1. Rachel Kloentrup ATTR 540 Research Methods in Human Performance

2. ◦ Chronic injury  Achilles and patellar tendonitis ◦ Conservative treatment methods  Eccentric exercise program  Most effective in treatment of achilles (Mafi, N., Lorentzon, R., Alfredson, H. Superior, 2001) and patellar tendinopathy (Jonsson, P., Alfredson, H., 2005)  Deep tissue massage  Sound Assisted Soft Tissue Mobilization (SASTM) ◦ Lack of conclusive research

3. ◦ To determine the effectiveness of SASTM in the treatment of lower body tendinopathy.

4.  SASTM combined with an eccentric exercise program will be effective in the treatment of lower body tendinopathy.

5.  Procedures ◦ Approval from the Manchester University IRB  Subject Selection ◦ 9 student athletes ◦ Manchester University ◦ Achilles or patellar tendinopathy ◦ Informed consent ◦ Demographics  Age, gender, sport, tendinopathy ◦ Informational eccentric exercise session ◦ VISA questionnaire

6.  Delimitations ◦ Achilles tendinopathy  Excluded if they have a history of ankle injury within the past 6 months ◦ Patellar tendinopathy  Excluded if they have a history of knee injuries within the past 6 months ◦ Out of season athletes  Limitations ◦ Small sample size

7.  Instrumentation ◦ Eccentric Exercise Program  Education session  Achilles tendinopathy  Calf raises using a stair (Achilles eccentric exercises)Achilles eccentric exercises  Patellar tendinopathy  25° decline board (Patellar eccentric exercises)Patellar eccentric exercises  Decline causes the calf muscles to relax in order to increase the stress on the knee extensor muscles (quadriceps)

8. ◦ Measurement Techniques  Victorian Institute of Sport Assessment-Achilles tendinopathy (VISA-A) (Robinson, J.M., Cook, J.L., Purdam C., et. al., 2001)  VISA-A VISA-A  Victorian Institute of Sport Assessment-patellar tendinopathy (VISA-P) (Zwerver, J., Kramer, T., Akker-Scheek, I., 2009)  VISA-P VISA-P

9. ◦ Sound Assisted Soft Tissue Mobilization  Assist the clinician’s hands  Polymer coated tools transmit sound waves through the tissue  Controlled microtrauma to soft tissue in order to promote the healing process  Clinician must be specially trained

10. ◦ Eccentric exercise program performed daily ◦ VISA questionnaire prior to treatment ◦ SASTM  2 treatments per week (2 days rest between) for 3 weeks  5 minute SASTM treatment time

11.  VISA-A and VISA-P questionnaires  Value of 0 to 100 (VISA-A and VISA-P)VISA-AVISA-P  Friedman  Wilcoxon Signed Ranks test

12. Treatment Four – Base Line Treatment Six – Base Line Treatment Four – Treatment Three Treatment Five – Treatment Three Treatment Six – Treatment Three Z-2.016-2.077-2.081-2.386-2.549 Asymp. Sig. (2- tailed) 0.0440.0380.0370.0170.011

13.  Results ◦ Accept hypothesis:  SASTM combined with an eccentric exercise program will be effective in the treatment of lower body tendinopathy.

14.  Mafi, N., Lorentzon, R., Alfredson, H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surgery Sports Traumatology Arthroscopy. 2001; 9: 42 -47.  Jonsson, P., Alfredson, H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomized study. British Journal of Sports Medicine. 2005; 847 – 850.  Robinson, J.M., Cook, J.L., Purdam C., et. al. The VISA-A questionnaire: A valid and reliable index of the clinical severity of Achilles tendinopathy. British Journal of Sports Medicine. 2001; 35: 335 – 341.  Zwerver, J., Kramer, T., Akker-Scheek, I. Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy. BioMed Central Musculoskeletal Disorders. 2009; 10: 102 – 106.

15. Questions/Comments?