Abstract The Achilles tendon is the largest tendon in the human body and is affected by many diseases and is vulnerable to many forms of damage due to the heavy loads it must bear. Rupture of the Achilles tendon has become more common in recent times, with an almost four-fold increase in prevalence from 1979–1990 to 1991–2000 and a peak incidence of 19 ruptures per 100 000 of population in 1999 in our epidemiological assessment. The incidences of major complications, re-rupture and deep infection, increased along with primary ruptures, peaking in 1999. The results after successful primary repair are good in over 90% of cases, as we have shown in a randomized study and in a review of the literature, and the result after re-rupture is still good in about 70% of cases, but achieving good performance after deep infection is a highly random matter. Our retrospective survey did not identify any good results, but the deep infection cases in our randomized study showed good performance due to prompt action taken for their treatment. The best method for treating a ruptured Achilles tendon has been under debate for almost 100 years, with surgery and conservative methods advocated to equal extents. We have advocated surgical treatment as the primary choice and conservative treatment is given for selected high risk patients, for example patients with diabetes, skin problems, systemic use of corticosteroids or severe other illness. The type of surgery technique is not a straightforward choice, either, and various forms of open surgery and percutaneous techniques exist. We compared an end-to-end simple suture with the same suture augmented with one central gastrocnemius turn-over flap in a randomized series of 60 patients and found no differences with respect to subjective complaints, calf muscle strength or tendon elongation with time. The end-to-end technique is simpler and is therefore justified as the primary method of choice for the surgical repair of fresh complete Achilles tendon ruptures. The tissue composition has been shown to alter not only with time but also after repeated tearing of the tendon collagen fibres. A normal tendon is mainly composed of type I collagen, but the rupture areas express more type III collagen, which is thinner and withstands loads less effectively. Type III collagen accumulates slowly in the tendon, since its production does not increase very much, a situation that is indicative of microtrauma. Crosslinking of the fibres is important for collagen matrix properties, and we found that there is a change in the quality of crosslinking with age and that this may have role in the observed changes in tendon stiffness, as also noted in other studies. We also studied the appearance of tenascin-C at the rupture site in the Achilles tendon and at two other sites in the same tendon, but found no difference in its expression. It has been proposed that tenascin-C may take part in the tendon’s reaction to loading, but its exact function remains unknown.

This essay by Andrew Allen-Olivar uses the film script form to present scenes that follow a fictional town where each scene follows different inhabitants – from the new kid, to the tree, to the fish, to the undead locals that inhabit the town. The work is inspired by magical realist writers, poets and philosophers such as Jorge Louis Borges, Alejandro Zambra, Anne Carson and Franz Kafka. Through these scenes, the author's intentions are to convey a place that shifts – between time and place; between memory and exaggerations; between narrative and documentation.

Background: The effect of trigger point dry needling (TDN) on myofascial trigger points (MTP) in Achilles tendinopathy are unknown. Objectives: To determine the feasibility of a large randomized controlled trial (RCT) to compare the effects of TDN to exercise in a patient population with Achilles tendinopathy. Methods: This single-factor, pretest-posttest control group design included 22 subjects between the ages of 24 and 65 years with Achilles tendinopathy. Subjects were randomly assigned to either a control group (MT+Ex) or experimental group (TDN+MT+Ex). Subjects in both groups completed 8 physical therapy treatment sessions over 4 weeks. The intervention for the TDN+MT+Ex group included TDN to MTPs in the gastrocnemius, soleus or tibialis posterior each session while the same soft tissue mobilization and exercise program was conducted in both groups. Results: Within group analysis was performed for each group at 4 week and 90 day follow up. Significant improvement (p < .05) was achieved for FAAM, NPRS, pain pressure threshold and strength in both groups at 4 weeks and 90 days. The GROC was significant for MT + Ex at 90 days. The MCID for the FAAM, GROC were surpassed in both groups at 4 weeks and 90 days. NPRS surpassed the MCID for the MT + Ex group at 4 weeks. Conclusion: A large RCT to investigate the effects of TDN on MTP in Achilles tendinopathy is feasible with modifications. Recommendations: Special considerations for data collection sites should be given to the health care system, insurance payor, and financial burden to subjects.

The main goal of the project was to compare how the Achilles tendon is affected while running with traditional shoes, minimalistic shoes and barefoot. Displacement and strain were calculated both for different shoes and for different foot strike patterns. The calculations were done with a speckle tracking algorithm and displacement was calculated for three different depths in the tendon: deep layer, mid layer and superficial layer. The goal was also to conduct this analysis after a review of the algorithm used. The review of the algorithm focused on the size of the region of interest, kernel size and frequency. Literature study showed that it is more common to use a smaller kernel size, but the same shape. The region of interest was chosen depending on the size of the tendon. Displacement and strain in the Achilles tendon was calculated for seven subjects and the result did not show any difference in amount of mean deformation due to different shoe types or foot strike patterns. It was a small sample group but the result indicated a difference in peak displacement between deep and superficial layer depending on different shoe types and foot strike patterns. The difference in peak displacement between deep and superficial layer was lowest when running barefoot, larger when running with minimalistic shoes and greatest when running with traditional shoes. This result was only achieved when running with rear foot strike pattern. When running with fore foot strike pattern the difference in peak displacement between layers did not change with different conditions. In all conditions the difference in peak displacement between the layers was greater when running with rear foot strike pattern than when running with front foot strike pattern. The deep layer displaced more than the superficial layer (p&lt;0.01) for all conditions and foot strike patterns.

Much is known about running economy while running on level ground surfaces. However, with the dynamic of elevation changes during running, more research is needed to understand how various grades that will favor respective mechanics. PURPOSE: In this study, we focused on determining whether certain running mechanics and anatomy would predict a runner's oxygen uptake between downhill versus uphill running. METHODS: Twenty-one experienced runners completed six 5-min running trials (1 shoe x 3 grades x 2 visits) in a Saucony marathon racing shoe model (Type A) on level (3.83 m/s), uphill (+4% grade at 3.35 m/s), and downhill ( ˆ’4% grade at 4.46 m/s) conditions. These treadmill speeds at each grade were predicted as metabolic equivalents through all grades. We measured submaximal oxygen uptake and carbon dioxide production during the entire trial duration with the last 3 min of each trial being averaged. A best-fitting line was generated through oxygen uptake versus grade to classify whether runners were more economical in uphill or downhill conditions relative to other subjects. The slope of this line indicated whether runners were more economical at uphill or downhill running, where a positive slope represented a more economical uphill versus downhill runner. Various running mechanics were measured using Vicon Nexus and a Bertec treadmill. A linear regression determined any correlations between peak vertical force, stride rate, plantar velocity, and ground time against uphill/downhill running ability. RESULTS: Peak vertical force was the only factor associated with the slope of oxygen uptake versus grade (running grade ability; p < 0.01). The slope of oxygen uptake versus grade averaged 0.076 ± 0.278 ((ml/kg/min) / % grade). CONCLUSION: Runners that naturally prefer a higher peak vertical force when running on level ground led to a lower running grade ability (lower oxygen uptake during downhill versus uphill running).

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Ruptura do tendão calcâneo é uma das lesões tendíneas mais frequentes. Embora a maioria dos trabalhos sugira que o exercício seja benéfico na cicatrização tendínea, não há consenso sobre o efeito do antiinflamatório neste contexto. Trabalhos experimentais tentam reproduzir lesão aguda deste tendão, em diferentes espécies animais. Neste estudo, descrevemos uma técnica de tenotomia completa do tendão calcâneo direito em ratos e, em seguida, avaliamos os efeitos do uso do antiinflamatório e do exercício aeróbico, isoladamente e em combinação, sobre a proliferação celular e o perfil biomecânico do tendão calcâneo, durante o processo de cicatrização após tenotomia. Estudo experimental com 156 ratos machos adultos, da raça Wistar, com idade média de 3 meses e peso médio de 300g. Após anestesia com tiopental e com auxílio da microscopia de luz, foi realizada incisão longitudinal posterior de cinco milímetros, em direção proximal, a partir da tuberosidade posterior do calcâneo da pata direita do rato. Foi feito corte transversal do tendão calcâneo, a sete milímetros da tuberosidade do calcâneo, com preservação do tendão plantar. Utilizamos as técnicas de Hematoxilina e Eosina, Picrosirius-red e Resorcina-fucsina de Weigert para avaliação da cicatrização tendínea e das fibras dos sistemas colágeno e elástico. Após a tenotomia, metade dos animais receberam tenoxicam intramuscular por 7 dias e no 8o dia iniciou-se protocolo de exercício em esteira na metade de cada grupo. Os ratos foram divididos aleatoriamente em 4 grupos de tratamento: A sem antiinflamatório E sem exercício (controle); B com antiinflamatório E com exercício; C sem antiinflamatório E com exercício; D com antiinflamatório E sem exercício. Os animais foram eutanasiados com 1, 2, 4 e 8 semanas após a tenotomia, para avaliação histológica pelo PCNA, e biomecânica através do teste de resistência à tração e da medida do ciclo locomotor. Foram realizados análise de variância, teste de Kruskal-Wallis e o método de Bonferroni, no programa R Project, versão 2.11.1. O tempo cirúrgico médio foi de 1 minuto e 24 segundos, sem complicações observadas até a 8a semana pós-operatória. Observamos proliferação celular e fibrilogênese com duas semanas, e diminuição da celularidade e das fibras elásticas na 8a semana, além de mudanças na organização estrutural do sistema colágeno. Encontramos pico da imunomarcação com PCNA na 2a semana em todos os grupos, exceto no grupo A, cujo pico aconteceu com 1 semana da tenotomia. Evidenciamos resistência à tração significativamente maior (p=0,02) nos ratos submetidos ao exercício, 8 semanas após ruptura. Nos grupos com antiinflamatório, observamos um ciclo locomotor mais estável durante todo o tempo avaliado. Consideramos a técnica cirúrgica experimental de tenotomia completa do tendão calcâneo, realizada com auxílio da microscopia de luz e preservação do tendão plantar, simples, rápida, com sinais de cicatrização tendínea normal e de fácil reprodução em ratos. O exercício aeróbico, iniciado precocemente após tenotomia completa do tendão calcâneo, é significativamente benéfico na sua recuperação biomecânica e o uso combinado com antiinflamatório confere maior estabilidade na marcha, o que pode proteger contra rerruptura tendínea em ratos / Achilles tendon rupture is one of the most frequent tendon injuries. Although most studies have shown the benefits of exercise on tendon regeneration, controversy still exists concerning non-steroidal antinflammatory drug (NSAID) effects in this context. Several experimental models have been used for the study of Achilles tendon injury. In this study, we describe the surgical technique of right Achilles tenotomy in rats and subsequently evaluate the effects of NSAID and aerobic exercise, in an isolated fashion and combined, on cell proliferation and biomechanical aspects of the Achilles tendon after tenotomy. Experimental study with 156 male Wistar rats with an average age of 3 months and with average weight of 300g. Surgical procedures were performed under light microscopy, after anesthesia with thiopental. A five millimeters posterior longitudinal incision was created, proximally directed, starting five millimeters proximal to the posterior calcaneal tuberosity. A complete tenotomy of the Achilles tendon was performed, seven millimeters away from the calcaneal tuberosity. The plantaris tendon was preserved. We used Hematoxilin and Eosin, Picrosirius-red and Weigerts Resorcin-fucsin to observe general tendon healing, especially regarding collagen and elastic fibers. After tenotomy, half of the rats received an intramuscular injection of tenoxican for 7 days and exercise was initiated on the 8th day for half the animals of each group. Rats were randomly divided into four treatment groups: A) no NSAID and no exercise; B) NSAID plus exercise; C) no NSAID, with exercise; D) NSAID and no exercise. Animals were sacrificed at 1, 2, 4 and 8 weeks after the tenotomy and cell proliferation was evaluated by immunohistochemistry for PCNA, biomechanical evaluation was performed with ultimate load and gait cycle analysis was also carried out. We used the test of analysis of variance, the Kruskal-Wallis test and also, Bonferroni method, in the R Project program 2.11.1. The mean operative time was one minute and 24 seconds, without complications observed until the 8th postoperative week. Histological studies showed cellular proliferation and fibrilogenesis at two weeks, with decreased amounts of cellularity and elastic fibers at the 8th week, besides changes in structural organization of collagen fibers. The highest intensity of PCNA immunostaining was found at 2 weeks in all groups except for group A (control) that had the highest intensity at 1 week. Animals submitted to exercise had significantly higher (P = 0.02) ultimate loads at 8 weeks after injury. The animals that received NSAID presented with a more stable gait cycle. The surgical technique described for complete Achilles tenotomy, under light microscopy and sparing the plantaris tendon, is simple and quick, shows signs of normal healing process, and it is easily reproducible in rats. Aerobic exercise, initiated early after a complete Achilles tendon tenotomy, was beneficial to the biomechanical aspects of the tendon during regeneration and the combined use of NSAID improved the gaits characteristics, which could be protective against reruptures

Ruptura do tendão calcâneo é uma das lesões tendíneas mais frequentes. Embora a maioria dos trabalhos sugira que o exercício seja benéfico na cicatrização tendínea, não há consenso sobre o efeito do antiinflamatório neste contexto. Trabalhos experimentais tentam reproduzir lesão aguda deste tendão, em diferentes espécies animais. Neste estudo, descrevemos uma técnica de tenotomia completa do tendão calcâneo direito em ratos e, em seguida, avaliamos os efeitos do uso do antiinflamatório e do exercício aeróbico, isoladamente e em combinação, sobre a proliferação celular e o perfil biomecânico do tendão calcâneo, durante o processo de cicatrização após tenotomia. Estudo experimental com 156 ratos machos adultos, da raça Wistar, com idade média de 3 meses e peso médio de 300g. Após anestesia com tiopental e com auxílio da microscopia de luz, foi realizada incisão longitudinal posterior de cinco milímetros, em direção proximal, a partir da tuberosidade posterior do calcâneo da pata direita do rato. Foi feito corte transversal do tendão calcâneo, a sete milímetros da tuberosidade do calcâneo, com preservação do tendão plantar. Utilizamos as técnicas de Hematoxilina e Eosina, Picrosirius-red e Resorcina-fucsina de Weigert para avaliação da cicatrização tendínea e das fibras dos sistemas colágeno e elástico. Após a tenotomia, metade dos animais receberam tenoxicam intramuscular por 7 dias e no 8o dia iniciou-se protocolo de exercício em esteira na metade de cada grupo. Os ratos foram divididos aleatoriamente em 4 grupos de tratamento: A sem antiinflamatório E sem exercício (controle); B com antiinflamatório E com exercício; C sem antiinflamatório E com exercício; D com antiinflamatório E sem exercício. Os animais foram eutanasiados com 1, 2, 4 e 8 semanas após a tenotomia, para avaliação histológica pelo PCNA, e biomecânica através do teste de resistência à tração e da medida do ciclo locomotor. Foram realizados análise de variância, teste de Kruskal-Wallis e o método de Bonferroni, no programa R Project, versão 2.11.1. O tempo cirúrgico médio foi de 1 minuto e 24 segundos, sem complicações observadas até a 8a semana pós-operatória. Observamos proliferação celular e fibrilogênese com duas semanas, e diminuição da celularidade e das fibras elásticas na 8a semana, além de mudanças na organização estrutural do sistema colágeno. Encontramos pico da imunomarcação com PCNA na 2a semana em todos os grupos, exceto no grupo A, cujo pico aconteceu com 1 semana da tenotomia. Evidenciamos resistência à tração significativamente maior (p=0,02) nos ratos submetidos ao exercício, 8 semanas após ruptura. Nos grupos com antiinflamatório, observamos um ciclo locomotor mais estável durante todo o tempo avaliado. Consideramos a técnica cirúrgica experimental de tenotomia completa do tendão calcâneo, realizada com auxílio da microscopia de luz e preservação do tendão plantar, simples, rápida, com sinais de cicatrização tendínea normal e de fácil reprodução em ratos. O exercício aeróbico, iniciado precocemente após tenotomia completa do tendão calcâneo, é significativamente benéfico na sua recuperação biomecânica e o uso combinado com antiinflamatório confere maior estabilidade na marcha, o que pode proteger contra rerruptura tendínea em ratos / Achilles tendon rupture is one of the most frequent tendon injuries. Although most studies have shown the benefits of exercise on tendon regeneration, controversy still exists concerning non-steroidal antinflammatory drug (NSAID) effects in this context. Several experimental models have been used for the study of Achilles tendon injury. In this study, we describe the surgical technique of right Achilles tenotomy in rats and subsequently evaluate the effects of NSAID and aerobic exercise, in an isolated fashion and combined, on cell proliferation and biomechanical aspects of the Achilles tendon after tenotomy. Experimental study with 156 male Wistar rats with an average age of 3 months and with average weight of 300g. Surgical procedures were performed under light microscopy, after anesthesia with thiopental. A five millimeters posterior longitudinal incision was created, proximally directed, starting five millimeters proximal to the posterior calcaneal tuberosity. A complete tenotomy of the Achilles tendon was performed, seven millimeters away from the calcaneal tuberosity. The plantaris tendon was preserved. We used Hematoxilin and Eosin, Picrosirius-red and Weigerts Resorcin-fucsin to observe general tendon healing, especially regarding collagen and elastic fibers. After tenotomy, half of the rats received an intramuscular injection of tenoxican for 7 days and exercise was initiated on the 8th day for half the animals of each group. Rats were randomly divided into four treatment groups: A) no NSAID and no exercise; B) NSAID plus exercise; C) no NSAID, with exercise; D) NSAID and no exercise. Animals were sacrificed at 1, 2, 4 and 8 weeks after the tenotomy and cell proliferation was evaluated by immunohistochemistry for PCNA, biomechanical evaluation was performed with ultimate load and gait cycle analysis was also carried out. We used the test of analysis of variance, the Kruskal-Wallis test and also, Bonferroni method, in the R Project program 2.11.1. The mean operative time was one minute and 24 seconds, without complications observed until the 8th postoperative week. Histological studies showed cellular proliferation and fibrilogenesis at two weeks, with decreased amounts of cellularity and elastic fibers at the 8th week, besides changes in structural organization of collagen fibers. The highest intensity of PCNA immunostaining was found at 2 weeks in all groups except for group A (control) that had the highest intensity at 1 week. Animals submitted to exercise had significantly higher (P = 0.02) ultimate loads at 8 weeks after injury. The animals that received NSAID presented with a more stable gait cycle. The surgical technique described for complete Achilles tenotomy, under light microscopy and sparing the plantaris tendon, is simple and quick, shows signs of normal healing process, and it is easily reproducible in rats. Aerobic exercise, initiated early after a complete Achilles tendon tenotomy, was beneficial to the biomechanical aspects of the tendon during regeneration and the combined use of NSAID improved the gaits characteristics, which could be protective against reruptures

Title: The analysis of risk factors for tendinopathy in runners Objectives: The aim of this thesis is to find out the most important risk factor for development of Achilles tendinopathy, detect the most relevant diagnostic approach with preventive monitoring for Achilles tendinopathy and evaluate the best treatment for Achilles tendinopathy in runners. Methods: The diploma thesis is in form of literary review. The Scopus, PubMed and Web of science databases were used to search for studie using a combination of keywords. A total of 1084 titles were identified. Due to duplicates 402 titles were excluded. On the basis of the name of the article 51 titles were included. On the basis of the availability 50 titles were included. On the basis of the abstract 46 titles were included. Finally 29 titles were included in this review. Results: The most important risk factor for development of Achilles tendinopathy was training intensity for distances 1500-3000 m, week running volume >65 km or being new to running. The most relevant diagnostic approach for Achilles tendinopaty was clinical examination assessing pain (Achilles tendon pain, positive palpation test) and function (pain during physical aktivity) of Achilles tendon. This approach serves as indication for sonographic assessment of Achilles tendon...

This work deals with characteristics of Greek mythology and tries to define a myth and to describe the differences between myths and fairy tales. It focuses on an origin and a history of myths, on gods and on heroes. My work also examines a concept of collective unconscious and archetypes, that appears in antique mythology (especially the archetype of a hero). Based on these findings, this work forms characteristic features of heroes, that are applied on the Greek heroes Odysseus and Achilles. Their life stories prove they deserve to be considered as archetypes of heroes. A survey, that deals with a concept of heroism according to contemporary young people, is also part of the work. It reflects not just the teenagers' image of a hero, but it examines their knowledge of Greek mythology, too.