The new National Tendinopathy Centre (NTC), based at the Institute of Sport Exercise and Health (ISEH) is launching a large-scale study into tendinopathy. The study forms part of the ISEH’s commitment to answering challenging medical questions through research, and translating work with elite sports to benefit the general population.
What is tendinopathy?
In simple terms, tendinopathy refers to altered tendon structure. The complex tendon tissue changes typically result in localised pain, swelling and stiffness; these can be worse during movement, after activity, or even after rest. There can be associated small tears within the tendon, and changes to the surrounding structures. Early accurate diagnosis and tailored appropriate management provide the greatest chance of a successful outcome. However, a proportion of patients can struggle with the condition for months or even years. This in part reflects an incomplete understanding of tendinopathy amongst the scientific and medical community worldwide.
What are the aims of the Tendinopathy Centre?
Our aim at the NTC is to help all patients thought to be suffering with tendinopathy by applying current best clinical practice, while at the same time researching and advancing scientific understanding of tendinopathy, including underlying causes and mechanisms. This in turn is designed to help refine and develop new management strategies for sufferers, and to implement preventative strategies for those participating in activities that are known to currently result in higher prevalence of tendinopathy.
The ultimate aim is to reduce suffering and minimise time out of sport, work and other activities of daily living. Reducing ‘lay-off’ time can bring individual benefits including minimising loss of fitness, absenteeism from work, and the negative effect on health from an enforced sedentary lifestyle. Productivity and economic losses to employers, which can together run into millions of pounds nationally, can also be substantially reduced.
About the programme
The NTC sees people of all activity levels, from high-profile sportspeople and amateur athletes, through to less active patients wanting to return to normal daily activities and work.
Our research is currently focussing on Achilles and Patellar tendinopathy. Both conditions are very common among sports that involve running, jumping, pivoting and twisting. Among the general population, the incidence of Achilles tendinopathy has been found to be 2.35 per 1,000 people. However, a quarter of all athletes, and over half of all endurance runners, suffer Achilles tendinopathy at some point. It accounts for up to 17 per cent of all running injuries, with the highest prevalence amongst middle-aged men. Though a third of suffers are inactive people, with a lifetime cumulative incidence estimated to be 6 per cent. Patellar tendinopathy is most common among jumping athletes, affecting up to 20 per cent of this group. Males are twice as commonly affected as females.
There are dozens of known risk factors for both conditions. Though, as our understanding is far from complete, there are likely to be many factors that we have yet to uncover. The study team at the NTC provides an in-depth patient evaluation, including a thorough medical, physical and performance assessment. Routine and novel imaging options, including ultrasound tissue characterisation, are available, and the option of blood sampling for future genetic analysis in relation to tendinopathy is offered. By studying and analysing a very large dataset, the causes and development of the condition can be explored, and new prevention and treatment options identified. The research is intended to be ongoing, with patients being recalled for follow-up and further evaluation as the study progresses and new information or discoveries come to light.
New therapeutic approaches may well be considered appropriate and offered as part of clinical practice or a clinical trial. Outcomes will be monitored for the benefit of the patient and medical research.
How can I take part in the study?
The NTC encourages referrals of patients suffering with tendinopathy from all sources, including:
- UK GPs, who can refer to UCLH on Choose and Book.
- Community and secondary care NHS clinics.
- Private clinics.
- Professional and amateur sports clubs.
Referrals can be faxed (020 3447 9958) or e-mailed to Maureen.williamson@uclh.nhs.uk, marked for the attention of Dr Bhavesh Kumar, ISEH.
The research team
The NTC team comprises doctors, physiotherapists and surgeons, in collaboration with partners in medical informatics, cellular biology, genetics, biomedical science and imaging. Steering committee members include Dr Bhavesh Kumar, Mr Bruce Paton, Dr Mike Loosemore, Dr Courtney Kipps, Dr Noel Pollock, Dr Vishal Nangalia, Dr Akbar de Medici, Mr Aria Ghassemi, Mr Michael Oddy, Dr Margaret Hall-Craggs, Prof. Hugh Montgomery, Prof. Monty Mythen, and Prof. Fares Haddad.
Are there opportunities for collaboration?
We welcome collaboration with institutes that have a special interest and similar ambitions with tendinopathy, thereby increasing the clinical and research dataset. Current partners include the English Institute of Sport and Barts Health NHS Trust.
For more information please email the research team research.education@iseh.co.uk