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See detailOne injection of platelet-rich plasma associated to a submaximal eccentric protocol to treat chronic jumper's knee
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in The Journal of sports medicine and physical fitness (in press)

INTRODUCTION: Jumper's knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons ... [more ▼]

INTRODUCTION: Jumper's knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. METHODS: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10--point Visual Analogic Scale, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA--P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub--maximal eccentric reeducation. RESULTS: Pain during daily activities significantly decreased with time. During functional evaluation, it decreased as well, but without significant functional improvement. No improvements in the imagery measurements were observed. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. CONCLUSION: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol can improve symptoms of chronic jumper's knee in patients non--responsive to classical conservative treatments. [less ▲]

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See detailINFLUENCE OF PLAYERS’ LEVEL ON RACKET SPEED AND BALL ACCURACY IN THE TENNIS SERVE
Tubez, François ULg; Croisier, Jean-Louis ULg; Cordonnier, Caroline ULg et al

Conference (2014, July 06)

INTRODUCTION Serve in modern tennis game is an important offensive weapon for players (1-2). In kinematic analysis, serve is the most studied stroke of this game. The aim of our study was to compare the ... [more ▼]

INTRODUCTION Serve in modern tennis game is an important offensive weapon for players (1-2). In kinematic analysis, serve is the most studied stroke of this game. The aim of our study was to compare the performance of two specific populations: international players versus national players. In particular, racket speed at impact and accuracy of ball were assessed. METHODS A tennis court was reconstructed in a motion analysis laboratory. The position of the racket was evaluated in 3D at a frequency rate of 200 Hz. Tests were performed on 6 professional players (international level) and 9 non-professional players (national level). Each of them served 25 trials in direction of the “T” area of deuce diagonal. Two squares of 1m² and 2 m² respectively were delimited on the corner of the serve square. The instruction for both groups was to serve in the “T” area with the highest ball speed and minimal ball rotation (flat serve). RESULTS Although the forward speed of the racket at impact was identical between the two groups of players (International 36.35 ± 2.37 m/s and national 36.37 ± 2.90 m/s, p-value 0,991), the accuracy and consistency of serves on the target area is better for international players group (1m² area: International 33% ± 7% and national 14% ± 12%, p-value 0.0053; 2m² area (including 1m² area): International 71% ± 8% and national 54% ± 12%, p-value 0.0096; Out of zone: International 29% ± 8% and national 46% ± 12%, p-value 0.014). DISCUSSION High-velocity ball seems to be a key factor for serve performance (3). It is known that there is a relationship between racket speed and ball velocity (4). Both groups have high racket speed. However, international players serve with better accuracy and consistency than national players. We hypothesize that these differences are due to capacity of international players to adapt to a particular environment. Moreover, international players could give priority to consistency over velocity. We conclude that high-velocity serve is not a sufficient criterion to perform at international level; consistency and accuracy are two important factors to reach this level. [less ▲]

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See detailPlatelet-rich plasma to treat patellar tendinopathies: a 1 year follow-up.
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in Clinical Chemistry & Laboratory Medicine (2014, June), 52(Special Suppl), 1285

Background: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons ... [more ▼]

Background: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. Infiltration of Platelet Rich Plasma (PRP) may be considered as a recent therapeutic option for chronic tendinopathies. The aim of the current study is to evaluate the clinical status and the return to sports activities in patients with chronic upper patellar tendinopathies up to 1 year after 1 infiltration of PRP. Methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months and 1 year after the infiltration, using a 10-point Visual Analogic Scale and algofunctional scores (IKDC and VISA-P). Moreover, they had to answer an information questionnaire concerning their life and sports activities. The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub-maximal eccentric reeducation. Results: Pain during daily activities significantly decreased with time. VAS has significantly dropped, IKDC and VISA-P significantly improved over the follow-up of 1 year. Seventy percents of patients reported a favourable evolution with decrease of pain, 15% did never report any improvement and 15% were treated surgically. Seventy percents returned to sports activities, 64,3% without any pain, and 50% of them recovered the same sport level. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. Conclusions: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol can improve, at 1 year, symptoms of chronic jumper’s knee in patients non-responsive to classical conservative treatments. [less ▲]

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See detailEccentric training improves tendon biomechanical properties: a rat model
Kaux, Jean-François ULg; Drion, Pierre ULg; Libertiaux, Vincent et al

in British Journal of Sports Medicine (2014, April), 48(7), 155

Background: Even if eccentric exercises appear favourable in primary prevention of tendons lesions and, especially, in secondary prevention after tendinopathy, the biomechanical changes to the tissue are ... [more ▼]

Background: Even if eccentric exercises appear favourable in primary prevention of tendons lesions and, especially, in secondary prevention after tendinopathy, the biomechanical changes to the tissue are not yet clear. Objective: We aimed to better define the biomechanical changes that affect healthy tendon after eccentric and concentric training. Design: Randomised controlled trial. Participants: Eighteen Sprague-Dawley rats of 2 months. Interventions: The six rats in the control group (U) were not subjected to physical exercise. The 12 remaining rats (6 in each group) ran on a treadmill set at a +15° incline for concentric training (C) or a -15° incline for eccentric training (E), at a speed of 17 m/min for 1 h, three times per week for 5 weeks. Main Outcome Measurements: The tricipital, patellar and Achilles tendons were subsequently removed to perform a traction test until rupture, and a histological analysis was performed. Results: There was a significant improvement in the rupture force of the patellar and tricipital tendons between the U and E groups. The tricipital tendons in the control group presented a significantly smaller cross-section than the E- and C-trained groups, but none between E and C groups. No significant difference was observed for the mechanical stress at rupture per surface unit between the three groups for all three tendons. However, a tendency towards improvement these values was observed between the trained and the U groups for the patellar tendon. Histological studies demonstrated the tendency of the development of a greater number of blood vessels and a larger quantity of collagen in the eccentric group. Conclusions: The mechanical properties of tendons in rats improve after specific training, especially following eccentric training. Our results partly explained how mechanical loading, especially in eccentric mode, could improve the tendon structure. [less ▲]

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See detailEccentric training for elbow hypermobility
Kaux, Jean-François ULg; Delvaux, François ULg; Forthomme, Bénédicte ULg et al

in British Journal of Sports Medicine (2014, April), 48(7), 154

Background: Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Objective: Eccentric muscle strengthening could be very important to protect ... [more ▼]

Background: Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Objective: Eccentric muscle strengthening could be very important to protect hypermobile joints. Design: Case report. Patient: A girl (16 y.o.) affected by an Ehler-Danlos syndrome presented pain in the right elbow and the right wrist after a season of tennis. Interventions: Her training consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds within a limited range of motion in flexion and extension, on an isokinetic device after an evaluation. She was also given an orthesis restricting the joint range of motion of the wrist. Main outcome measurements: The evaluation was made by isokinetic evaluation, visual analog scale and MOS-SF36 questionnaire before and after training. Results: The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified a significant improvement in maximal torque in flexion-extension muscles of the right elbow. She was also given individualized home exercises. Conclusions: The goal of this eccentric training is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility and prevent pain during practicing tennis. [less ▲]

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See detailRevue épidémiologique des blessures lors de la pratique du rugby à XV
Kaux, Jean-François ULg; Julia, Marc; Chupin, Marie et al

in Journal de Traumatologie du Sport (2014), 31(1), 49-53

Rugby is an increasingly popular sport. Full contact being a major characteristic of rugby, injuries are not uncommon. The incidence of injury in Rugby Union reaches 30–91 per 1,000 hours of game time ... [more ▼]

Rugby is an increasingly popular sport. Full contact being a major characteristic of rugby, injuries are not uncommon. The incidence of injury in Rugby Union reaches 30–91 per 1,000 hours of game time. This epidemiological review of injuries in rugby players reports their localization, nature, causes, moment of occurrence in matches and seasonal trends as well as the influence of the player’s position, field conditions, and duration of off time after injury. [less ▲]

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See detailLe traitement médical conservateur des tendinopathies du genou
Kaux, Jean-François ULg; BAUVIR, Philippe ULg; Croisier, Jean-Louis ULg et al

in Ortho-Rhumato (2014), 12(1), 31-34

Les traitements «passifs» des tendinopathies sont généralement utilisés de manière empirique pour combattre la douleur mais ne modifient pas la structure histologique du tendon. Par contre, le travail ... [more ▼]

Les traitements «passifs» des tendinopathies sont généralement utilisés de manière empirique pour combattre la douleur mais ne modifient pas la structure histologique du tendon. Par contre, le travail excentrique a pour but de contrecarrer une théorie étiopathogénique proposant une insuffisance de résistance du tendon exposé à des charges externes qui peuvent progressivement entrainer des lésions. Les résultats cliniques suite à cette prise en charge montrent souvent une évolution favorable des douleurs. Les ondes de choc extra-corporelles demeurent une option thérapeutique non-invasives et présentent peu de complications. De plus, elles sont employées avec succès pour traiter des tendinopathies chroniques rebelles aux traitements conservateurs classiques. Le plasma riche en plaquettes (PRP) est obtenu par centrifugation de sang autologue afin d’obtenir une grande concentration plaquettaire dépendant de la technique employée. Malgré la preuve de l’efficacité du PRP sur la régénération tissulaire en laboratoire, il existe actuellement peu de preuves cliniques tangibles concernant le traitement des tendinopathies chroniques. Enfin, d’autres nouvelles options thérapeutiques (patches de dérivés nitrés, infiltrations de polidocanol, d’acide hyaluronique et de cellules souches) sont également abordées. [less ▲]

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See detailDescription of a standardized rehabilitation program based on sub-maximal eccentric following a platelet-rich plasma infiltration for jumper’s knee.
Kaux, Jean-François ULg; Forthomme, Bénédicte ULg; NAMUROIS, Marie-Hélène ULg et al

in Muscles, Ligaments and Tendons Journal (2014), 4(1), 85-89

Introduction: Different series emphasized the necessity of rehabilitation program after infiltration of platelet-rich plasma (PRP) in case of tendinopathy. However, most of them describe only briefly the ... [more ▼]

Introduction: Different series emphasized the necessity of rehabilitation program after infiltration of platelet-rich plasma (PRP) in case of tendinopathy. However, most of them describe only briefly the reeducation protocol and these programs vary. Our aim was to extensively describe a specific standardized rehabilitation program. Methods: After a review of literature of post-PRP infiltration protocols, we had developed a standardized rehabilitation protocol. This protocol was evaluated by 30 subjects with chronic jumper’s knee who. A a standardised progressive sub-maximal eccentric program supervised by a physical therapist for 6 weeks was started 1 week post-infiltration. The patient benefited also from electromyostimulation, isometric strengthening and stretching of the quadriceps, cycloergometer and cryotherapy. After the supervised program, the patient had to make an auto-reeducation added to the reathletisation protocol for 6 more weeks which was followed by maintenance exercises up to 1 year. The assessments were made using a VAS, IKDC and VISA-P scores. Results: The VAS , IKDC and VISA-P scores decreased very significantly with time. The compliance to auto-reeducation was good. Conclusion: We proposed a simple and efficient protocol based on sub-maximal eccentric reeducation to add to PRP infiltrations in case of patellar tendinopathy. [less ▲]

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See detailIsocinétisme : aspects spécifiques chez le sportif
Croisier, Jean-Louis ULg; Kaux, Jean-François ULg; Crielaard, Jean-Michel ULg et al

in Kinésithérapie Scientifique (2014), 550

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See detailRééducation raisonnée de l’épaule opérée et non opérée (4ème édition)
Forthomme, Bénédicte ULg

Book published by Frison-Roche (2014)

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See detailExperimental Study of the Human Ability to Deliberately Excite a Flexible Floor
Schwartz, Cédric ULg; Berger, Alexis; Bruls, Olivier ULg et al

in Zingoni, Alphose (Ed.) Proceedings of the 5th International Conference on Structural Engineering, Mechanics and Computation (2014)

Human-structure interactions are not completely understood yet. This paper presents an experimental study focusing on the interaction between a human and a flexible support, with a major aim to better ... [more ▼]

Human-structure interactions are not completely understood yet. This paper presents an experimental study focusing on the interaction between a human and a flexible support, with a major aim to better understand how the behavior of a human subject, bouncing on a flexible structure, adapts to the support motion. Exploratory experiments are undertaken with a 7m-span timber footbridge tested in the Human Motion Analysis Laboratory of the University of Liege. The movements of the coupled system composed of the subject and the footbridge are recorded by Motion Capture technology; the subject\textquoteright{}s 3-D body motion is defined by three important angles: ankle, knee and hip. The interaction between the subject and the footbridge is also quantified by means of force platform measurements. The experiments indicate an influence of the support amplitude and natural frequency on the phase shift between the oscillatory floor motion and the three angles characterizing the motion. [less ▲]

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See detail3D analysis of gait using accelerometer measurements
Boutaayamou, Mohamed ULg; Schwartz, Cédric ULg; Stamatakis, Julien et al

Scientific conference (2013, November 07)

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See detailLa qualité de force relative : paramètre sous-exploité ?
Croisier, Jean-Louis ULg; Delvaux, François ULg; Cordonnier, Caroline ULg et al

in Livret des interventions - XVèmes Rencontres Médimex - "Isocinétisme - Actualités et Controverses" (2013, November)

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See detailRééducation des plasties du LCA : quels pièges ?
Croisier, Jean-Louis ULg; BAUVIR, Philippe ULg; NAMUROIS, Marie-Hélène ULg et al

in Abstract Book du Symposium d'Axxon - Actualité en Kinésithérapie (2013, November)

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See detailLe mode excentrique appliqué aux rotateurs d'épaule
Forthomme, Bénédicte ULg; Kaux, Jean-François ULg; Crielaard, Jean-Michel ULg et al

in Livret des interventions - XVèmes Rencontres Médimex - "Isocinétisme - Actualités et Controverses" (2013, November)

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See detailUne épaule sur laquelle s'appuyer
Forthomme, Bénédicte ULg

E-print/Working paper (2013)

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See detailActualités thérapeutiques dans la prise en charge des tendinopathies
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Forthomme, Bénédicte ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(Sup 1), 050-003

“Conventional” treatments of tendinopathies are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are ... [more ▼]

“Conventional” treatments of tendinopathies are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are not completely satisfactory and the recurrence of symptoms is common. In contrast to the passive pattern of many therapies dedicated to tendon disorders, some authors have promoted an eccentric training mode. Such active eccentric training programs are aimed at thwarting an aetiopathogenic theory proposing insufficient tensile strength of the tendon exposed to external loads which could progressively damage it. Though the literature remains incomplete on tendon architecture remodelling and real histological adaptations following an adapted eccentric training, clinical results following such therapy appear promising. Due to its noninvasiveness, low complication rate and high applicability combined with good results, extracorporeal shock wave therapy has become a well known option within the therapeutic spectrum for many tendinopathies. More specifically, it has been successfully applied in chronic tendinopathy resistant to a conservative training program including eccentric exercises. Platelets release different cytokines and growth factors that could promote angiogenesis, tissue remodelling (bone, skin etc.), and wound healing. Platelet-rich plasma (PRP) is obtained by centrifuging autologous blood to have a high concentration of platelets depending on the isolation method. For this reason, different PRP preparation techniques cannot provide a consistently identical final product, but there is currently no international consensus on this issue. Despite the proven efficacy of PRP tissue regeneration in labs, there is currently little tangible clinical evidence for chronic tendon disorders. The few studies that have been performed appear unlikely to be comparable. Up to now, randomised controlled studies with appropriate placebo groups are needed to determine the real effectiveness of PRP for treating chronic tendon conditions. However, this therapeutic option remains very popular in sports, and many top athletes are using it in case of musculoskeletal conditions. What is more, it has been removed from the doping lost of the World AntiDoping Agency. Other new therapeutic options (infiltrations of polidocanol, hyaluronic acid, botulinum toxin, patches of derivatives Nitro...) for treating tendinopathies are also discussed in this review. [less ▲]

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See detailShoulder and handball
Gleizes Cervera, S.; Croisier, Jean-Louis ULg; Kaux, Jean-François ULg et al

in European Journal of Sports Medicine (2013, September), 1(1),

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