FROM  THEORY  TO  PRACTICE  2  CASES  FROM  FCB  Dr.  Daniel  Medina  Leal  

Team  Physician  FC  Barcelona  

2  

“Carreer Ending”

“Availability” All ages

“Performance”

Tendinopathy represents 6 % of all injuries in football 3 % Achilles Tendinopathy 2 % Patellar Tendinopathy

Other Sports 15 - 33 % Basketball 30 - 40 % Volleyball

  Ekstrand, J . Br J Sports Med , 2009

3  

INFRAPATELAR  TENDON  IN  FOOTBALL  

139  patellar  tendon  injuries  (1.5%  of  all  injuries)    

Incidence  of  0.12  injuries/1000  h  

Season  prevalence  of  2.4%.  

No  difference  in  season  prevalence    

Hägglund, M. Am J Sports Med 2011

INFRAPATELAR  TENDON  IN  FOOTBALL  

60%  minimal  to  mild  (<8  days  absence)  

19%  were  recurrent  complaints.    

MulXvariate  logisXc  regression  High  total  exposure  hours  

Increased  body  mass    

  Hägglund, M. Am J Sports Med 2011

LA  LIGA  2012  

Noya, J. Apunts, 2012

“Tendinitis” 104 4,8% 1.434 3,9 53,1

LA  LIGA  2012  

Noya, J. Apunts, 2012

FCB  EPIDEMIOLOGY          Pro  Team   2,3%  of  all  injuries  

Academy   1,2%  of  all  injuries  

Indoor  Soccer   3,2%  of  all  injuries  

WHAT  DO  WE  DO?  

Shock Wave Excentric exercises

D degree recommendations B-C degree recommendations

Manual Therapy

Ultras / Diathermia

Plasma Rich Plaquelet Sclerosis

Stem Cells

High Volum Iny NSAIDs Surgical Treatment Recalcit

WHAT  DO  WE  DO?  

Surgical Treatment

Recalcitrant

D degree recommendations B-C degree recommendations

World  Class  26y.  

Defender  

Jumper’s  Knee  

VAS=  6/10  

Pain  in  daily  acXviXes  

No  other  history  

 

 

 

 

CASE  1  

14  

WHAT  WE  DID  Esclerosis  inyecXon  x1  

Some  improvement  

Excentric  exercise  

Back  to  pracXce  in  2  weeks,  with  mild  pain.  

Excentric  exercise  

 

 

 

 

WHAT  HAPPENED  Mild  pain  during  next  season  

Excentric  exercise  

Surgery  due  to  lateral  instability  (same  knee)  

Following  season  

VAS=0  

Mantained  excentric  exercise  

 

 

 

 

February 2006 July 2011

Pro Footballer (14 y) 33 years

5 years

18  

22  years  old.  

Striker  

“Lifle  pain  that  goes  away”  

VAS=  3/10  

No  pain  in  daily  acXviXes  

No  other  history  

 

 

 

 

CASE  2  

WHAT  WE  DID  (Doing)  Excentric  protocol  

Flexibility  Quad/Hamstrings  

Has  not  been  out  for  this  reason  

 

 

 

 

HOW  ARE  WE  DOING    AFTER  8  WEEKS……  

SUPRAPATELAR TENDINOPATHY

Con/Con 60º/s-1

38%

SUPRAPATELAR TENDINOPATHY

Con/Con 240º/s-1

23%

TAKE  HOME  MESSAGES  Around  two  “significant”cases  a  year  

“Similar  clinical  symtoms”  but    physio-­‐patho-­‐biology  is  not  necessary  the  same.  

We  should  not  focus  in  treaXng  images  but  clinically.  

Customise  treatment  for  each  case.  

     

Thank you