Karin Grävare Silbernagel

Karin Grävare Silbernagel
University of Delaware | UDel UD · Department of Physical Therapy

PT, PhD, ATC

About

182
Publications
119,681
Reads
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6,750
Citations
Additional affiliations
August 2011 - August 2014
University of the Sciences in Philadelphia
Position
  • Professor (Assistant)
June 2009 - May 2011
University of Delaware
Position
  • PostDoc Position
May 2001 - present
University of Gothenburg
Position
  • Researcher

Publications

Publications (182)
Article
Full-text available
Background Achilles tendinopathy is a complex injury and the clinical presentation spans multiple different domains: physical and psychological symptoms, lower extremity function and tendon structure. A conceptual model of Achilles tendon health comprising these domains has been proposed in the literature. The aim of the study was to fit a model of...
Article
Background The 11+ program prevents anterior cruciate ligament (ACL) injuries in athletes through unknown mechanisms. Purpose The aim of the current study was to evaluate the effects of The 11+ intervention program, performed by female soccer players during a single season, on the frequency of Early Peaks during athletic tasks. Methods Three team...
Article
Full-text available
Background Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated.Objective To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in pro...
Article
Athletes are defined by their ability to move and are often accustomed to pain as it relates to their sports and exercise regime. The forced movement restriction and pain associated with an acute or overuse injury has a profound effect not only on their physical abilities but also on their psychological well-being and social context. With the goal...
Article
The clinical relevance of altered tendon structure in patellar tendinopathy is contested since structural change persists after symptom resolution. The purpose of this study was to explore the relationships between tendon structure and clinical impairments in patellar tendinopathy. In this retrospective, secondary analysis of individuals with patel...
Article
Full-text available
Tendinopathy describes a complex multifaceted pathology of the tendon, characterized by pain, decline in function and reduced exercise tolerance. The most common overuse tendinopathies involve the rotator cuff tendon, medial and lateral elbow epicondyles, patellar tendon, gluteal tendons and the Achilles tendon. The prominent histological and molec...
Article
A Correction to this paper has been published: https://doi.org/10.1038/s41572-021-00251-8.
Article
Full-text available
Athletic performance relies on tendons, which enable movement by transferring forces from muscles to the skeleton. Yet, how load-bearing structures in tendons sense and adapt to physical demands is not understood. Here, by performing calcium (Ca2+) imaging in mechanically loaded tendon explants from rats and in primary tendon cells from rats and hu...
Article
Editor-in-Chief Clare Ardern and JOSPT's editors thank all of those who contributed to JOSPT in 2021. J Orthop Sports Phys Ther 2021;51(12):552-555. doi:10.2519/jospt.2021.0111.
Article
Surgical repair of acute mid-substance Achilles tendon ruptures is performed in active patients, but the postoperative rehabilitation program is often based on the experience of the surgeon or therapist, rather than on evidence-based protocols. The aim of the study is to establish an evidence-based protocol for rehabilitation. This study is a conse...
Article
Full-text available
This study aimed to compare recovery of gait patterns in patients treated with early functional mobilization (EFM) or standard treatment (ST) after Achilles tendon rupture repair. Second, this study aimed to explore associations between gait patterns and tendon elongation and calf muscle atrophy, respectively. Forty-seven patients (12 females), mea...
Article
Full-text available
Purpose The purpose of this qualitative study was to describe women’s experiences with anterior cruciate ligament reconstruction (ACLR) and a subsequent ACL rupture, and to identify potential facilitators and barriers for coping with rehabilitation after the second injury. Methods Eight women between 17 and 36 years (mean 26, SD 6.5) who had exper...
Article
Full-text available
Introduction Achilles tendinopathy (AT) is a common and disabling musculoskeletal condition. First-line management involving Achilles tendon loading exercise with, or without, other modalities may not resolve the problem in up to 44% of cases. Many people receive injections. Yet there are no injection treatments with demonstrated long-term efficacy...
Article
Full-text available
Objectives: (1) Validate thresholds for minimal, low, moderate, and high fear of movement on the 11-item Tampa Scale of Kinesiophobia (TSK-11), and (2) Establish a patient-driven minimal clinically important difference (MCID) for Achilles tendinopathy (AT) symptoms of pain with heel raises and tendon stiffness. Methods: Four hundred and forty-two a...
Article
Full-text available
Global participation in running continues to increase, especially amongst adolescents. Consequently, the number of running-related injuries (RRI) in adolescents is rising. Emerging evidence now suggests that overuse type injuries involving growing bone (e.g., bone stress injuries) and soft tissues (e.g., tendinopathies) predominate in adolescents t...
Article
Objective: Kinesiophobia has been proposed to influence recovery in patients with Achilles tendinopathy. However, whether there are differences in outcomes in patients with different levels of kinesiophobia is unknown. The purpose of this study was to compare the characteristics of patients at baseline and recovery over time in patients with Achil...
Article
Background Deficits in sporting performance after Achilles tendon repair may be due to changes in musculotendinous unit structure, including tendon elongation and muscle fascicle shortening. Purpose/Hypothesis The purpose was to discern whether Achilles tendon rupture reduces triceps surae muscle force generation, alters functional ankle range of...
Article
Objective: To identify latent subgroups among patients with Achilles tendinopathy, describe patient characteristics and clinical attributes that defined each subgroup, and develop a clinical classification model for subgroup membership. Design: Cross-sectional study. Methods: 145 (73 men) participants (age (mean±SD) 51±14 years) with clinicall...
Article
Objectives Fear of movement may be a source of systemic bias in studies reporting functional deficits in patients with Achilles tendinopathy. The purpose of this study was to assess the effects of kinesiophobia on completion rate and performance on tests evaluating lower extremity function, while controlling for self-reported pain. Design Cross-se...
Article
Quadriceps neuromuscular electrical stimulation (NMES) may stimulate patellar tendon remodeling and recovery, but it is unclear if hip and knee joint angles during NMES affect patellar tendon loading. Therefore, the purpose of this study was to evaluate the effects of hip and knee joint angles on patellar tendon properties during quadriceps NMES. T...
Article
Full-text available
Background Activity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was t...
Article
Editor-in-Chief Clare Ardern thanks all of those who contributed to JOSPT in 2020. J Orthop Sports Phys Ther 2020;50(12):653-656. doi:10.2519/jospt.2020.0110.
Preprint
Full-text available
Tendons enable movement by transferring muscle forces to the skeleton, and athletic performances critically rely on mechanically-optimized tendons. How load-bearing structures of tendon sense and adapt to physical demands is an open question of central importance to musculoskeletal medicine and human sports performance. Here, with calcium imaging i...
Article
Objectives: To (1) describe which resistance exercises are used in the first eight weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. Design: Scoping review. Literature search: We searched the Medline, Embase, Cinahl, Cochrane and PEDro databases. Study selection cri...
Chapter
The foot and ankle is the most frequently injured body region in high school and collegiate basketball players, and it is the most commonly injured region in professional basketball players during game play. Lateral ankle sprains are the most common diagnosis; however, syndesmotic sprain, foot fracture (Jones fracture), and Achilles tendon rupture...
Chapter
Tendinopathy is one of the most common overuse injuries in basketball players, with patellar and Achilles tendinopathy occurring most frequently. In athletic populations, these injuries typically result from excessive load (acute or chronic) placed upon the tendon with inadequate time for recovery. A variety of non-invasive treatment options are av...
Article
Tendon injuries are difficult to heal in part because intrinsic tendon healing, which is dominated by scar tissue formation, does not effectively regenerate the native structure and function of healthy tendon. Further, many current treatment strategies also fall short of producing regenerated tendon with the native properties of healthy tendon. The...
Article
Background: Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. Purpose: To analyze differences in tendon and muscle morphology recovery over time between groups treated wi...
Preprint
Full-text available
Background: Activity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was...
Preprint
Full-text available
Background: Activity modification is a key component of patellar tendinopathy treatment but there is a lack of evidence guiding activity modification prescription. Use of activity modification in treatment studies has varied widely and the impact of those recommendations has not been directly investigated or compared. The purpose of this study was...
Preprint
Full-text available
Tendon injuries are difficult to heal in part because intrinsic tendon healing, which is dominated by scar tissue formation, does not effectively regenerate the native structure and function of healthy tendon. Further, many current treatment strategies also fall short of producing regenerated tendon with the native properties of healthy tendon. The...
Article
Purpose: The purpose of our study was to evaluate Achilles tendon loading profiles of various exercises and develop guidelines to incrementally increase the rate and magnitude of Achilles tendon loading during rehabilitation. Methods: Eight healthy young adults completed a battery of rehabilitation exercises. During each exercise, we collected 3...
Article
Background Physical therapy (PT) is recommended to reduce pain and improve function. However, only 10%–15% of adults with knee osteoarthritis (OA) use PT in the United States. The purpose of this study was to explore patient‐reported barriers and facilitators to PT utilization for knee OA, to understand why PT is underutilized. Methods Qualitative...
Article
Background and Purpose: Backwards walking has shown promise as an intervention in many at-risk populations. The purpose of this study was to determine the benefits of backward walking training on balance, mobility, and plantar flexor endurance in individuals 60 years of age and older. Methods: Participants were community-dwelling, ambulatory older...
Article
Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports. In addition to pain, Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties, altered lower extremity function, and fear of movement. Cumulatively, th...
Article
Full-text available
Background Achilles tendinopathy is a debilitating overuse injury characterized by pain, altered Achilles tendon structure, and impaired functional performance. Evaluating tendon structure as part of the physical examination may help establish a well-defined prognosis. However, the usefulness of measuring tendon structure for developing a prognosis...
Article
Full-text available
Background Functional deficits and health-related impairments are common after an Achilles tendon rupture (ATR). Rehabilitation protocols vary greatly, and few studies have allowed loading in combination with ankle motion immediately after surgery (ie, early functional mobilization [EFM]). It is unclear whether EFM may counteract the negative impac...
Article
Full-text available
Background Achilles tendon rupture leads to weakness of ankle plantarflexion. Treatment of Achilles tendon rupture should aim to restore function while minimizing weakness and complications of management. Purpose To determine the influence of factors (age, sex, body mass index [BMI], weight, time from injury to operative repair, and tightness of r...
Article
Tendon mechanical properties have been proposed as a biomarker of tendon health to track response to injury and treatment. Prior to utilizing these properties in an injured population, it is critical to understand how these are influenced by age and sex in an uninjured population. A retrospective analysis was conducted of 118 uninjured Achilles ten...
Article
As 2019 draws to a close, it is the right time for the JOSPT editors to say thank you, and celebrate all who contributed to the Journal this year. It is your knowledge, willingness to share, and commitment to quality that allow JOSPT to publish high-quality content to help rehabilitation clinicians help patients and athletes. J Orthop Sports Phys T...
Article
Background: The absence of any agreed-upon tendon health-related domains hampers advances in clinical tendinopathy research. This void means that researchers report a very wide range of outcome measures inconsistently. As a result, substantial synthesis/meta-analysis of tendon research findings is almost futile despite researchers publishing busil...
Article
Full-text available
Purpose The hypothesis was that early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery. A secondary aim was to evaluate if the amount of weightbearing and daily steps influenced the risk of sustaining a DVT. Methods One-hundred and fifty patients with...
Article
Full-text available
Background Early functional rehabilitation is frequently discussed in treating Achilles tendon rupture. A consistent definition of what constitutes early functional rehabilitation has not been established across the literature, despite studies supporting its efficacy. A standardized definition would be helpful to pool data across studies, allow for...
Article
Heel‐rises are commonly used in the rehabilitation of individuals following Achilles tendon rupture, however, the impact of tendon elongation on triceps surae activation in seated versus standing positions has not been investigated. The purpose of this study was to investigate changes in triceps surae activation during seated compared to standing h...
Article
Full-text available
We aimed to establish consensus for reporting recommendations relating to participant characteristics in tendon research. A scoping literature review of tendinopathy studies (Achilles, patellar, hamstring, gluteal and elbow) was followed by an online survey and face-to-face consensus meeting with expert healthcare professionals (HCPs) at the Intern...
Article
Jumper's knee is not synonymous with patellar tendinopathy. The term includes patellar tendinopathy and quadriceps tendinopathy. Although the patellar and quadriceps tendons work in tandem as part of the extensor mechanism of the knee, they have distinct anatomy and functional roles. As a result, there are probable differences in risk factors, etio...
Article
Background: Insertional tendinopathy is likely caused by different pathologies. This variation could account for the recalcitrant nature of this condition to treatment. Ultrasound imaging may assist in identifying underlying pathology to inform patient management. Hypothesis/purpose: The primary purpose of this study was to quantify the presence...
Article
Purpose Achilles tendon rupture leads to long-term plantar flexor deficits, but some patients recover functional performance better than others. Early indicators of tendon healing could be helpful in establishing patient prognosis and making individualized decisions regarding rehabilitation progression. The purpose of this study was to investigate...
Article
Background: Electromyography signal amplitude is influenced by a variety of factors. Normalization strategies aimed at decreasing signal variability include using peak electromyography signal during a maximum voluntary contraction and peak-to-peak M-wave amplitude. However, whether these normalization methods are comparable has not been investigat...
Article
The purposes of this study were to (i)evaluate the intra-rater reliability of estimating Achilles tendon mechanical properties with continuous shear wave elastography (cSWE), (ii)propose an equivalent shear modulus comparable to Supersonic Shear Imaging, (iii)demonstrate construct validity of cSWE and (iv)explore relationships between tensile and s...
Article
Objective:. Many trauma patients are at risk of pulmonary embolism due to unrecognized deep vein thrombosis (DVT). Restricted ankle dorsiflexion (AD) range of motion during leg immobilization is known to cause reduced venous blood flow. The aim of the present study was to assess whether AD at plaster cast removal is related to the incidence of DVT...
Chapter
Achilles tendinopathy is a common problem and often difficult to treat. The best-known and best-researched treatment is mechanical loading, either with eccentric or concentric-eccentric exercises or with a heavy-load, slow-speed (concentric-eccentric) rehabilitation program. To experience a favorable outcome from exercise, the exercises are allowed...
Conference Paper
Introduction Achilles tendinopathy is an overuse injury that commonly sidelines runners and has a reinjury rate of 44%. Aberrant loading patterns during the return-to-sports (RTS) phase may partially explain reinjury rates, but it remains unknown if clinical measures are associated with loading behaviors. Therefore, we aimed to establish relationsh...
Conference Paper
Introduction Tendinopathy (local tendon pain associated with physical activity) is a challenge to treat despite recent advances. One factor contributing to this challenge is our limited ability to synthesise/meta-analyse research findings, which is further compounded by a lack of valid outcome measures. We determined the core outcome domains agains...
Article
Objectives Evaluate the immediate (within 4 hours) effects of laser‐induced photobiomodulation (PBM) therapy on Achilles tendon morphology and mechanical properties in healthy and pathologic tendons. Materials and Methods Twenty people with healthy Achilles tendons and twelve people with Achilles tendinopathy participated. One Achilles tendon rece...
Article
Achilles tendon rupture leads to long term plantar flexor deficits. The purpose of this study was to describe changes in jumping biomechanics along with triceps surae structure and activation in individuals after Achilles repair. Eleven individuals 1‐3 years following Achilles repair and 10 healthy controls were included. Kinetics and kinematics, a...
Article
Background:: Mechanical loading is essential for tendon healing and may explain variability in patient outcomes after Achilles tendon rupture (ATR) repair. However, there is no consensus regarding the optimal postoperative regimen, and the actual amount of loading during orthosis immobilization is unknown. Purpose:: The primary aim of this study...
Article
Background Orthopaedic boots with wedging are commonly used in the treatment of individuals with Achilles tendon rupture to immobilize the foot in plantar flexion and approximate tendon ends. Research question To describe changes in muscle activity of the triceps surae and gait mechanics with the use of wedges in an orthopaedic boot immediately an...
Article
Full-text available
Purpose This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex- and age-matched patients presenting acutely. Ba...
Article
Purpose Optimizing tendon structural recovery during the first 12 weeks after Achilles tendon rupture is a prime target to improve patient outcomes, but a comprehensive understanding of biomarkers is needed to track early healing. The purpose of this study was to observe healing of tendon structure over time using ultrasound-based, tendon-specific...
Chapter
The incidence of Achilles tendon rupture is increasing. Even when ruptures are “successfully” managed without any complication, patients almost always demonstrate objective calf strength weakness. Treatment aims to stabilize the injured tendon and optimize the strength recovery whilst minimizing complications. The viscoelasticity of the tendon need...
Article
Individuals with plantar flexor weakness often require rehabilitation and/or orthoses, which should be personalized based on level of weakness. While plantar flexor weakness can be measured via peak plantar flexion moment during gait (MGAIT), motion analysis systems are often not clinically available. Clinical measures, such as the single-leg heel...
Article
Objective To perform a systematic review and meta-analysis identifying (1) potential modifiable risk factors and (2) associated modifiable factors for patellar tendinopathy in athletes. Design A systematic review and meta-analysis was conducted. Risk of bias was assessed using the Newcastle-Ottawa Scale and grouped based on study design. Meta-anal...