Background: The goal of the study was to determine the rate of running-associated tendinopathy in light of the amount of time training and other risk factors. Materials and Methods: 291 elite runners (average age 42 ± 9 years) who ran an average of 65.2 ± 28.3 km/week were included with an overall distance of 9,980,852 km (34,416 km/athlete). Descriptive statistics with Chi ² -Test, Fisher-Exact-Test and Mann-Whitney-Test were used to calculate relative risks (RR). Results: The overall injury rate was 0.08/1000 km (2.93/athlete). Overuse injuries (0.07/1000 km) were more frequent than acute injuries (0.01/1000 km). Achilles tendinopathy was the predominant injury (0.02/1000 km) followed by anterior knee pain (0.01/1000 km), and shin splints (0.01/1000 km). Achilles tendon rupture was rarely encountered (0.001/1000 km). At some time, 56.6% of the athletes had an Achilles tendon overuse injury, 46.4% anterior knee pain, 35.7% shin splints, and 12.7% had plantar fasciitis. Mid-portion Achilles tendinopathy was more common (0.01/1000 km) than insertional (0.005/1000 km). An asphalt running surface decreased mid-portion tendinopathy risk (RR 0.47, p = 0.02). In contrast, sand increased the relative risk for mid-portion Achilles tendinopathy tenfold (RR 10, CI 1.12 to 92.8, p = 0.01). Runners with more than 10 years experience had an increased risk (RR 1.6, p = 0.04) for Achilles tendinopathy. Conclusion: Achilles tendinopathy is the most common running-associated tendinopathy followed by runner's knee and shin splints.

Background: Neovascularisation can be detected qualitatively by Power Doppler in Achilles tendinopathy. Quantitative data regarding tendon microcirculation have not been established and may be substantial. Purpose: To assess the microcirculation of the Achilles tendon and the paratendon in healthy volunteers as well as in athletes with either midportion or insertional tendinopathy. Study Design: Cohort study; Level of evidence, 2. Methods: In 66 physically active volunteers, parameters of Achilles tendon and paratendon microcirculation, such as tissue oxygen saturation, relative postcapillary venous filling pressures, and microcirculatory blood flow, were determined at rest at 2-mm and 8-mm tissue depths. Forty-one patients never had Achilles pain (25 men, 27 ± 8 years), 14 patients had insertional pain (7 men, 29 ± 8 years), and 11 patients had midportion tendinopathy (7 men, 38 ± 13 years, not significant). Results: Achilles tendon diameter 2 cm and 6 cm proximal to the insertion was increased in symptomatic tendons. Compared with the uninvolved opposite tendon, deep microcirculatory blood flow was significantly elevated at insertional (160 ± 79 vs 132 ± 42, P<. 05) as well as in midportion tendinopathy (150 ± 74 vs 119 ± 34, P<. 05). The microcirculation in the uninvolved opposite tendon and the normal athlete controls were not significantly different from each other (132 ± 42 insertional asymptomatic vs 119 ± 34 mid-portion vs 120 ± 48 healthy tendon). Insertional paratendon deep microcirculatory flow was elevated in all groups, whereas tissue oxygen saturation and relative postcapillary venous filling pressures were not significantly different. Conclusion: Microcirculatory blood flow is significantly elevated at the point of pain in insertional and midportion tendinopathy. Postcapillary venous filling pressures are increased at both the midportion Achilles tendon and the midportion paratendon, whereas tissue oxygen saturation is not different among the studied groups. We found no evidence of an abnormal microcirculation of the asymptomatic limb in Achilles tendinopathy.

Background: A soccer-specific balance training has been shown to decrease injury incidence of the anterior cruciate ligament and ankle sprains in randomized controlled trials. However, hamstring injuries and tendinopathy remain significant issues in soccer. Hypothesis: Proprioceptive training can reduce the incidence of hamstring muscle injuries and tendinopathy in elite soccer. There is a dose-effect relationship between balance training duration and injury incidence. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-four elite female soccer players (body mass index, 21.7 ± 1.2; age, 21 ± 4 years) of a German premier league soccer team were prospectively included. Starting in January 2004, an additional soccer-specific proprioceptive multistation training was initiated over 3 years. Injury data/1000 hours of exposure with documentation of all occurred injuries, detailed training, and match exposure data as well as time loss data were 100% complete. Results: At the end of the 3-year proprioceptive balance training intervention, noncontact hamstring injury rates were reduced from 22.4 to 8.2/1000 hours (P = .021), patellar tendinopathy from 3.0 to 1.0/1000 hours (P = .022), and Achilles tendinopathy from 1.5 to 0.0/1000 hours (P = .035). There was no effect of balance training on contact injuries. Mean time loss of all assessed injuries significantly decreased from 14.4 days during the control period to 1.5 days during intervention periods (P = .003). The more minutes of balance training performed, the lower the rate of overall injuries (r = −0.185, P = .001), hamstring injuries (r = −0.267, P = .003), patellar tendinopathy (r = −0.398, P = .02), and gastrocnemius strains (r = −0.342, P = .002). Conclusion: Soccer-specific balance training (protective balancing) can reduce noncontact hamstring injuries and patellar and Achilles tendinopathy. A dose-effect relationship between duration of balance training and injury incidence is evident. A proprioceptive training program reduced the rehabilitation time in noncontact injuries, which warrants further investigation.

Therapeutic strategies aiming to reduce ischemia/reperfusion injury by conditioning tissue tolerance against ischemia appear attractive not only from a scientific perspective, but also in clinics. Although previous studies indicate that remote ischemic intermittent preconditioning (RIPC) is a systemic phenomenon, only a few studies have focused on the elucidation of its mechanisms of action especially in the clinical setting. Therefore, the aim of this study is to evaluate the acute microcirculatory effects of remote ischemic preconditioning on a distinct cutaneous location at the lower extremity which is typically used as a harvesting site for free flap reconstructive surgery in a human in-vivo setting.

Study Design A controlled, randomized, prospective study. Objective To assess the changes in paratendon microcirculation after 12 weeks of daily painful eccentric training in individuals with chronic Achilles tendinopathy. Background Changes in tendon and paratendon microcirculation are evident in insertional and midportion Achilles tendinopathy. Whether the paratendon is involved in eccentric training response is not known. Methods Twenty patients with chronic Achilles tendinopathy were recruited for a prospective, controlled trial using eccentric exercise. A laser Doppler system assessed capillary blood flow (flow), tissue oxygen saturation (S02), and postcapillary venous filling pressure (rHb) at 8 paratendon locations at depths of 2 and 8 mm. Results Pain in the eccentric-training group was reduced by 48% (from a mean of 4.1 ± 2.9 to 2.1 ± 2.2, P<.05). Deep paratendon blood flow decreased at the midportion paratendon location (P<.05). Superficial blood flow at the medial distal midportion position (by...