These are my top take home messages from the Achilles and calf conference in Barcelona this week #BarcaMedicine. It was a great opportunity to keep up to date and share ideas in a top class venue in a top class city #Barcelona
Plantarflexion weakness predisposes to AT and many risk factors related to this weakness. But it's not all about strength: improved neuromuscular control also important @Seth0Neill hypothesised how NM control could help tendinopathy 
how effective is exercise in tendinopathy? @DrPeteMalliaras suggested that evidence for exercise (compared to placebo/wait and see) is not as good as we believe. Only one Achilles study demonstrated effectiveness compared to wait and see. how much placebo is in exercise?
there are no clear loading favorites in tendinopathy: use principles rather than protocols - progressive, pain-monitoring and at least 12 weeks @DrPeteMalliaras
How does 'rehab' work in tendons? Is it only about correcting deficits/function or is the primary purpose of rehab to desenstise the stretch/short cycling. Do we have to correct strength deficits first before moving onto SSC? so many questions... @DrPeteMalliaras
how might a SSC progressive programme look? @sancho_igor outlined a programme dependent on pain and irritability to SSC (hopping). Note that if hopping doesn't irritate, then plyometrics and be started immediately (see first pic). I'm looking forward to seeing his papers.
@ProfJillCook argues that strength deficits need correction before starting SSC. Outlined is a progressive programme incorporating small steps through strength, speed and SSC. HSR improves muscle strength but also tendon stiffness.
@Dr_Ramon_Balius : calf injuries are more complicated than thought. You need to define whether myofacial, aponeurosis or free proximal Achilles tendon is involved - affects prognosis and RTP. Expect a paper outlining these subgroups soon.
soleus is one complicated muscle: MRI scan is investigation of choice; only a quarter of soleus tears are detected on US. Prognosis of tears dependent on the site of injury. Central aponeurotic tears have the worst prognosis - RTP twice as long. @carlespedret
High volume injection is used to assist rehab. 2 RCTs have been performed by Copenhagen group. HVI with steroid is better at 6/12 weeks but same at 6 mths compared to PRP/HVI without steroid. This suggests effectiveness of HVI with steroid is a steroid effect and not a HV effect.
mesenchymal cells are thought to have a dual role in treatment of tendinopathy. RCT study was performed comparing injection of MSC to PRP. MSC allowed for faster recovery. However, we need a sham/placebo arm to prove effectiveness.
