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Silent contributors to injury - illness - performance, 18-19 March 2016 : Session 2 - Pathology : Role of collagen to keep tendon structures strong and healthy / Stephan Praet.
Available for Clearinghouse for Sport member groups B, C, D & E only. Presenter : Dr. Stephan Praet is a Dutch Sport and Exercise Physician, who received his medical training at the Vrije University of Amsterdam, the Netherlands, following a Master’s Degree in Human Movement Sciences at the same university. In April 2015 he joined the Australian Institute of Sport, where, together with his colleagues from the department of Sports Medicine, he is responsible for the clinical management of athlete’s injuries and illnesses. He holds a PhD in Clinical Exercise Physiology from Maastricht University, The Netherlands and he is a Fellow of the European Board of Sports Medicine as well as the Australasian College of Sports and Exercise Physicians. In January 2016 he was appointed as Adjunct Associate Professor at the University of Canberra to further stimulate research collaboration between the University of Canberra and the Australian Institute of Sport. During the past 6 years Dr. Praet has been involved in >15 research projects on the clinical application of exercise testing and therapeutic exercise in both primary and secondary health care settings. Through transfer of knowledge from Sports Medicine and Exercise Science, and in collaboration with the departments of Intensive Care Medicine, Child Neurology, the Orthopaedic Research Laboratory at Erasmus University Medical Center and the Musculoskeletal Rehabilitation Research Unit & Institute of Sports Medicine Copenhagen Bispebjerg Hospital, Denmark, his translational type of research has been focused on both the cardiovascular and musculoskeletal consequences of chronic and excessive metabolic stress. His current research at the Australian Institute of Sport is aimed at developing and validating highly novel imaging modalities (ultrasound/MRI) for the clinical diagnosis and treatment of chronic musculoskeletal overuse injuries. Parallel to this, he is investigating the potential benefits of nutraceuticals as an add-on treatment for tendinopathy. This Symposium was jointly presented by Sports Medicine Australia ACT and the Australian Institute of Sport. Sub themes for the conference include: Planning Periodisation – Training errors, planning for performance, monitoring injury/illness/performance, planning for the gaps and travel ; Pathology Specific – Muscle, tendon, pain, mental health, gender ; Medical – Iron, Viral, respiratory, infectious diseases, vitamins, probiotic, immunology, genetic development ; Physical – sleep, body composition, energy availability, making weight, gender. Abstract : Recreational running is one of the most practiced sports when the aim is to enhance physical fitness and overall health. According to the growing numbers of participants at running events the popularity of recreational running is still increasing. Unfortunately, the incidence of sports injuries is high, causing high dropout rates. Recent studies indicate that both cardiometabolic, as well as nutritional factors can modulate local tendon healing following mechanical overloading. At a histological level this imbalance in tendon collagen synthesis and structural fibril degradation is represented by reduced numbers and rounding of fibroblasts, increased content of proteoglycans, glycosaminoglycans and water, hypervascularisation and disorganized collagen fibrils. In accordance, a wide range of different therapeutic modalities aimed at restoring the disturbed tendon healing response have been tested, with limited long-term success. Although both animal and clinical studies are still equivocal, some research suggests that certain collagen derivatives may have chondroprotective and bone stimulating effects in respectively osteoarthritis and osteoporosis. As such, the question arises whether the self-repair processes in tendon matrix could be stimulated by 1) an oversupply of certain collagen specific building blocks (e.g. (hydroxyl)proline and glycine), or by 2) reducing local inflammation, apoptosis and extracellular matrix degradation. Although there is currently no scientific evidence for a nutritional collagen deficiency in chronic tendinopathy patients, most athletes’ main (and sometimes only) dietary source of collagen is porcine derived gelatin (e.g. Jello and Gummy Bears), since most people in Australia do not consume animal or meat products with high natural collagen content. Besides studying the ‘building block deficiency’ theory as a risk factor for overuse injuries in recreational runners, we are currently investigating whether the oral ingestion of bio-active hydrolyzed collagen is able to improve Achilles tendinopathy symptoms, tendon vascularization as well as tendon structure in patients with chronic Achilles tendinopathy. To improve our understanding of the in vivo working mechanism of this nutraceutical, the ultrastructural and microvascular changes of the Achilles tendon are being studied using contrast enhanced ultrasonography, ultrasonographic tissue characterization as well as ultra-short echo time MRI algorithms . Furthermore, in this project we are using focussed- ultrasound-based dolorimetry to generate sensitivity maps of both the symptomatic and asymptomatic tendon at baseline; these sensitivity maps will be the gold-standard against which local image-based evaluations of matrix abnormalities will be compared.The outcome of our AIS Achilles study is expected to give direction to a large-scale randomized controlled trial on the clinical benefits of hydrolyzed collagen in the treatment of chronic midportion Achilles tendinopathy. Conference program session 2 - Pathology : Changes in muscle morphology, neuromuscular capacity and tendon function with training: implications for athletic performance, patient rehabilitation and aging individuals / Professor Per Aagaard, University of Southern Denmark -- When the neuroimmune system screams: Practical Applications of DIMs and SIMs / Associate Professor David Butler, Neuro Orthopaedic Institute and University of South Australia -- Molecular mechanisms causing common exercise-associated musculoskeletal soft tissue injuries / Professor Malcolm Collins, University of Cape Town -- Role of collagen to keep tendon structures strong and healthy / Dr Stephan Praet, Australian Institute of Sport -- •Questions and answers session / Pathology panel.