Revisión bibliográfica sobre la eficacia del ejercicio excéntrico como tratamiento para la tendinopatía del tendón de Aquiles

  1. Anna Arnal-Gómez 1
  2. Gemma Victoria Espí-López 1
  3. Diego Cano Heras 1
  4. Elena Muñoz-Gómez 1
  5. Isabel Balbastre Tejedor 2
  6. Mª Victoria Ramírez Iñiguez-de la Torrez 3
  7. Mª Teófila Vicente- Herrero 4
  1. 1 Universitat de València
    info

    Universitat de València

    Valencia, España

    ROR https://ror.org/043nxc105

  2. 2 Especialista en Medicina Física y Rehabilitación, Umivale
  3. 3 Especialista en Medicina del Trabajo, Grupo Correos, Albacete
  4. 4 Especialista en Medicina del Trabajo, Grupo Correos, Valencia
Journal:
Archivos de prevención de riesgos laborales

ISSN: 1138-9672 1578-2549

Year of publication: 2020

Volume: 23

Issue: 2

Pages: 211-233

Type: Article

DOI: 10.12961/APRL.2020.23.02.07 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Archivos de prevención de riesgos laborales

Abstract

Introduction: Tendinopathies are a consequence of excessive tendon loads, so they are frequent both in athletes and in the workplace due to repetitive movements and forced postures. Achilles tendinopathy is characterized by a disorganized healing response, asso-ciated with a certain degree of neovascularization, with conservative treatment being the initial strategy. Objectives: To carry out a bibliographic review in order to identify the different eccentric exercise protocols and their effectiveness in Achilles tendinopathy. Methods: A literature review of scientific articles has been implemented in the databases of PubMed and The Cochrane Library databases using the key words “((tendinopathy) AND (Achilles Tendon) AND (exercise OR exercise therapy OR Muscle Stretching Exercises OR physical therapy modalities OR rehabilitation))” Results: 635 studies were obtained from Pubmed and 134 from Cochrane Library of which 14 met all the inclusion criteria. Selected studies showed that, in general, eccentric exercis-es are an effective therapy applied between 6 and 12 weeks in Achilles tendinopathy, either on their own or combined with the vibration platform, nutritional supplements, soft tissue treatment, laser therapy or shock wave therapy. Conclusion: this review showed eccentric exercise has a great scientific evidence in Achil-les tendinopathy treatment.

Bibliographic References

  • Jozsa L, Kannus P. Human tendons: Anatomy, physiology, and pathology. Champaign (IL): Human Kinetics; 1997. p.4-95.
  • Astrom M. On the nature and etiology of chronic achilles tendinopathy. Lund University, Sweden; 1997.
  • Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009; 43:409-16.
  • O’Brien T. The needle test for complete rupture of Achilles tendon. J Bone Joint Surg Am. 1984;66(7):1099-101.
  • Komi PV, Fukashiro S, Järvinen M. Biomechanical loading of Achilles tendon during normal locomotion. Clin Sports Med. 1992;11(3):521-31.
  • Galloway MT, Jokl P, Dayton OW. Achilles Tendon Overuse Injuries. Clin Sports Med. 1992; 1(4):771-82.
  • Benjamin M, Evans EJ, Copp L. The histology of tendon attachments to bone in man. J Anat. 1986;149:89-100.
  • Rufai A, Ralphs JR, Benjamin M. Structure and histopathology at the insertional region of the human Achilles tendon. J Orthop Res. 1995;13:585-93.
  • Maganaris CN, Narici MV, Almekinders LC, Maffulli N. Biomechanics and pathophysiology of overuse tendon injuries. Ideas on insertional tendinopathy. Sports Med. 2004;34:1005-17.
  • Hunter G. The conservative management of Achilles tendinopathy. Phys Ther Sport. 2000;1:6-14.
  • Khan KM, Cook JL, Maffulli N, Kannus P. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med. 2000;34:81-3.
  • Bennazo F, Zanon G, Mafulli N. An operative approach to Achilles tendinopathy. Sports Med Arthroscopy Rev. 2000;8:96-101.
  • Komi PV. Relevance of in vivo force measurements to human biomechanics. J Biomech. 1990. 1990;23(Suppl 1):23-34.
  • Mafulli N, Sharma P, Luscombe K. Achilles tendinopathy: Aetiology and management. J R Soc Med. 2004;97(472):6.
  • Rice H, Patel M. Manipulation of foot strike and footwear increases Achilles tendon loading during running. Am J Sports Med. 2017;45(10):2411-2417.
  • Biundo JJ, Irwin RW, Umpierre E. Sports and other soft tissue injuries, tendinitis, bursitis, and occupation-related syndromes. Curr Opin Rheumatol. 2001;13(2):146-9.
  • Hopkins C, Fu SC, Chua E, et al. Critical review on the socio-economic impact of tendinopathy. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2016;4:9-20.
  • Barker-Davies RM, Nicol A, McCurdie I, et al. Study protocol: A double blind randomised control trial of high volume image guided injections in Achilles and patellar tendinopathy in a young active population. BMC Musculoskelet Disord. 2017;18(1):2014.
  • Renninger CH, Kuhn K, Fellars T, Youngblood S, Bellamy J. Operative and nonoperative management of Achilles Tendon Ruptures in active duty military population. Foot Ankle Int. 2016;37(3):269-73.
  • Zellers JA, van Ostrand K, Silbernagel KG. Calf Endurance and Achilles Tendon Structure in Classical Ballet Dancers. J Dance Med Sci. 2017;21(2):64-69.
  • Clain MR, Baxter DE. Achilles tendinitis. Foot Ankle. 1992;13(8):482-487.
  • García Tormos J. Principales problemas podológicos derivados del uso del calzado de seguridad. Elche: Universidad Miguel Hernández; 2017.
  • Rosenblad-Wallin EF. The design and evaluation of military footwear based upon the concept of healthy feet and user requirement studies. Ergonomics. 1988;31(9):1245-1263.
  • Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports Med Arthrosc Rev. 2009;17(2):112-126.
  • Aström M. Partial rupture in chronic Achilles tendinopathy. A retrospective analysis of 342 cases. Acta Orthop Scand. 1998;69(4):404-7.
  • de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011; 45(13):1026-8.
  • Secretaria de Estado de la Seguridad Social-Dirección General de Ordenación de la Seguridad Social. Observatorio de enfermedades profesionales (CEPROSS) y de enfermedades causadas o agravadas por el trabajo (PANOTRATSS). Informe Anual 2018. 2019;NIPO: 270-15-059-8.
  • Kristoffersen M, Ohberg L, Johnston C, Alfredson H. Neovascularisation in chronic tendon injuries detected with colour doppler ultrasound in horse and man: Implications for research and treatment. Knee Surg Sports Traumatol Arthrosc. 2005;13(505):8.
  • Knobloch K. Eccentric training in Achilles tendinopathy: Is it harmful to tendon microcirculation?. Br J Sports Med. 2007;41(6):e2.
  • Knobloch K, Kraemer R, Jagodzinski M, Zeichen J, Meller R, Vogt P. Eccentric training decreases paratendon capillary blood flow and preserves paratendon oxygen saturation in chronic Achilles tendinopathy. J Orthop Sports Phys Ther. 2007;37:269-76.
  • Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007;41(4):211-6.
  • Kader D, Saxena A, Movin T, Mafulli N. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. 2002;36:239-49.
  • Kannus P. Tendon pathology: Basic science and clinical applications. Sports Exerc Inj. 1997;3(62):75.
  • Curwin S. The aetiology and treatment of tendinitis. En: Harries M, Williams C, Stanish WD, Micheli LJ (eds.). Oxford textbook of sports medicine. Oxford: Oxford University Press; 1984.
  • Curwin S, Stanish WD. Tendinitis: Its etiology and treatment. Lexington: Collamore Press; 1984.
  • Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360-6.
  • Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials. 1996;17(1):1-12.
  • Romero-Morales. C., Martín-Llantino PJ, Calvo-Lobo C, et al. Effectiveness of eccentric exercise and a vibration or cryotherapy program in enhancing rectus abdominis muscle thickness and inter-rectus distance in patientswith chronic mid-portion achilles tendinopathy: a randomized clinical trial. Int J Med Sci. 2018;15(14):1764-1770.
  • Balius R, Álvarez G, Baró F, et al. A 3-arm randomized trial for achilles tendinopathy: eccentric training, eccentric training plus a dietary supplement containing mucopolysaccharides, or passive stretching plus a dietary supplement containing mucopolysaccharides. Curr Ther Res Clin Exp. 2016;78:1-7.
  • McCormack JR, Underwood FB, Slaven EJ, Cappaert TA. Eccentric exercise versus eccentric exercise and soft tissue treatment (ASTYM) in the management of insertional Achilles tendinopathy. Sports Health. 2016;8(3):230-237.
  • Tumilty S, Mani R, Baxter GD. Photobiomodulation and eccentric exercise for achilles tendinopathy: a randomized controlled trial. Lasers Med Sci. 2016;31(1):127-35.
  • Beyer R, Kongsgaard M, Hougs K, B., Øhlenschlæger T, Kjær M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(7):1704-11.
  • Munteanu SE, Scott LA, Bonanno DR, et al. Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2015;49(15):989-94.
  • Stevens M, Tan CW. Effectiveness of the Alfredson protocol compared with a lower repetition-volumeprotocol for midportion achilles tendinopathy: a randomized controlled trial. J Orthop Sports Phys Ther. 2014;44(2):59-67.
  • Bell KJ, Fulcher ML, Rowlands DS, Kerse N. Republished research: Impact of autologous blood injections in treatment of mid-portion achilles tendinopathy: double blind randomised controlled trial. Br J Sports Med. 2013;346:f2310.
  • Horstmann T, Jud HM, Fröhlich V, Mündermann A, Grau S. Whole-body vibration versus eccentric training or a wait-and-see approach for chronic Achilles tendinopathy: a randomized clinical trial. J Orthop Sports Phys Ther. 2013;43(11):794-803.
  • Yu J, Park D, Lee G. Effect of eccentric strengthening on pain, muscle strength, endurance, and functionalfitness factors in male patients with Achilles tendinopathy. Am J Phys Med Rehabil. 2013;92(1):68-76.
  • Zhang BM, Zhong LW, Xu SW, Jiang HR, Shen J. Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Chin J Integr Med. 2013;19(12):900-4.
  • Tumilty S, McDonough S, Hurley DA, Baxter GD. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(5):733-9.
  • de Jonge S, de Vos RJ, Van Schie HT, Verhaar JA, Weir A, Tol JL. One-year follow-up of a randomised controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy. Br J Sports Med. 2010;44(9):673-7.
  • Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37(3):463-70.
  • Norregaard J, Larsen C, Bieler T, Langberg H. Eccentric exercise in treatment of Achilles tendinopathy. Scand J Med Sci Sports. 2007;17(133):8.
  • Roos E, Engstrom M, Lagerquist A, Soderberg B. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy: A randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004;14:286-95.
  • Rompe J, Nafe B, Furia J, Mafulli N. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis. A randomized controlled trial. Am J Sports Med. 2007;35:374-83.
  • Sussmilch-Leitch S, Collins N, Bialocerkowski A, Warden S, Crossley K. Physical therapies for Achilles tendinopathy: Systematic review and meta-analysis. J Foot Ankle Res. 2012;5(1):15.
  • Foye PM, Sullivan WJ, Panagos A, Zuhosky JP, Sable AW, Irwin RW. Industrial medicine and acute musculoskeletal rehabilitation. 6. Upper- and lower-limb injections for acute musculoskeletal injuries and injured workers. Arch Phys Med Rehabil. 2007;88(3 Suppl 1):S29-33.
  • Magnussen R, Dunn W, Thomson B. Nonoperative treatment of midportion Achilles tendinopathy: A systematic review. Clin J Sport Med. 2009;19:54-64.
  • Van Usen C, Pumberger B. Effectiveness of eccentric exercises in the management of chronic Achilles tendinosis. J Allied Health Sci Pract. 2007;5(2):1-14.