four sequentially extracted humic substances fractions of soil organic matter (SOM) were extracted and characterized before and after a 215-day laboratory incubation at 25 degrees C from two arable soils, a woodland soil and an occasionally stubbed soil. The fractions corresponded to biochemically stabilised SOM extracted in 0.5M NaOH (free fulvic acids (FA) and humic acids (HA)) and chemically plus biochemically stabilised SOM extracted from the residue with 0.1M Na4P2O7 plus 0.1M NaOH (bound FA and HA). Our aim was to investigate the effects of chemical and biochemical stabilization on carbon sequestration. The non-humic to humic (NH/H) C ratio separated the soils into two distinct groups: arable soils (unless fertilised with farmyard manure) had an NH/H C ratio between 1.05 and 0.71, about twice that of the other soils (0.51-0.26). During incubation a slow, but detectable, decrease in the NH/H C ratio occurred in soils of C input equivalent or lower to 4Mgha(-1)y(-1), whereas the ratio remained practically constant in the other soils. Before incubation the free to bound humic C ratio increased linearly (R2=0.91) with C inputs in the soils from the Broadbalk experiment and decreased during incubation, showing that biochemical stabilization is less effective than chemical stabilization in preserving humic C. Changes in delta13C and delta15N after incubation were confined to the free FA fractions. The delta13C of free FA increased by 1.48 and 0.80 per thousand, respectively, in the stubbed and woodland soils, indicating a progressive biological transformation. On the contrary, a decrease was observed for the bound FA of both soils. Concomitantly, a Deltadelta15N of up to +3.52 per thousand was measured after incubation in the free FA fraction and a -2.58 Deltadelta15N in the bound FA. These changes, which occurred during soil incubation in the absence of C inputs, indicate that free FA fractions were utilised by soil microorganisms, and bound FA were decomposed and replaced, in part, by newly synthesized FA. The 13CPMAS-TOSS NMR spectra of free HA extracted before and after 215 days of incubation were mostly unchanged. In contrast, changes were evident in bound HA and showed an increase in aromatic C after incubation.

The role of stretching in tendon injuries.

The function of tendons can be classified into two categories: tensile force transmission, and storage and release of elastic energy during locomotion. The action of tendons in storing and releasing energy is mainly seen in sports activities with stretch-shortening cycles (SSCs). The more intense the SSC movements are (jumping-like activities), the more frequently tendon problems are observed. High SSC movements impose high loads on tendons. Consequently, tendons that frequently deal with high SSC motion require a high energy-absorbing capacity to store and release this large amount of elastic energy. As the elasticity of tendon structures is a leading factor in the amount of stored energy, prevention and rehabilitation programmes for tendon injuries should focus on increasing this tendon elasticity in athletes performing high SSC movements. Recently, it has been shown that ballistic stretching can significantly increase tendon elasticity. These findings have important clinical implications for treatment and prevention of tendon injuries.

Trapezius activity and intramuscular balance during isokinetic exercise in overhead athletes with impingement symptoms.

We compared normalized trapezius muscle activity and intramuscular balance ratios between overhead athletes with impingement symptoms and non-injured athletes during isokinetic abduction and external rotation movements. Thirty-nine overhead athletes with chronic impingement symptoms and 30 non-injured athletes participated in the study. Electromyographic activity of upper, middle, and lower trapezius was measured during isokinetic abduction and external rotation, using surface electrodes. The results show a significant increase of upper trapezius activity during both movements in the patient group, with decreased activity in the lower trapezius during abduction, and in the middle trapezius during external rotation. Analysis of the intramuscular activity ratios revealed muscle imbalance on the injured side of the patient group for upper/middle trapezius and upper/lower trapezius during abduction, and for all three muscle activity ratios during external rotation. These results confirm the presence of scapular muscle imbalances in patients with impingement symptoms and emphasize the relevance of restoration of scapular muscle balance in shoulder rehabilitation.

Mechanisms of phosphorus solubilisation in a limed soil as a function of pH.

Phosphorus (P) quantity-intensity relationships are central to the solubility and release of P from soil to water. Relationships between P extractable by 0.5 M NaHCO extractable P (Olsen P; quantity, Q) and P extractable by 0.01 M CaCl(2) (CaCl(2)-P; possible predictor of soil solution or drainage water P; intensity, I) are curvilinear: above a certain Olsen P concentration, CaCl(2)-P becomes much more soluble than when below it. Aluminium-, Fe- and Ca-P forms (extractable by Olsen's reagent) are thought to control P solubility. Thus, our objectives were to identify P forms in equilibrium with CaCl(2)-P via solubility equilibrium experiments, and the behaviour of CaCl(2)-P in relation to Al, Fe and Ca associated P, determined with 31P high power decoupling magic angle spinning nuclear magnetic resonance spectroscopy (31P HPDec/MAS NMR). Results indicated that two Q-I relationships occurred, one for soils above pH 5.8, and the other for soils below pH 5.8. Above pH 5.8, soils were saturated with respect to hydroxyapatite (Ca(5)(PO(4))(3)OH) and undersaturated with respect to beta-tricalcium phosphate (beta-Ca(3)(PO(4))(2)), while log ion-activity products showed that all soils and pHs were either saturated or in equilibrium with variscite (AlPO(4).2H(2)O) or its amorphous analogue. Using 31P HPDec/MAS NMR, Ca-P was best correlated with CaCl(2)-P in soils above pH 5.8, and with Al-P in soils below this pH. This study demonstrates the value of solid-state NMR in conjunction with wet chemical techniques for the study of labile P and P loss from pasture soils with a wide range of managements.

Multinuclear magnetic resonance analysis of two humic acid fractions from lowland rice soils.

To determine the effects of intensive cropping of tropical lowland rice (Oryza sativa L.) and the associated long-term soil submergence on chemical properties of soil organic matter, we used solid-state 13C and 15N and solution 31P nuclear magnetic resonance (NMR) spectroscopy to analyze the labile mobile humic acid (MHA) and the more recalcitrant calcium humate (CaHA) fractions extracted from a series of soils supporting several long-term field experiments in the Philippines. The soils varied mainly in degree of submergence and cropping intensity, ranging from a rainfed rice field without soil submergence to irrigated double- and triple-cropped fields in which soil remains submerged almost all year long. As reported previously, all analyses associated increasing intensity of rice cropping with larger proportions of less humified material in the MHA and CaHA, such as diester phosphorus (P), amide nitrogen (N), and phenolic carbon (C). We established significant correlations between proportions of various spectral areas as well as between some spectral areas and other humic acid (HA) properties such as visible light absorption and free radical concentration (positive indices of humification) and hydrogen (H) concentration (negative index of humification). For example, spectral proportions of heterocyclic N were positively, and proportions of amide N and phenolic C negatively, correlated with visible light absorption and free radical concentration, and each of these spectral proportions had an opposite sign when correlated with H concentration. The correlations of N-alkyl C proportions were the strongest with these properties and with other functional group proportions.

Analysis of potentially mobile phosphorus in arable soils using solid state nuclear magnetic resonance.

In many intensive agroecosystems continued inputs of phosphorus (P) over many years can significantly increase soil P concentrations and the risk of P loss to surface waters. For this study we used solid-state 31P nuclear magnetic resonance (NMR) spectroscopy, high-power decoupling with magic angle spinning (HPDec-MAS) NMR, and cross polarization with magic angle spinning (CP-MAS) NMR to determine the chemical nature of potentially mobile P associated with aluminum (Al) and calcium (Ca) in selected arable soils. Three soils with a range of bicarbonate-extractable Olsen P concentrations (40-102 mg P kg(-1)) were obtained from a long-term field experiment on continuous root crops at Rothamsted, UK, established in 1843 (sampled 1958). This soil has a threshold or change point at 59 mg Olsen P kg(-1), above which potentially mobile P (as determined by extraction with water or 0.01 M CaCl2) increases much more per unit increase in Olsen P than below this point. Results showed that CaCl2 and water preferentially extracted Al-P and Ca-P forms, respectively, from the soils. Comparison among the different soils also indicated that potentially mobile P above the threshold was largely present as a combination of soluble and loosely adsorbed (protonated-cross polarized) P forms largely associated with Ca, such as monetite (CaHPO4) and dicalcium phosphate dihydrate (CaHPO4-2H2O), and some Al-associated P as wavellite. The findings of this study demonstrate that solid-state NMR has the potential to provide accurate information on the chemical nature of soil P species and their potential mobility.