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Return-to-play after PRP injection for lower limb tendinopathy

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Return-to-play after PRP injection

for

lower limb tendinopathy

François Delvaux, Jean-François Kaux, Jean-Louis Croisier

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Introduction

Literature search

PRP Platelet-rich plasma Platelet concentrate … Rehabilitation Treatment Physiotherapy Exercise …

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PRP and rehab: evidence is scarce!

Experience &

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Is rehab essential after PRP injection?

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Rehabilitation after PRP: content

Time Tendinopathy 1st symptoms PRP injection [..other treatmentsfailure…] Load [4-6 days] Start rehab (Isometric) Eccentric Strength Speed & power Plyometrics & Specific to sport [> 3 months]

[Small to very small steps]

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1st step : start loading

Isometric Contractions Are More Analgesic Than Isotonic Contractions for Patellar Tendon Pain:

An In-Season Randomized Clinical Trial.

Rio E1,van Ark M,Docking S,Moseley GL,Kidgell D,Gaida JE,van den Akker-Scheek I,Zwerver J,Cook J.

BJSM 2015 JSMS 2016 CJSM 2017 60° 5 X 45’’ 2’ 70% Isometric contractions

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1st step : start loading

Real influence of isometrics on pain? To be continued…

However, isometric contractions may represent a good option for starting loading a musculotendinous unit after PRP injection

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1st step: Eccentric contractions

Isolated sub-maximal eccentric contractions

• (3)-7*/week • 1-2*/day

• 2-3 series of 15-30 reps • Rest time = adapted • Body weight

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Exercises and pain

Can eccentric contractions / exercises be painful?

Smith et al. BJSM 2017

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Smith et al. BJSM 2017

Tendinopathy

During exercises After exercises session

> 5/10 3-4/10 0-2/10

 night and/or day after

No increase

 temporary (few hours)

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2

nd

step : improve strength

• 3 sessions/week

• 3-4 exercises/session • 3-4 series/exercise • Slow velocity

• Rest intervals: long

• 15RM → 12RM → 10RM → 8RM → 6RM • ≈ 70 ➔ ≈ 85% 1RM

Patellar tendinopathy Achilles tendinopathy

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3rd step : speed & power

(2-)3 sessions/week:

o 1 session = strength (6-8RM) o (1-)2 sessions = speed & power

Speed Power

1. Flat ground

• Soft ➔ hard ground • Progressively from 60%

to 100% of maximal speed

• Importance of running technique

2. Decline ground

2-4 exercises/session

3-4 series/exercise

Fast velocity

Rest intervals: long

30 ➔ 60% 1RM

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Importance to individualise rehab

• Personal history • Sport goals • Age • Physical fitness • … 30-40% = Sedentary people

• Steps 1 & 2, steps 3 & 4

• Very small steps progression • Importance of becoming active

Ex: Achilles tendinopathy

Individualised rehab

60-70% = Athlete

• Steps 1 to 4

• Small steps progression

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Is there a place for passive treatments?

• Stretching • US

• Deep transverse massage

• Osteopathy – manual therapy • Taping

• Dry needling • …

No high scientific evidence

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Conclusion

• Rehabilitation programs after PRP injections for tendinopathy do not really differ

from usual tendinopathy rehabilitations

• The main objective = increase of tendon capacity ➔ progressive loading is the key treatment • A progressive 4-stage rehabilitation continuum includes:

o Analytical progressive loading (isometric and especially eccentrics) o Strength training

o Speed and power training

o Plyometrics and sport-specific training

• Pain management is a key component for every stage

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TITRE

SOUSTITRE

Thank you for your attention!

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