Introduction Tissue engineering has been a topic of extensive research over the last years. The ability of human body to regenerate tissue loss such as cartilage, tendon and muscle is limited leading often to chronic injuries. In recent years there have been rapid developments in the use of several novel approaches to muscular and tendinous injuries - growth factors, platelet-rich plasma (PRP) or mesenchymal stem cells (MSCs) to name a few for accelerated healing of injury.The advances made in cellular biology, genetics and recombinant technology has initiated the development of new techniques and new therapeutic strategies allowing treatment of many pathological conditions providing restoration of tissue continuity and function. Those approaches have been used with success and the technology is now being developed for orthopaedics and sports medicine applications for repair of soft tissues such as muscle, tendon and ligament following acute traumatic or overuse injury, and animal studies have demonstrated clear benefits in terms of accelerated healing. Although, in some of those new techniques and new therapeutic strategies minimal clinical evidence is currently available, their use has increased, given its safety as well as the availability of new techniques many controlled clinical trials are underway. Should we approach tissue engineering cautiously until high-level clinical evidence supporting the new techniques and new therapeutic strategies’ e�cacy is available? On another area related to the approaches to muscular and tendinous injuries, we find studies performed using a focused model of injury causation and prevention strictly from a biomechanical perspective. One could argue this model would be equivalent to the failure of a machine or structure - a result from a transfer of energy to the tissue taking into consideration the mechanical properties of human tissue, such as stiffness (stress–strain relation), ultimate strength, and critical stress, and ultimately governing how the body responds to physical loads. Is this approach too simplistic? Biomechanics, one of the disciplines in the field of Human Movement and Exercise Science from a research perspective may be seen to have a disagreeing approach to muscular and tendinous injuries. Clinical biomechanics involving research in several areas such as neuromuscular control, tissue mechanics, and movement evaluation during rehabilitation from either injury or disease will be discussed, with the primary aim to show the role of biomechanics in sports science and sports medicine. Scientists, medical researchers, biomechanics and practitioners working in the field of sports injury prevention tend to have very tangible objectives and focus on identifying and solving specific injury risks. There is an uncertainty, however, that “solving” one problem may not simply create another or that “solving” one problem may be done with only one approach. As the field of the muscular and tendinous injuries matures, it is worth considering whether theories and models can be developed that have more general application to a range of injury issues. There is a need for an integrated perspective on sports injury that is inclusive of medical and biomechanical factors.

III MTN WORKSHOPMUSCLE INJURIES AND REPAIR:CURRENT TRENDS IN RESEARCH September, 27th-28th, 2011

Futbol Club Barcelona StadiumAv. Arístides Maillol, s/n 08028 Barcelona

Program

Tuesday, 27th Wednesday, 28th

8:45 Hotel pick up - bus transfer 8:45 Hotel pick up - bus transfer

9:00 Registration

9:00

Update in regenerative therapies in the muscle and tendon Johnny Huard Richard Lieber Nicola Maffulli Chairs: María José Martínez; Lluís Orozco; Robert Soler Discussion panel:Ramon Cugat; José López Calbet; Mario Marotta; Jordi Puigdellivol; LLuís Til

9:30 Welcome

9:45 MuscleTech Network, moving forward Gil Rodas Francesc X. Roca

10:00 Key note lectures Thomas M. Best Johnny Huard Willem van Mechelen

11:00 Coffee break 11:00 Coffee break

11:30

Presentation of the magazine FEM Xavier Gassó Evaluating strength tests as elements of injury prediction Thomas M. Best Pierre Portero Chair: Joaquim Chaler Discussion panel: Rosa Angulo-Barroso; Xavier Balius; Angel Sánchez; Antoni Turmo

11:30

Scientific evidence and clinical validation of the F.C. Barcelona Clinical Practice Guide of tendon injuries Henning Langberg Nicola Maffulli Per Tesch Chairs: Daniel Medina; Ricard Pruna Discussion panel: Angel Cotorro; Ramon Cugat; Alfons Mascaró, Jordi Puigdellivol

13:00 Lunch 13:00 Lunch

14:00

Injuries in the adolescent stage Nikos Malliaropoulos Per Tesch Pierre Portero Chair: Xavier Valle Discussion panel: Manuela González; José Antonio Gutiérrez; Mauricio Mónaco; Jordi Puigdellivol; Lluís Til

14:00

Update in muscle and tendon injury and repair biomarkers Walter Herzog Henning Langberg Richard Lieber José López Calbet Chairs: Roser Cussó; Ginés Viscor Discussion panel: Jordi Ardevol; Josep Cadefau; Franchek Drobnic; Xavier Yanguas 15:30 Coffee break

15:45

Prognostic value of ultrasound and MRI in muscle and tendon injuries Carl Askling Nikos Malliaropoulos Xavier Alomar Ramon Balius Chairs: Ramon Balius; Ma Isabel Miguel Discussion panel: Manuela González; Jordi Puigdellivol; Marta Rius; LLuís Til

16:00

Conslusions and closing remarks of the "3rd MuscleTech Network Workshop on Muscle and Tendon" Carles Pedret Gil Rodas

18:30 Visit to FCB, Stadium and Museum 16:30 Bus to the FCB sport city

20:00 Dinner at FCB 16:45 Visit to FCB sport city

22:30 Bus to the hotel 18:00 Bus to the Hotel

Program Tuesday, September 27th ____________________________________________________________________________ 9:00 Registration 9:30 Welcome

9:45 MuscleTech Network, moving forward

Gil Rodas Scientific Director of MuscleTech Network, Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona Francesc X. Roca Coordinator Manager of MuscleTech Network and Senior Researcher on Medicinal Chemistry at LEITAT Technological Centre

10:00 Key note lectures

Challenges and Dilemmas in Muscle-Tendon Research and Implementation to Clinical Practice Thomas M. Best Professor and Pomerene Endowed Chair, Department of Family Medicine, Professor of Biomedical Engineering and Biostatstics, Director, Division of Sports Medicine, Co-Medical Director, The OSU Sports Medicine Center, Team Physician, OSU Athletic Department, The Ohio State University, President, American College of Sports Medicine. Regenerative Medicine based on Adult Stem Cells for Musculoskeletal Tissue Regeneration & Repair Johnny Huard Henry J. Mankin Professor and Vice-chair for Musculoskeletal Cellular Therapeutics in the Department of Orthopaedic Surgery and in the Departments of Microbiology and Molecular Genetics, Pathology and Physical Medicine, Bioengineering, and Rehabilitation. Director of the Stem Cell Research Centre of Children’s Hospital of Pittsburgh. Deputy Director of the McGowan Institute for Regenerative Medicine, United States of America

Cost-Effective Secondary Prevention of Musculo-skeletal Problems; Myth or Reality? Willem van Mechelen Head of the Department of Public and Occupational Health of VU University Medical Centre and Co- Director EMGO+ Institute of VU University Medical Centre, Chairman of the Research Centre Body@Work TNO VU University Medical Centre and Director of the spin-off company Evalua Nederland B.V. ('Ltd').

11:00 Coffee break 11:30 Presentation of the magazine FEM – Forum Egarsat del Múscul

Xavier Gassó , Director of Health Management at “Mútua d’accidents EGARSAT”

11:40 Evaluating strength tests as elements of injury prediction

The assessment of muscle strength and especially the knowledge of the relationship between agonist and antagonist muscles allow the analysis of the muscle state. It is postulated that knowledge in this way allows us to understand the risk of muscle-tendinous injuries. In this regard, isokinetic studies have been really important because they study the muscle strength performed in a determined range of motion and velocity, allowing observing the presence of injuries or imbalances between muscle groups. However there is still controversy as to whether it measures the real movement of the athlete when performing their various sporting gestures. Other methods of analysis have emerged in recent years, seeking to be more specific and decisive in finding athletes with a high risk of lesion and who could benefit from prevention programs specifically designed according to their morpho-functional deficits. What we should discuss is which are the best methods for assessing the risk of injury and how can they be applied.

Core Training for Hamstring/Groin Problems – Myths And Evidence For Injury Prediction and Prevention Thomas M. Best Professor and Pomerene Endowed Chair, Department of Family Medicine, Professor of Biomedical Engineering and Biostatstics, Director, Division of Sports Medicine, Co-Medical Director, The OSU Sports Medicine Center, Team Physician, OSU Athletic Department, The Ohio State University, President, American College of Sports Medicine.

Characterization of the Passive Mechanical Properties of the Muscle-tendon Complex Using Isokinetic Dynamometers Pierre Portero Service de Rééducation Neuro-Orthopédique Hôpital Rothschild, Paris, France Chair: Joaquim Chaler Senior Researcher at EGARSAT-SUMA Intermutual and lecturer at the Psychology, Education and Sport Sciences School at Blanquerna, Universitat Ramon Llull, Barcelona, Spain.

Discussion panel members: Rosa Angulo-Barroso Senior Researcher at the Research Unit of the National Institute of Physical Education (INEF- Catalunya), Barcelona, Spain Xavier Balius Research Leader at GIRSANE - Performance and Health Research Group for High Level Sports. Head of the Biomechanics Department Representing GIRSANE, Sport Sciences Unit (Olympic Training Centre) and Health Unit (Health Consortium of Terrassa), Barcelona, Spain Angel Sánchez Senior Researcher and Rehabilitation physician at Eurosport, Barcelona, Spain Antoni Turmo Director of the Medical School of Physical Education and Sport, Universitat de Barcelona, Barcelona, Spain and Sports Medicine Specialist at the Medical Services RCD Español, Barcelona, Spain

13:00 Lunch 14:00 Injuries in the adolescent stage

It is increasingly difficult to reduce the processing time of muscle and tendon injuries. In sports medicine the tendency is to prevent these injuries. Prevention guidelines should be started at an early age. It is precisely for this reason that is basic to know the epidemiology of the different injuries at the stage of adolescence. This knowledge will allow us to design individualized treatment strategies and adequate preventive protocols. What we should discuss is precisely what are the most common injuries and what should be achieved using certain protocols.

Clinical Prognostic Values in Hamstring Injuries. Nikos G. Malliaropoulos Sports Medicine Physician-EJU Medical Committee Member, Chair European College of Sports and Exercise Physicians (ECOSEP).

Improving Health Through Better Muscle Health Per A. Tesch. Professor at the Department of Health Sciences, Mid Sweden University, Östersund and Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Passive viscoelastic characteristics of the calf muscle-tendon complex in former international female gymnasts vs. control subjects

Pierre Portero Service de Rééducation Neuro-Orthopédique Hôpital Rothschild, Paris, France

Chair: Xavier Valle Senior Researcher and Lecturer at the Medical School of Physical Education and Sport, Universitat de Barcelona, Barcelona, Spain and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona.

Discussion panel members: Manuela González Head of Service of the Department of Postural Imaging and Assessment at Centre for Sports Medicine of the Consejo Superior de Deportes (National Sports Council), Madrid, Spain Jose Antonio Gutierrez Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona Mauricio Monaco Paediatrician, Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona

Jordi Puigdellivol Orthopaedic Surgeon and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona Lluis Til Senior Researcher at the Physiological and Functional Evaluation Department, High Performance Centre - CAR - Sant Cugat del Vallès, Spain and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona

15:30 Coffee break 15:45 Prognostic value of ultrasound and MRI in muscle and tendon injuries.

It is well known the high diagnostic value of ultrasound and MRI in muscle and tendon injuries. Similarly we consider these techniques the gold standard for assessing the evolution of these lesions. At present, the improvement in image quality and the processing of the images give us even more possibilities in the world of imaging. So we can speak not only about imaging but also for prognostic assessment and treatment using ultrasound and MRI. High-speed Running Type or Stretching-type of Hamstring Injuries Makes a Difference to MRI Findings Carl M. Askling Lecturer at the Swedish School of Sport and Health Sciences, Research Leader at the Orthopaedics and Sports Medicine Group, Department of Molecular Medicine and Surgery at the Karolinska Institutet, Stockholm, Sweden

Cost-effective Prevention of Lateral Ankle Injury Nikos G. Malliaropoulos Sports Medicine Physician-EJU Medical Committee Member, Chair European College of Sports and Exercise Physicians (ECOSEP)

Longitudinal Studies of Hamstring Muscle Injuries in Athletes Xavier Alomar Director of the Diagnostic Imaging Department at Creu Blanca Clinic, Barcelona, Spain Chairs: Ramon Balius Research Leader at the High Performance Sports Research Centre (CEARE), Catalan Sports Council, Barcelona, Spain Mª Isabel Miguel Professor at the Department of Pathology and Experimental Therapeutics, Research Unit on Muscle Anatomy and Pathology, School of Medicine (Campus Bellvitge), University of Barcelona, Barcelona, Spain

Discussion panel members: Manuela González Head of Service of the Department of Postural Imaging and Assessment at Centre for Sports Medicine of the Consejo Superior de Deportes (National Sports Council), Madrid, Spain Jordi Puigdellivol Orthopaedic Surgeon and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona Marta Rius Sports Medicine Specialist at “Mutualidad de Futbolistas” of the Catalan Football Federation, and Traumatology Institute at Quiron Hospital, Barcelona, Spain and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona Lluis Til Senior Researcher at the Physiological and Functional Evaluation Department, High Performance Centre - CAR - Sant Cugat del Vallès, Spain and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona

18:30 Visit to FCB Stadium and Museum 20:00 Dinner at FCB

Wednesday, September 28th ____________________________________________________________________________ 9:00 Update in regenerative therapies in the muscle and tendon

The reality today is that after decades of treating muscle and tendon injuries with a standard treatment, often with little scientific evidence, the appearance of a treatment with "platelet-rich plasma", stem cells and various tissue engineering techniques had opened to the world a hope to make a treatment that can improve the recovery time of muscle and tendon injuries as well as improving the rate of recurrence associated with this type of injury. While this seems a really important goal, the few published studies do not seem to find scientific evidence yet. Also we want to know the opinion of experts in this field, especially from the clinical experience and analyze the practical aspects of its application and indications.

Biological Approaches to Improve Muscle Healing After Injuries Johnny Huard Henry J. Mankin Professor and Vice-chair for Musculoskeletal Cellular Therapeutics in the Department of Orthopaedic Surgery and in the Departments of Microbiology and Molecular Genetics, Pathology and Physical Medicine, Bioengineering, and Rehabilitation. Director of the Stem Cell Research Centre of Children’s Hospital of Pittsburgh. Deputy Director of the McGowan Institute for Regenerative Medicine, United States of America

Mechanical and Biological Interaction Between Muscle Cells and the Extracellular Matrix Richard Lieber Professor of Orthopaedics and Bioengineering, Veterans Affairs Medical Centre, and Department of Orthopaedics and Bioengineering, University of California at San Diego, San Diego, United States of America. Regenerative Therapies in the Muscle and Tendon Nicola Maffulli Centre Lead and Professor of Sports and Exercise Medicine Consultant Trauma and Orthopaedic Surgeon Queen Mary University of London Barts and The London School of Medicine and Dentistry William Harvey Research Institute Centre for Sports and Exercise Medicine Mile End Hospital. Chairs: María José Martínez Specialist in Clinical Pharmacology at the Clinical Epidemiology and Public Health Department of the Iberoamerican Cochrane Centre, Institute for Biomedical Research of the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Lluís Orozco Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain. Robert Soler Regenerative Tissue Therapy Institute at the Teknon Medical Centre (ITRT), Barcelona, Spain.

Discussion panel members: Ramon Cugat Orthopaedic Surgeon, Head of the Orthopaedic Unit at the “Mutua Montañesa”, Head of Service of “Mutualidad de Futbolistas” of the Catalan Football Federation at the Trauma Institute Quiron Garcia Cugat Foundation and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona. José A. López Calbet Professor of the Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. Mario Marotta Researcher at the Paediatric Surgery, Orthopaedics and Bioengineering Laboratory at the Research Institute “Institut de Recerca Hospital Universitari Vall d'Hebron”, Barcelona, Spain. Jordi Puigdellivol Orthopaedic Surgeon and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona. LluÍs Til Senior Researcher at the Physiological and Functional Evaluation Department, High Performance Centre - CAR - Sant Cugat del Vallès, Spain and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona.

11:00 Coffee break

11:30 Scientific evidence and clinical validation of the F.C.Barcelona Clinical Practice Guide of

tendon injuries F.C. Barcelona is one of the pioneering clubs in medical research and the application of scientifically validated protocols for prevention and treatment of injuries to its athletes. In the 2nd MuscleTech Network, the guide “Clinical practice of muscle injury” published at the journal Apunts Medicina de l’Esport was presented. We are currently in the process of validation of the Clinical Practice Guide of tendon injuries. To do this we have to put into discussion the different sections of the guidance that range control of risk factors, diagnosis, treatment and secondary prevention.

Connective Tissue, Fibroblasts and Myofibroblasts - Structure, Function and Responses to Mechanical and Physiological Stimuli Henning Langberg Associate Professor and lecturer at the Institute of Sports Medicine, Bispebjerg Hospital, School of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

Prevention and Management of Tendon Injuries Nicola Maffulli Centre Lead and Professor of Sports and Exercise Medicine Consultant Trauma and Orthopaedic Surgeon Queen Mary University of London Barts and The London School of Medicine and Dentistry William Harvey Research Institute Centre for Sports and Exercise Medicine Mile End Hospital. Combining Aerobic and Resistance Exercise: Can Muscle Comply? Per A. Tesch Professor at the Department of Health Sciences, Mid Sweden University, Östersund and Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden.

Chairs: Daniel Medina Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona. Ricard Pruna Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona.

Discussion panel members: Angel Cotorro Senior Researcher and Medical Director of the Medical Services of the Royal Spanish Tennis Federation. MAPFRE Tennis Medicine Centre, Barcelona, Spain. Ramon Cugat Orthopaedic Surgeon, Head of the Orthopaedic Unit at the “Mutua Montañesa”, Head of Service of “Mutualidad de Futbolistas” of the Catalan Football Federation at the Trauma Institute Quiron Garcia Cugat Foundation and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona. Alfons Mascaró Senior Researcher and Sports Physiotherapist Specialist. Jordi Puigdellivol Orthopaedic Surgeon and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona.

13:00 Lunch 14:00 Update in muscle and tendon injury and repair biomarkers.

The signalling pathway occurring after injuries, the effect of nerve activity in adult skeletal muscle, and specifically the pathways which control muscle growth and fibre type specification will be subjects in the limelight during this session. Amongst them, the study of biological markers of myoconnective injuries can help and be complementary to the imaging studies of muscle and tendon injuries. The determination of serum proteins may have a diagnostic and prognostic value of muscle and tendon injuries. These studies may reveal novel injury recovery protocols and lead to the creation of a glucose reader like device rating the injury grade. The Mystery of Popping Sarcomeres Walter Herzog Associate Dean of Research, Faculty of Kinesiology, The University of Calgary and Adjunct Professor, Faculty of Medicine, Department of Surgery, The University of Calgary.

What processes are taking place in the healing tendon? Henning Langberg Associate Professor and lecturer at the Institute of Sports Medicine, Bispebjerg Hospital, School of Health Sciences, University of Copenhagen, Copenhagen, Denmark.

Cellular and Transcriptional Changes After Muscle Injury Richard Lieber Professor of Orthopaedics and Bioengineering, Veterans Affairs Medical Centre, and Department of Orthopaedics and Bioengineering, University of California at San Diego, San Diego, United States of America.

In the Search of Human Models of Muscle Damage and Reparation: Repeated Muscle Biopsies José López Calbet Professor of the Department of Physical Education, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.

Chairs: Roser Cussó Professor at the Department of Physiological Sciences I. Biochemistry and Molecular Biology Unit. Metabolic Regulation and Molecular Pathology Group. School of Medicine, University of Barcelona, Barcelona, Spain. Ginés Viscor Professor at the Physiology Department, School of Biological Sciences, University of Barcelona, Barcelona, Spain.

Discussion panel members: Jordi Ardevol Senior Researcher and Sports Medicine Specialist, Orthopaedic Surgeon with specialty on Arthroscopic Surgery at the Orthopaedic Surgery and Traumatology Unit of the ASEPEYO Hospital and Clinica Diagonal, Barcelona, Spain. Josep Cadefau University of Barcelona, Barcelona, Spain. Franchek Drobnic Research Leader at GIRSANE - Performance and Health Research Group for High Level Sports Department of Sport Physiology, High Performance Centre - CAR - Sant Cugat del Vallès and Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona. Xavier Yanguas Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona

16:00 Conclusions and closing remarks of the “3rd MuscleTech Network Workshop Muscle Injuries

and Repair: Current Trends in Research”

Carles Pedret Senior researcher at the MAPFRE Medicine Tennis Centre, and Centre for Image Diagnostics, Tarragona, Spain. Gil Rodas Scientific Director of MuscleTech Network, Senior Researcher and Sports Medicine Specialist at the Medical Services Futbol Club Barcelona.

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rsat del Músout the imporBased on thelite sport, Fmuscular injuhanisms of sport practice

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Willem vaOccupationaInstitute of Centre Bodspin-off com Willem van After compAmsterdam of Amsterdaout-patient

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agazine FEM

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an Mechelal Health ofVU Universy@Work TN

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dependent pe skeletal muprovements, sat del Múscrage an ope

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len is Heaf VU University Medical NO VU Univea Nederland

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intment at ths PhD in Hugistered epidll professor o

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platform to duscular syste scientific inncul is focusn communicpair to prom

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born and raiss a PE-teacned this with as an MD inoccupationa

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disclose andem, preventinovations ased to create

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sed in Amstecher he wor studying men 1982 he stal physician. f Human Mo

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share informon of possibwell as to th

e awarenessen society aner ageing an

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partment of d Co- Direcairman of thnd Director o

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ovement Sciees in 1992. He is employerts Medicine

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mation, giveble injuries ahe experiencs on the imnd research,nd finally to

tbol Club Ba

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e advice andnd muscular

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Beirut (LebStandardizaorganisationagainst Neu(Health Dep Characterizisokinetic d Traditionallypower, and measuring need for mostretching pinformation be used as range of minfluences connective decrease ininactive areelements capproximatemuch of thechanges to ideal prescrfor 20-30 sundertaken dynamic) cstretches arstiffness. Wmotion and stretching iscycle is notand landing Passive visgymnasts v The purposmuscle-tendintensive trais not clearintensive trdynamometthe maximaaverage paThe area unIn addition,

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n tension is e less stiff than rise to leely 80 percee early gainsthe muscle.

ription for strseconds, tha

slowly to limcan influencere more likely

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scoelastic cvs. control s

se of this studon unit betaining from er and needs raining for 5ter was used

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Pierre Portehysiotherapyom the Univrofessor at tesearch activhe Rothschildmovement anervical spine00 invited cos referee byrofessor at Ais involved European Neational Agenc

Disorders (Ae University

e passive mters

dynamomecharacteristassociated on on the prhe use of dymore preciseuipment to faso reduces these reductserve as a frnot known. han the tendevels simila

ent of their m in range of Structural aretching remat the first smit stress ine the degrey to influencretch for spothe individua

d. In sports whe need to s

characteristisubjects

udy was to etween formeearly childhoo

to be inves5 to 17 yead to passivelorsiflexion (Rss was calcument-angle cl voluntary to

ero is profey in Paris (19versity of Tecthe Sport Svities take pd Hospital in

nd muscle bi. He has pub

onferences (iy 15 indexedAuckland Unin several s

euromusculacy for HealthAFM), the Frof Teeside (

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orts or not deal. If a persowhere there istretch is less

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examine the er internationod. The impastigated.Sevears and 6 sy stretch the

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Science Depalace in the Nn Paris wheriomechanicsblished over including ove

d internationaniversity of Tscientific org

ar Centre). Hh Accreditatiorench Minist(UK), Royal S

properties o

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or the muscleave generaler, when murecorded in nge of motiour as a resultare more likewn. Current vides the mo. There is srange of m

motion while epends uponon has sufficis concentrics compared

alf muscle-te

difference inal female gact of such sen former insedentary se right calf ms-1. The maxeen 15 and 2alculated as e plantar flex

olds a PT dceived his PhCompiègneartment of tNeuro-Orthore he is in c

s with specifi60 scientific

er 40 at inteal journals. Technology (ganisations e serves als

on and Evalutry for ReseaSociety of Ne

f the muscle

o measure ss attention h Researcheroutines to ee responsesto be instituten range of m

at any partin the tend

e. The relativly found thauscle is activthe tendon. n, they oftent of reduced ely to be obsevidence suost gains, aome evidenc

motion increadynamic stre

n the type of ient range of

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endon comp

n passive vigymnasts anstrenuous tranternational fubjects part

muscle-tendoximal passive25° of dorsiflthe average

xors and exte

degree from hD degree in (1993). He ihe Universit

opaedic Rehacharge of thec reference

c articles, 27 rnational levHe has serv(NZ) and Un(e.g. Internao as expert a

uation (HAS)arch, the Freew Zealand (

e-tendon co

variables ashas been givrs have comnhance the to stretchin

ed. Furthermmotion. Stret

ticular muscdons, contrave contributiot muscle covated; the te

When musn become acmuscle activ

served over wggests that s

and that initce that the tases or stiffetches are msport being f motion, theion primarilyat require la

plex in form

scoelastic cnd controls. aining on the female gymnticipated to n unit from r

e resistive toexion and fo of absorbedensors were

the Nationa Biomedical is currently wty Paris-Est abilitation dee researcheto muscle d book chapte

vel). He has ved as visitinniversity Sainational Orgaadvisor in m

), the Frenchench Ministry(Rutherford F

omplex usin

ssociated wven to their

mmented thasafety and t

ng can providmore, dynamotching not oncle length anactile elemenon of these tiontractile eleension in thescles are strctive. It seemvity rather thweeks of strstretches shtial stretchestype of stretfness is red

more effectiveplayed and

en the need ty and the strearge amounts

mer internati

characteristicGymnasts

musculoskenasts that hathe study.A

relaxed plantorque was meor the final 10d passive-ela also measu

al School ofEngineering

working as aCréteil. His

epartment ats on human

disease, anders and overbeen invitedng or invitednt-Joseph inanization for

many nationalh Associationy of DefenceFoundation).

g

ith strength,potential for

at there is ahe results ofde importantometers cannly improvesnd thereforents and thessues to thements whene contractileretched pastms likely thatan structuraletching. Theould be helds should betch (static oruced. Static

e in reducingthe range ofto undertakeetch-shortens of jumping

onal female

s of the calfusually start

eletal systemave stopped

An isokinetictar flexion toeasured and0% of ROM.astic energy.red. Despite

f g a s t n d r d d n r l

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similar maximal voluntary plantar flexion and dorsiflexion torques, former international gymnasts exhibited significant higher maximal passive dorsiflexion ROM (+35%), maximal passive resistive torque (+48%) and passive-elastic energy (+63%). Furthermore, former gymnasts showed significant lower passive stiffness within the 15-25° of dorsiflexion (-33%) and higher for the last 10% of ROM (+41%). Although speculative, these results suggest that long term loading during childhood have modified passive properties of the calf muscle-tendon unit of former international female gymnasts that persist several years after the cessation of sport practice. Longitudinal follow up will assist in determining whether or not passive properties of plantar flexors is genetically determined and/or able to be modified with further gymnastic training.

Physicians-Hellenic VoPhysicians-Sports andmedicine Ro Clinical Pro Muscle injusports. Accinjuries are positioning the hip andreceives innknow. Contbiceps femokicking andclassify the imaging findrange of molesion. Folloprotocol to pto differentiathe Posterioinjuries .Wephase. Opemuscles, eifound to beAccording tassess theof Prognosia proximal farea of injurat a normal less than 4 return to pla Cost-effect Injuries to tthe frequenmanagemeninversion ananterior taloligament (Cthem in thre

NMFSHLDsAGT

-ECOSEP Molley Ball Fe-ECOSEP . Exercise moyal College

ognostic va

ries are amoording to sothe commo

and relationsd knee .Longnervations frtraction injuroris, long he

d primary invseverity of tdings, time totion deficit owing a clinipredict the tiate Commonor Thigh froe as clinicianerative intervether at the in

e 12–31% Eto our clinica

e risk of re-ins the followinfree tendon, ry. Past histopacepain-freweeks from

ay timescale

tive prevent

the lateral anncy and thent, and long-nd plantar flofibular ligam

CFL) as well. ee grades, a

Nikos G. MMember, ChFellow of theScience (MHospital. DipLondon HosDirector of tsince 1986. Athens 2004Games 200Thessalonikiedical Commederation . Founding m

medicine Ase of Surgeons

lues in Ham

ong the mosome studies, nest muscleship to the gg head receirom the comries occurrinead and thevolving Semhe injury. Thto walk painbetween thecal classificame to full rehn Signs and m another S

ns have to pention is resnsertion or aEarly return al classificat

njury followinng factors haproximity of

ory of hamstee within 24 the time of inwhich is imp

tion of latera

nkle ligamene impact of-term compliexion [6]. Eiment (ATFLVarious sys

as mild .mod

Malliaropohair Europeae Faculty of MSc) in Spoploma in Sp

spital. PhD fhe Sports MChief Medic

4. Director of7. Director 2009. Cha

mittee MembFounding m

member of thsociation-BAs Ireland. Me

mstring Injur

st common, muscle inju

e injury in allground it canives innervat

mmon persong during Ru

ey heal fastemimembranoshey classify th-free. Our C

e injured andation we are habilitation aSymptoms o

Source. Rehprescribe theerved only fo

at the origin to sport &

tion Objectivg acute ham

ave been shof the injury totring injury ish of injury w

njury. Defininportant in gui

al ankle inju

nts constitutef acute ankcations. Earghty percen

L). In 20%, stems have bderate, seve

oulos Sportsan College oSports and E

orts Medicineports Medicifrom MedicaMedicine Cencal Officer of the Medicaof the Med

air of the Eurber Europeanmember of the Greek SpASEM. Μ.F.Sember of the

ries.

most misunduries accountl Sports. Ha

n serve as a tions via a t

nal nerve. Thunning at Maer comparingsus, proximahem in three

Clinical classd the healthable to dec

and to assessof a Hamstrihabilitation ise right clinicaor severe inj(avulsion). Tpoor rehabil

ve clinical finmstring muscown to requiro the ischial s the main riswas independng the severiding rehabili

ury

e 15% to 45kle ligamentrlier studies it of lateral amore violen

been used tore. In our s

s Medicine of Sports anExercise Mee - Universine (DSM) Ul School of ntre, Athleticof the Hellenal Services odical Servicropean Collen Judo Unionthe Europeaorts MedicinSEM MembGreek Traum

derstood, ant for 10 - 30mstrings funhip extensortibia portion he mechanisaximal or Neg to stretchial tendon. Ve grades, as sification is by side. Ultraide for the trs the reinjureng Strain Inj

s one of theal applicationuries, such a

The reinjure itation progr

ndings can cle strains in re a greater ctuberosity, i

sk factor for dent predictoity of the injuitation and in

% of all spot Injuries lendicate that

ankle sprain nt inversion o classify thesetting, we p

Physician-End Exercise dicine UK, ity of LondoUniversity ofAristotle Un

cs Federationnic Olympic of the First Ses World F

ege of Sportsn –EJU. Medan College oe Associatioer Faculty oma Associati

d inadequat0% of all injunction is comr, knee flexoof the sciati

sm of the injear-Maximal ng injuries oarious systemild .modera

based on estasound is usreatment, to e rate. We mjury Compar

e key points n correlated tas complete rate for ham

ram met withprovide an elite track aconvalescenncreased lenthe next injuor of being uury enable usn team plann

orts related Inads to poo85% of anklinjuries mosforce dama

e severity of tplan the initia

EJU MedicalPhysicians F. FSEM U

on Queen Mf London Q

niversity of Tn SEGAS, TTeam XXV

South EasterFinal Gran s medicine adical Commitof Sports a

on. Member oof Sports aion.

tely treated curies in spormplex. Depen

r, and externic nerve, thejury is very Speed Primoccurring in

ems have beate, severe, timating the

sed to imagedesign the r

must always kred to Those

dealing witto each hearupture of th

mstring injurieh a high riseffective cli

nd field athlent period: injngth and cro

ury. Being unnable to retus to assess ting.

njuries. Undor diagnosisle sprains inst commonly

ages the calthe injury. Tal managem

Committee(ECOSEP).

K. Master ofMary-LondonQueen Mary-Thessaloniki.Thessaloniki,VIII Olympicsrn EuropeanProux IAAF

and Exercisettee Membernd Exerciseof the Britishnd Exercise

conditions inrt. Hamstringnding on legnal rotator ofe short headimportant to

mary involveDancing or

een used toaccording toknee active

e the musclerehabilitationkeep in minde Referred toh Hamstring

aling processhe hamstringes has beenk of reinjurenical tool toete. In termsury involvingoss-sectionalnable to walkurn to play inthe expected

erestimating, unsuitablevolve forced

y involve thecaneofibular

They classifyment of ankle

e . f

n -. , s n F e r e h e

n g g f

d o e r o o e e n d o g s g n e o s g l

k n d

g e d e r y e

sprain according to pain, ability to bear weight, range of motion (ROM), oedema (EDE), and stress radiographs. In addition, we routinely measure active ROM, and quantify the presence of EDE by the figure-of-eight method. We had the clinical impression that the grading of ankle sprains in athletes. Could be enriched by further sub grouping.Recently, we proposed a new classification system into 4 categories (I, II, IIIA, IIIB). Our Clinical classification based on estimating the ankle active range of motion deficit between the injured and the healthy side The extent of the acute swelling was measured in cm by using the figure of eight method and AD ankle radiographic stress evaluation. Following a clinical classification we are able to decide for the treatment, to design the rehabilitation protocol to predict the time to full rehabilitation and to assess the reinjure rate. Defining the severity of the injury enable us to assess the expected return to play timescale which is important in guiding rehabilitation and in team planning. Rehabilitation is one of the key points dealing with Ankle Ligament Injuries. Treating ankle sprains in elite athletes is a challenge for both the physician and the patient. The pressing question when managing such an injury is how to shorten the time required for full and safe return to sports. One of the main key points for rehabilitation is to induce the proper application of therapeutic intervention, according to the healing process phases. The reinjure rate for Ankle Ligament Injuries has been found to be 10%–73 % Early return to sport & poor rehabilitation program met with a high risk of reinjure According to our clinical classification Objective clinical findings can provide an effective clinical tool to assess the risk of re-injury following Ankle Ligament Injuries in elite track and field athletes. From our study regarding re injury rate of Ankle Ligament Injuries we conclude that Athletes with a grade I or II lateral ankle sprain are at higher risk of experiencing a re injury. Low-grade acute lateral ankle sprains result in a higher risk of re injury than high-grade acute lateral ankle sprains. The results of our study provide cost-effectiveness and general applicability predictive criteria for the evaluation of patients with acute lateral ankle sprain, and may be useful for further studies on this topic.

High-speed Hamstring slocation andand the anahamstrings probably neplay again wrehabilitatiorehabilitatioacute hamsinjury type lengtheningtype is mainjunction. In tissue of theacute hamsnoticed thacomparing injury locatioIn the presewhere the lengtheningincluded leninjuries. Behamstring tein athletes anticipated but can prolocation and

CoDS2resin

d running ty

strains are ad size. A maatomy is commuscles. Dif

eeds full funcwithout 100%

on period. Alon time and sstring strainsoccurs durin

g of the hamsnly located tocontrast; thee semimembstring strainsat different ihamstring son can give ently ongoinaim is to c

g exercises, wngthening ex

efore the athest without aincluded in and it has b

obably be avd size.

Carl Asklingof Sport and Department oSweden. He 2008. He is esearch thaoccer/track a

njuries.

ype or stretc

a heterogeneajority of the mplex, characfferent sport

ctional recove% restored full these parasafe return tos, which are ng high-speestrings, sucho the long h

e stretching-tbranosus. Ins in elite fooinjury situatitrains typicaimportant infg study (Askcompare twowith respect xercises sho

hletes are alany remainin

the study. become increvoided to a

g is a reseaHealth Scienof Moleculadefended hisupported bt deals withand how to

ching-type o

eous group, strains are locterized by os put differenery after injuunction. Eveameters mako sport difficu

best distinged running an as; high kicead of biceptype is locatea prospectiv

otball (n=80)ions can re

ally sustainedformation abokling CM. et o different rto time loss ortens the relowed to ret

ng symptomsTaken toget

easingly knowlarge degre

rcher and lences and ther Medicine is Thesis, “H

by The Swedh different toptimize the

of hamstring

especially iocated in theoverlapping tnt demands

ury before con psychologke the progult to predict.guished by thnd the other

cking, sliding ps femoris aned close to thve randomize), track and

esult in diffed by sprinteout the injuryal) on acute

rehabilitationand return toehabilitation turn to full t

s or signs of ther, hamstrwn how diffi

ee, provided

cturer in Spoe Section of and Surger

Hamstring mdish Centre types of acue rehabilitatio

g injuries ma

in terms of te proximal patendons and on the hams

ompeting agaical aspects nosis after aThere are athe different r occurs duritackle and s

nd typically ihe ischial tubed ongoing sfield (n=50

erent types rs versus day prognosis. e hamstring n protocols, o sports, we period sign

training and injury. So fa

ring injuries cult they aresound know

orts MedicineOrthopaedic

y, Karolinskmuscle strain”

for Sport Rute hamstrinon period an

akes a diffe

the different art of the hamstructural in

strings, for eain, but a foo

on an indiviacute hamstt least two diinjury situating moveme

sagittal split. nvolves the

berosity and study (Asklin) and other of hamstrinancers. The strains (170i.e. convenhave observ

nificantly in bcompetition

ar we have oare more c

e to treat. Rewledge abou

e at the Swecs and Spor

ka Institutet, ” at Karolins

Research in ng strains ind how to pr

erence to MR

t types of injmstring muscnterrelations example the otball player idual level catring strains istinctly diffeions. The mo

ents leading The high-spproximal mutypically invo

ng CM. et al) sports (n=4

g strains; foinjury situat

0 elite athletentional exercved that the both types on they shoulonly noticed ocommon thaecurrences aut the injury

edish Schoolrts Medicine,

Stockholm,ska Institutethis ongoingn especiallyrevent these

RI findings

juries, injurycles/tendonsbetween theelite sprintercan possiblyan affect the

in terms ofrent types ofost commonto extensive

peed runninguscle-tendonolves tendondealing with

40) we haveor example,tion and the

es included),cises versusprotocol thatof hamstringd perform aone re-injuryn previously

are common,type, injury

l , , t g y e

y s e r y e f f

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, s t g a y y , y

Wednes__________

has made smuscle-deritreatment pconditions icartilage. Csuffering frosuffering froNational Insprivate and Dr. Huard wChancellor’sprestigious Regenerati Members omuscle of myogenic acharacteristderived stedifferentiatethat of othemicroenviroresistance tlocal enviroapplicationsthe genetic and anti-angthese variotechnology results on hstem cell-ba Biological A Muscle injuproduction aat the originhealing of mformation othe capacitymuscle injuand losartandecorin are Gamma-inte

sday, Sep__________

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significant pived stem cprograms to ncluding ske

Clinical trial om urinary iom cardiac istitutes of Hepublic found

was recognizs DistinguisKappa Delta

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of my laboratnormal mice

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e toward varir myogenic c

onment they to oxidative onmental cus designed tomodification

giogenic factous tissues.

to delay aghuman muscased gene th

Approaches

uries are extand re-injury

nal site of injumuscle injurf fibrotic tissy to differentury in vivo. Vn can improvmolecules t

erferon, sura

ptember ___________

ohnny HuOrthopaedic Microbiology Medicine andCenter of ChiMcGowan Ins

ittsburgh TisCook Myositeontinues to etem cell to imreclinical ad

cells. He isaddress Du

eletal and causing muscncontinencenjury. Dr. Huealth, the Dedations. He zed by Univehed Resear

a Award in 20

e based on A

tory have isoe on the bal marker expto those of DSCs). MDSous lineagescells, can im

are transpand inflamm

ues. I will do improve pen of MDSCs tors and how I will also ing in an an

cle derived stherapy and ti

s to Improve

tremely comy frequently aury. Gene theries. Transfosue that limitsiate into a mVarious inhibve muscle rethat can be eamin and los

28th ___________

ard PhD, iSurgery anand Molec

Rehabilitatildren’s Hosp

stitute for Regssue Enginee, Inc, a bexpand the pmprove the hvances in ths currently uuchenne muardiac musclle derived s and this stuard’s reseaepartment ofhas publishe

ersity of Pittsrch Award. 004.

Adult Stem

olated variouasis of the

pression profsatellite cell

SCs exhibit ls, both in vitrprove tissue lanted into.

matory stressdiscuss the eripheral nerv

to express ow these types

outline in mnimal model tem cells, whssue engine

e Muscle He

mmon and hare attributederapy may porming grows muscle heyofibroblast-

bitors of TGFegeneration aexpressed bysartan repres

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is the Henrnd hold secular Genetion. He is tpital of Pittsbgenerative M

eering Initiatibiotechnologypossibilities ohealing of vahe isolation, using those uscular dystrle injuries asstem cells htem cell techarch programf Defense, Med over 200 sburgh ChanHe was als

Cells for Mu

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s and their ause of MD

ve, bone andosteogenic ps of modificamy presenta

of accelerahich we belie

eering to impr

ealing after

have a high d to the deveprove useful fwth factor-beealing after s-like lineage F- β1, includand force pry cells and dsent drugs w

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ry J. Mankicondary aptics, Bioengthe current

burgh. Dr. HuMedicine (MIR

ve (PTEI). y company.

of regenerativarious tissueidentificatiofindings to

rophy (DMDs well as the

has been inihnology is a

m is funded bMuscular Dys

manuscriptsncellor Mark so the recip

usculoskele

ns of myogesion charactgh most of thhave identif

roliferation avo. The trann mainly throivability appbility to secr

DSCs in gend articular caproteins (BMations can enation new reated aging (peve will openrove tissue r

Injuries

tendency toelopment of rfor the devel

eta 1 (TGF-βsevere injuryin vitro and cing relaxin,

roduction by delivered to mwith other cl

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n Professor pointment iineering, PDirector of tuard is also RM) and an AFinally, Dr.

.Dr. Huard’sve medicine e of the musn and chara

explore anD) and a vare regeneratiotiated for thlso being ex

by a variety strophy Assos in peer revA. Nordenbepient of the

etal Tissue R

enic cells froteristics, prohese cell popied a uniquend high selfsplantation oough their abpears to be rete paracrinne therapy rtilage healinP2 and -4), nhance the cesults obtainprogeria). Finn new avenuegeneration

o reoccur. Bregenerationopment of te

β1) plays a k. Muscle Stecan contributdecorin, gamlimiting mus

muscle via ginical indicat

__________

r in the Dein the dep

Pathology anthe Stem Cea Deputy DiAssociate DHuard is co

s main resethrough the

sculoskeletalacterization ond develop riety of muson of bone ahe treatmentxplored to trof sources i

ociation, as wviewed journaerg, as a rece Orthopaed

Regeneratio

m the postnoliferation bepulations have populationf-renewal ratof MDSCs, inbility to highly

due to thene factors in

and tissue ng. Further, angiogenic f

cells ability toned with adunally, I will pes for the us

Both limitation-restrictive fiechniques tokey role in tem Cells hate to scar formma-interferscle fibrosis. gene therapytions and ar

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epartment ofartments ofnd Physicalell Researchrector of theirector of theo-founder ofearch focususe of adult system. Heof post-natalcutting-edgesculoskeletaland articulart of patientsreat patientsncluding the

well as otherals. In 2003,cipient of thedic Society’s

on & Repair

natal skeletalehavior, andve displayedn of muscle-tes and cann contrast toy survive their increasedresponse toengineering

I will discussfactor VEGFo regenerateult stem cellpresent newse of muscle

ons in forceibrotic tissueimprove the

inducing theave exhibitedrmation afterron, suraminRelaxin and

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f f l

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e s

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w e

e e e e d r n d . y

available for clinical use. However, due to the potential side-effects of some of these agents, further research must be performed in order to determine clinical safety. Ex vivo gene therapy techniques may provide a method to deliver inhibitors of TGF-β1 to injured muscle. The proteoglycan, decorin, appears to be beneficial, not only for reducing fibrosis, but also for improving muscle regeneration. Delivery of MDSCs expressing decorin or a viral vector carrying decorin to injured muscle may help to improve long-term outcomes by reducing muscle fibrosis and hence the recurrence of injury. The protein, myostatin has been shown to inhibit muscle growth and enhance the deposition of fibrosis. Follistatin has been shown to inhibit myostatin and produces muscle hypertrophy and improves muscle strength. In this talk, we will review the current knowledge concerning the use of gene therapy and tissue engineering applications based on muscle stem cells to improve the recovery of skeletal muscle after injuries and disease.

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h strain resultan causes wc the effectsroteins give iding of the dons that hav

eber Profestre, and DepSan Diego, Sphysics fromlied to mechego in 1985 of the Depd by its inteiomechanicsurnals ranginof Cell Bioland Related

xpression pawhich gene

n of the clinicof Orthopae

rd) the Amerolars (Fulbrigatory is suppalth.

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cles (i.e., “ecre common id have dramnd biology ofssociated witts in relativelaves of mus

s seen in humnsights into ldamage mece a rational s

ssor of Orthpartment of San Diego, U

m U.C. Davisanical studiewhere he h

partment of rdisciplinary

s and Orthopng from the vlogy to thosd Research. atterns in mues are introdcal impact oedic Surgeonrican Collegeght Fellowshported prima

en Muscle C

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stresses thahampered b

series of biocan remodetative electro

Muscle Injury

ccentric contn everyday m

matic biologif eccentric ch injury are ly rapid brea

scle-specific gmans. In adload bearingchanism mayscientific bas

hopaedics anOrthopaedic

United Statess in 1982 dees of single mas spent his

Orthopaednature—an

paedic Surgvery basic s

se more app More rece

uscles subjecuced to musf his basic s

ns (Kappa Dee of Sports Mhip) and the arily by gran

Cells and the

edded in thee mechanicaat exist at thaby the fact thaomechanical el dynamicallon microsco

y

tractions”) prmovements acal consequ

contraction-inmechanical kdown or reogene expresddition, the u and transm

y improve ousis.

nd Bioenginecs and Bioens of America

eveloping a tmuscle cells. s entire acadic Surgery. approach t

ery. He hauch as The

plied such antly, he has cted to high sscles in an

science studielta Award),

Medicine (FelAmerican Sts from the

e Extracellu

extracellulal and biologiat interface. at the precisand structu

ly and mounpy and simu

roduce injuryas well as spuences, it isnduced muscin nature andorganization sion. We ha

use of muscleission in ske

ur ability to p

eering, Vetengineering, Ua. Rick Liebetheory of lig He joined t

demic careerDr. Liebe

that is relevaas published

Biophysical as The Jour implementestress and inattempt to cies, Dr. Liebthe America

llow), and theSociety for B

Department

ular Matrix

ar matrix (ECical interactio Unfortunate

se structural fural studies nt a systemaultaneous bio

y and, ultimaports activities becoming cle injury. Cd are based of cytoskele

ave developees with “kno

eletal muscleprovide rehab

erans AffairsUniversity ofer earned hisht diffractionthe faculty ofr and is nowr’s work isant to those

almost 200Journal andnal of Hand

ed molecularn performingchange theirer has been

an Bone ande Council foriomechanicsof Veterans

CM). Recentons betweenely, attemptsfeatures thatof cell-ECMtic biologicalomechanical

ately, musclees. Becauseincreasingly

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etal elementsed models ofocked out” or. Ultimately,bilitative and

s f s n f

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Regenerati New regenexample, scfactors and constructs fthe repair dconsidered recommendfactors abuunknown. Gthis technolprompt resemeasures formulationsrecommend Prevention

Tendon injucombinationabnormalitiematrix. The orthopaedicrecovery. Msurgery aimincisions in remaining vabnormal neintrinsically pathologicaminimally inand can be formation of

NPSaMaacoQDM

ive therapie

nerative thercaffolds to btenocyte-se

for rotator cudepends on to accelerate

d as best pndant in PR

Given our rudlogy to promearchers to uand clinicals and applding best pra

n and manag

uries can ben. Tendinopaes in tenocyscientific ev

c surgery minMinimally invms to excise

the tendon viable cells toeoinnervatiodifferent fro

al lesion, bunvasive strip

performed wf adhesions,

Nicola MafProfessor ofSurgeon Queand DentistrMedicine Miankle surgerankle arthroscontributed tof Sports anQueen MaryDentistry InsMedicine Mil

s in the mus

rapies havebridge masseeded scaffouff repairs ha

biologic hee muscle andractice for m

RPs have bedimentary knmote early heundertake aply approprialication proc

actice guidelin

gement of te

e acute or cathy is essenytes with disrvidence basenimize the prvasive surge

fibrotic adhto detect intro initiate cell on to interferem the classt act only tping. Percutwithout a touthis will allow

ffulli, MD, f Sports andeen Mary Unry William Hle End Hospry, Sports trascopy, minimto well over 6nd Exercise y University stitute of Heae End Hospi

scle and ten

e been recenive rotator clds to augmve been alsoaling at the d tendon heamanagementeen extensivowledge of tealing, and ppropriately pate follow ucedures, nenes.

endon injuri

chronic and ntially a failedruption of co

e for managinroblems posery representesions, remratendinous matrix respo

e with the paical ones in to denervateaneous long

urniquet. If pow the return

MS, PhD, Fd Exercise niversity of LoHarvey Resepital. Dr. Nicauma, Deformally invasiv600 publisheMedicine Cof London B

alth Sciencesital.

ndon

ntly developcuff tears anent tendon-to used to br tendon-to-baling and allot of musculvely studied the mechanisproduce imppowered lev

up. Thereforeed to be

es

caused by d healing resollagen fiberng tendinopaed by open sts new optioove areas olesions and

onse and heain sensation

present usee them. Thegitudinal tenoost-operativeto high level

FRCS (OrthMedicine Coondon Barts earch Institucola Maffulli mity correctie surgery. Hed works. Heonsultant TrBarts and Ts Education

ped to manand adjuvant to-bone healridge large gabone junctionow early retuoskeletal injin tissue re

sm of actionproved and avel I studies wre, major isaddressed

intrinsic or sponse with rs, and subsathies is limitsurgery, redu

ons for the mof failed hea

to restore valing. New s

n caused by e as they doey include eotomy is sime mobilisatios of activity i

) and Profeonsultant Trand The Lonte Centre fohas particu

on and ComHe has writtee is now Cenrauma and Ohe London Sand Centre

ge muscle abiologic moding have beap in tendonn. Platelet R

urn to elite couries. Even

egeneration, of the PRPs

accelerated with adequatssues, includ

to inform

extrinsic fachaphazard pequent increted. Minimallucing complimanagementling, and maascularity an

surgical techntendinopathy

o not attemptendoscopy, ple, requiresn is carried on the majorit

essor. Centrerauma and ndon Schoolor Sports a

ular interest mplex traumaen, been editntre Lead anOrthopaedic School of M for Sports a

and tendon dalities inclu

een used. Bion injuries. TheReach Plasmompetition, a

though sevthe key fac

s, it is challefunctional rete and relevading standaclinical stu

ctors, either proliferation oease in non-ly invasive teications and t of tendinopake multiplend possibly sniques aim toy. These prot to directly electrocoag

s only local aout early, prty.

e Lead andOrthopaedicl of Medicinend Exercisein Foot and

a, knee andtor of or hasnd Professor

Surgeon atMedicine andand Exercise

injuries. Foruding growthomechanicale success ofma (PRP) isand it is oftenveral growthctors are yetnging to useecovery. Weant outcome

ardization ofdies before

alone or inof tenocytes,-collagenousechniques inpostsurgical

pathy. Openlongitudinal

stimulate theo disrupt the

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several boomany internInternationaincluding th Connectiveand physio Tendons artransmit thethat skeletaexercise thrcell activatioThe changeincreases thmuscles fibtissue with tadapt to theavoid injurymuscles antendons nesynthesis bOveruse of ergonomicsloading on overuse injtendons to tendons (coquality andclinical prac What proce Despite a hAchilles tenThe collagesmall diamethe tendonsmarkers of and markerpain produconnective higher exprsigns of fibtendinopath

HSFhteS“Truk

ok chapters national and al Federatione Research A

e tissue, fibological stim

re fibrous, tee forces geneal muscle carough quantion, muscle he in muscle he stress on

bers. This mathe risk of suese changedy. This is sund their tendeed to adaptby the fibrobf tendon tisss stressing ththe connecturies and cchanges in

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rs of collagencing mediattissue takes

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Henning LaSports MedicFaculty of Heholds a MSc endinopathySports MedicTendionpathesearch on

used lecturerkey-note lectin the area national scie

n of Sports PAward of the

roblasts anmuli

ension-bearierated by then adapt to citative mecha

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hat adaptatioive tissue duompared wiloading. A n

hich will allowparameters.

presented.

aking place

easing incides well as the n the tendin

er μm2. In adetermined. nthesis (Colln breakdowntors has be place in tenlated structu

s, inflammatongoing dege

angberg, Dcine – Copenealth Scienceand a PhD f. He is a specine – Copehy – from basadaptation o

r at national tures, and pof sports me

entific and prohysiotherapy

e Internationa

d myofibrob

ng elementse muscles tochanges in fuanism basedand a qualitaases the forctive tissue w

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data indicaer to maintaw situation bng to hyperin pain and

n of the tenduring physicath muscle ti

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Though no

in the healin

ence of patiepathology leopathic areaddition an inOverall colla

lagen 1, Coln (MMP-2, Men found. I

ndinopathic teral proteins ion or wouenerative pro

DMSc, Ph.Dnhagen, Bispes, Universitfrom the Univecialist in Spoenhagen, Desic science toof connectiveand internat

published moedicine, basofessional ory. He is recipal Federation

blasts - stru

s interposedo the skeletounctional reqd on changesative mechanrces distributwithin the muwhere the for

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ctive of the rethe effect of

o conclusive

ng tendon?

ents with Aceading to thea has been foncreased volagen turnovllagen 3, Fib

MMP-9 and TIN summeryendons, assand factors nd healing

ocess with in

. PT, is asspebjerg Hosty of Copenhversity of Coorts Medicineenmark. He o evidence be tissue to etional conferore than 100ic science arganisations pient of seven of Sports P

ucture, funct

d between thon effecting lquirements as in muscle nism based oted from the scle as well rces on the sential for theon, increasee relationshiptionship and ng tissue streased crossn representsnot always s

However in slittle is knowesearch is thvarious intedata exists

hilles tendone disease is sound to haveume fraction

ver is increasbronectin, TeTIMP 2). No y this indicasociated withinvolved in ccan be decreased tiss

sociate profepital and Cehagen, Denmpenhagen, De and the cois head of

based rehabiexercise andences and h0 scientific p

and related aincluding as

eral internatioPhysiotherapy

tion and res

he muscles imb movemeand to increamass and fibon a change

muscles thras on the tetendons exc

e tendons to s in strengthp between cwithstand t

ength eithers-links or ins a major prosufficient to wpite of the hwn about thhat we haverventions or

s but hypoth

n problems thstill largely une a significann of cells in tsed with increnascin C, Tsigns of incr

ates that anan increase

controlling thtermined suue turnover.

essor of theentre for Heamark. HenninDenmark ando-Found of th

the researcilitation” and

d loading. Hehas more thapeer-review areas. He has a board meonal and natiy.

sponses to

and bones ent. It is wellases in loadbre size throin fibre type

rough the teendons in seceed the streprecede the

h and vascucross-sectionthe increaser by increas

ncreased tissoblem withinwithstand thehigh incidenche adaptive e been able

growth factohesis with re

he underlyinnknown. ntly increasethe tendinopreased mRN

TGF-b and Freased wounn increased ed number ohe formation upporting th

e Institute ofalthy Ageing,ng Langbergd a DMSc one Institute of

ch group onin charge of

e is a highlyan 60 invitedarticles and

as served inember for theional awards

mechanical

designed tol establisheding e.g. with

ough satellitedistribution. ndons 5 and

eries with theength of thee potential toularisation tonal areas of in load the

sed collagensue density.n sports ande increase ince of tendonresponse ofto form new

ors on tissueelevance for

g etiology of

ed number ofpathic part ofNA levels foribromodulin)

nd healing orturnover of

f cells and aof fibrils. Noe notion of

f ,

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Foundation Improving Skeletal muhormonal adisease or research, hato maintain will be discu Combining Chronic aeathletes arethese two eskeletal muskeletal mu

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Per A. TesUniversity ÖInstitute, Stoand the Texraised in StoInstitute, StoResearch InNASA’s KenSciences. Wand physiolofocuses on smethods to covermo.se)

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sch ProfessÖstersund anockholm, Sweas A&M Unockholm, Swockholm in 1stitute of En

nnedy SpaceWhile Dr. Tesogy issues anskeletal muscounteract m

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t organ of thThus, a sig

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alth” as well

e exercise:

xercise resue both exercen scrutinizeoted by resrrent aerobic

sor at thend Departmeeden, adjunciversity, Collweden, rece1980. He convironmental e Center, FLsch’s early rend muscle mscle adaptatmuscle loss.

lth

he human bonificant loss s on healthuscle size anas results fr

Can muscle

ult in contrascise modalitied. In particuistance train

c and resista

Department ent of Physct Professor lege Stationived a PhD

ompleted hisMedicine a

L., and the esearch dea

metabolism, oions to resisDr. Tesch is

ody. As suchin muscle s

. Exercise cnd performanrom studies

e comply?

sting skeletaes in their t

ular, if precening, might nce exercise

of Health iology & Phat Ball State

, TX. Per Tein Physiolo

Post-Doc tt Natick, MAUniversity o

alt with classover more restance exercs also found

its role is crsize resultingcountermeasnce under thof athletes s

al muscle adraining routinded by aerobe attenuat

e will be pres

Sciences, Mharmacologyte Universityesch (1950) ogy from thetraining at thA., and held of Arkansas sical sports pecent years cise, muscleer of the Te

ritical in maing from disussures, based

hese conditiostill competin

daptations. nes, the com

obic exerciseted. Researcsented.

Mid Sweden, Karolinska, Muncie, INborned and

e Karolinskahe US Army

positions atfor Medical

performancehis research disuse and

esch-Övermo

ntaining vitalse, inactivity,d on spacens. Methods

ng at age 90

While manympatibility ofe, it appearsch exploring

n a N d a y t l

e h d o

l , e s 0

y f s g

The Myster AV Hill introrelationshipat different increasing mif this was without cheby experimethe notion tbecomes incorrespondicalled poppand to be re In order to asarcomere serially arraThree mainsarcomeressarcomeressarcomeresmuscles.

ry of Poppin

oduced the np. This notion

muscle lenmuscle lengtnot only a s

ecking the dyents using sthat a musc

njured becauing stretch o

ping sarcomeesponsible fo

address quepopping, we

anged sarcom results that

s are stables’ passive fos protects ag

Walter HeUniversity oSurgery, ThPhysical EdMSc/PhD inin BiomechaProfessor inis the Killamand Cellulabiomechani

ng Sarcome

notion that mn has been bngths gave ths. Needlesstatic but alsynamic propesingle musclele that is acse of sarcom

of the weakeere hypothesor the loss of

estions of mu developed ameres), and,will be discu (not unstab

orces increaainst injury a

erzog is Asof Calgary ahe Universitducation fromn Biomechananics and Nn Kinesiologym Memorial Cr Biomechancs and the c

res

muscles are ubased on thea negative s to say thatso a dynamerties of muse fibre testinctively stretchmere instabilest sarcomesis. Popped sf force assoc

uscle injury oapproaches , for the firstussed and thble) on the se dramatic

and loss of fo

ssociate Deand Adjunct ty of Calgarm the Fede

nics from theeurosciencey, EngineerinChair at Calgnics. His res

clinical applic

unstable on te fact that co

slope, thatt any materiaic property.scles. Furthe

ng and relatinhed on the dlity, the assores to lengthsarcomeres ciated with ac

on the sarcomfor the testint time ever, that relate to t

descendingcally when aorce, rather t

ean of ReseProfessor, F

ry.Walter Heeral Technica University o

e at the Univng and Medigary and a Csearch intere

cation of mus

the so-calledonnecting thet is, maximaal with such The notion

ermore, suppng findings tdescending ociated differh beyond acare thought ctive stretchin

mere level, ang of single mthe testing othe notion ofg limb of tha muscle is than cause lo

earch, FacuFaculty of Merzog receival Institute iof Iowa, and versity of Cacine at the U

Canada Reseests are in msculoskeletal

d descendinge statically oal isometric properties wof instability

port for suchto individual limb of the rences in sactin-myosin fto be indicatng of muscle

and tackle thmyofibrils (a of mechanicaf eccentric me force-lengactivated, a

oss of force i

lty of KinesMedicine, Deved his BScn Zurich, hidid postdoctlgary. PreseUniversity of earch Chair muscle mecbiomechani

g limb of the observed ma

forces decwould be highy was adopth instability w

sarcomeresforce-length

arcomere forcfilament ovetive of structues.

e ideas of insub-cellular

ally isolated muscle injuriegth relationsand (iii) thatin eccentrica

siology, Theepartment ofc degree inis combinedtoral training

ently, he is af Calgary; hein Molecular

chanics, jointcs.

force-lengthaximal forcescreased withhly unstable,ed by many

was provided. This led torelationship

ces, and therlap; the so-ural damage

nstability andorganelle ofsarcomeres.

es are (i) thathip, (ii) thatt popping ofally damaged

e f

n d g a e r t

h s h , y d o p e -e

d f . t t f d

ScandinaviaOne and TCollege. In the searc Prevention sound scientraining canthis is achiethese injurieshares sommuscle or pathways ininitiating thebe used to directly in hSTAT3 sigmechanismtype) strateg

JPUBUBRrmpii

an Journal oThe Journal

ch of human

of muscle ontific knowledn be applied seve remains es. However

me similitude tendon inju

nvolved in: e process ofboth cause umans. We naling path involved in gies to preve

José AntonPalmas de GUniversity ofBarcelona. SUniversity oBarcelona. PRigshospitaleresponse tomechanism bpapers in pen Spain annternational

of Medicine of Physical

n models of

r tendon injudge is availasuccessfully unknown. Litr, much morwith the ske

ries, new ea) enhancin

f reparation. a muscle inhave recentway, likely muscle repa

ent muscle d

nio López CGran Canariaf Barcelona

Specialty in Sf Barcelona

Postdoctoral et, Copenha

o exercise; by which leper reviewed nd other colevel.Memb

and ScienceActivity and

f muscle dam

uries is a mable on the efto prevent mttle is also knre is known eletal musclexperimental ng the neuroIn this prese

njury and thely shown thamediated b

aration it will amage and a

Calbet is pra. Canary Is Medical d

Sports Medica Specialty

appointmenagen, Denmobesity and

ptin and insuljournals.Thi

ountries.Morber of the ede in Sports, d Health. Me

mage and re

ajor focus inffectiveness

muscle and tenown about about how

es. To increamodels wil

ro-mechanicaentation we en study theat an early evby interleukbe easiest t

accelerate re

rofessor of Exslands, Spaindoctor (Hospcine at the Uin Rheuma

nts: The Copmark. Main d exercise, lin act on hurty six book

re than 25 ditorial boardEuropean J

ember of th

eparation: r

the preparaof preventiv

endon injuriepharmacologto reduce isase our knowl be neede

al competenwill shown h

e signaling invent after mu

kin 6 (IL-6).to elaborate eparation and

xercise Physn. Master in pital Clinic Bniversity of Mtology PhD

penhagen Mtopics of rewith emph

man skeletachapters. Abresearch g

d of: Journaournal of Ape Scientific

epeated mu

ation of athlee treatments

es, but the mgic of nutritiochemic damwledge on hd to explorece of muscl

how repeatednvolved in thuscle damag By undersstrategies phd functional r

siology, Univ Sports Scie

Barcelona) UMontpellier (D at the U

Muscle Reseaesearch: ca

hasis on theal muscle. Mobout 120 invgrants at nl of Applied pplied PhysiBoard of th

uscle biopsi

etes. Howeves. It seems th

mechanism thonal strategiemage in the how to prevee the specifles and tendd muscle biohe process oge is the actistanding theharmacologirecovery.

versity of Lasences at theUniversity of(France) andUniversity ofarch Centre,ardiovasculare molecularore than 120vited lecturesnational and

Physiology;ology, PLoS

he European

es

er, very littlehat eccentrichrough whiches to preventheart, which

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b BarcelonaMaillol, s/n.

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