Beat the exercise-induced muscle damage Qamar, Muhammad Mustafa; Javed, Muhammad Shahid; Dogar, Muhammad Zahoor Ul Hassan ...
Journal of the Pakistan Medical Association,
11/2019, Letnik:
69, Številka:
11
Journal Article
Achilles tendinopathy is a degenerative process due to excessive and cumulative use of microtrauma with internal and external risk factor. Approximately 52% of runners experience an Achilles ...tendinopathy (AT) injury during their lifetime. Achilles Tendinopathy can limit Indonesia's athletic performance due to pain on the side of the knee during running, walking and jumping. The aim of this study was to evaluate the physiotherapy management for Achilles Tendinopathy cases in Indonesian para-athletics. This research is a descriptive case studyinvolving one client with participatory observation. The physiotherapy intervention involved modality intervention using Eccentric exercises, ESWT, Stretching, Muscle release, Electrical Stimulation, and Cryotheraphy. The subject of the study was An. B, a 28 year old para athlete with height 182 cm, weight 77 kg, and BMI 23.3 in the ideal category. The patient came to the physiotherapy clinic of NPC Indonesia on 20 August 2023 with complaints of pain and burning in the left leg. Physical examination showed normal results except for pain examination using Numeric Rating Scale (NRS), where silent pain 0/10, tenderness 9/10, and motion pain 7/10 were found. The diagnosis of Achilles Tendinopathy sinistra was confirmed through specific examination. After four physiotherapy sessions Based on the results of studies that have been carried out, ESWT and Eccentric exercise can reduce pain, increase joint range of motion, increase muscle strength, increase ankle stability and improve functional abilities in Achilles tendinopathy patients.
While the pathoetiology is disputed, a wide array of treatments is available to treat tendinopathy. The most common treatments found in the literature include therapeutic modalities, exercise ...protocols, and surgical interventions; however, their effectiveness remains ambiguous. The purpose of this study was to perform a systematic review of systematic reviews to determine the ability of therapeutic interventions to improve pain and dysfunction in patients with tendinopathy regardless of type or location. Five databases were searched for systematic reviews containing only randomized control trials to determine the effectiveness of treatments for tendinopathies based on pain and patient‐reported outcomes. Systematic reviews were assessed via the Assessment of Multiple Systematic Reviews (AMSTAR) for methodological quality. From the database search, 3,295 articles were found, 107 passed the initial inclusion criteria. After further review, 25 systematic reviews were included in the final qualitative analysis. The AMSTAR scores were relatively high (8.8 ± 1.0) across the 25 systematic reviews. Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low‐level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet‐rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy‐related pain and improve function. Corticosteroids also showed some effectiveness for short‐term pain, but for the long‐term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy‐related pain and improve self‐reported function.
Purpose: Rehabilitation professionals typically use motor imagery (MI) or action observation (AO) to increase physical strength for injury prevention and recovery. Here we compared hamstring force ...gains for MI during AO (AO + MI) against two pure MI training groups.
Materials and methods: Over a 3-week intervention physically fit adults imagined Nordic hamstring exercises in both legs and synchronized this with a demonstration of the same action (AO + MI), or they purely imagined this action (pure MI), or imagined upper-limb actions (pure MI-control). Eccentric hamstring strength gains were assessed using ANOVAs, and magnitude-based inference (MBI) analyses determined the likelihood of clinical/practical benefits for the interventions.
Results: Hamstring strength only increased significantly following AO + MI training. This effect was lateralized to the right leg, potentially reflecting a left-hemispheric dominance in motor simulation. MBIs: The right leg within-group treatment effect size for AO + MI was moderate and likely beneficial (d = 0.36), and only small and possibly beneficial for pure MI (0.23). Relative to pure MI-control, effects were possibly beneficial and moderate for AO + MI (0.72), although small for pure MI (0.39).
Conclusions: Since hamstring strength predicts injury prevalence, our findings point to the advantage of combined AO + MI interventions, over and above pure MI, for injury prevention and rehabilitation.
Implications for rehabilitation
While hamstring strains are the most common injury across the many sports involving sprinting and jumping, Nordic hamstring exercises are among the most effective methods for building eccentric hamstring strength, for injury prevention and rehabilitation.
In the acute injury phase it is crucial not to overload damaged soft tissues, and so non-physical rehabilitation techniques are well suited to this phase.
Rehabilitation professionals typically use either motor imagery or action observation techniques to safely improve physical strength, but our study shows that motor imagery during observation of Nordic hamstring exercises offers a safe, affordable and more effective way to facilitate eccentric hamstring strength gains, compared with pure motor imagery.
Despite using bilateral imagery and observation training conditions in the present study, strength gains were restricted to the right leg, potentially due to a left hemispheric dominance in motor simulation.
platelet-rich-plasma is increasingly used in chronic patellar tendinopathy. Ideal number of PRP injections needed is not yet established. This study compares the clinical outcomes of a single versus ...two consecutive PRP injections.
between December 2009 and January 2012, 40 athletes with proximal patellar tendinopathy were treated by PRP injection. Patients received single (20 patients) or two PRP injections 2 weeks apart (20 patients). All patients underwent prospective clinical evaluation, including Victorian Institute of Sport Assessment-Patella (VISA-P) score, visual analog scale (VAS) for pain, and Tegner scale before PRP and after a minimum of 2 year follow-up.
9 patients failed PRP treatment and needed surgery. 1 patient was lost to follow-up. For the remaining patients, the VISA-P, VAS, and Tegner scores all significantly improved from 35.2 to 78.5 (p = 0.0001), 6.6 to 2.4 (p = 0.0001), and 4.8 to 6.9 (p = 0.0003). Patients who received two injections had better scores than those who received single injection with VAS of 1.07 versus 3.7 (p = 0.0005), Tegner score of 8.1 versus 5.9 (p = 0.0003) and VISA-P of 93.2 versus 65.7 (p = 0.0001).
two consecutive PRP injections in chronic patellar tendinopathy showed better improvement in outcomes when compared to single injection.
randomized prospective consecutive series, Level 2.
Introduction: Subacromial Impingement Syndrome (SIS) is a common shoulder problem that leads to considerable functional loss and a decline in Quality of Life (QoL). Conservative treatment is the ...first line of management, often multimodal where physiotherapy is commonly recommended. But limited information is available regarding the combined effect of various treatments. Aim: To evaluate the combined effect of manual therapy and specific exercise conditioning in improving function and QoL among patients with SIS and also to compare with the conventional therapy. Materials and Methods: This single-blinded randomised controlled study was conducted in the rehabilitation center, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India, from January 2017 to February 2020. A total of 126 subjects were recruited and randomly allocated into two groups: Group 1 (n=63) received manual therapy and eccentric exercise, Group 2 (n=63) received conventional exercise, spread over three weeks followed by a home program for another nine weeks. Regional and self-rated functional limitations were obtained using the Shoulder Pain and Disability Index (SPADI) and Patient Specific Functional Scale (PSFS) at baseline, after 10 sessions of treatment and follow-up at 12 weeks with other clinical outcomes. A short form health survey (SF 36) was used to obtain QOL status at baseline and followup at 12 weeks. Data were analysed using one-way analysis of variance, and unpaired t-test. Results: The mean age was 45.02±10.30 years and 45.12±11.42 years in groups 1 and 2, respectively. Male to female ratio was 25:21 and 30:21 in groups 1 and 2, respectively. All outcomes improved by three weeks and during follow-up at 12 weeks in both groups (p-value <0.00001 and p-value <0.0005, respectively). However, on between group analysis significant improvement was observed with pain intensity (p-value <0.0005), range (p-value <0.05), external rotator strength (p-value=0.016) and PSFS score (p-value=0.014) by three weeks. External rotator strength (p-value<0.0005), SPADI (p-value <0.0005), PSFS (p-value=0.035), physical (p-value <0.008) and mental (p-value <0.006) cumulative scores of SF 36 had significant improvement in group 1 during follow-up at 12 weeks. Conclusion: The combined effect of manual therapy and specific exercise conditioning improved regional, self-rated functional ability and QoL among individuals with SIS.
Tendinopathy is one of the most frequent overuse injuries associated with sport. It is a failure of a chronic healing response associated with both chronic overloaded and unloaded states. Although ...several conservative therapeutic options have been proposed, very few of them are supported by randomized controlled trials. Eccentric exercises provide excellent clinical results both in athletic and sedentary patients, with no reported adverse effects. Combining eccentric loading and low-energy shock wave therapy produces higher success rates compared with eccentric training alone or shock wave therapy alone. High-volume injection of normal saline solution, corticosteroids, or anesthetics can reduce pain and improve long-term function in patients with Achilles or patellar tendinopathy. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, and corticosteroids in and around tendons is not support by strong clinical evidence. Further randomized controlled trials are necessary to define the best conservative management of tendinopathy.
Prospective Case Series.
Variety of studies inquired the effectiveness of exercise treatment in LET (Lateral Elbow Tendinopathy). The research on the effectiveness of these approaches are still ...ongoing and very much needed due to the uncertainty of the subject.
We aimed to understand how the application of exercises in a graded manner affect the treatment outcomes in terms of pain and function.
This study is completed by 28 patients with LET and it was planned as a prospective case series. Thirty participants were included to participate in the exercise group. Basic Exercises (Grade 1) were performed for four weeks. Advanced Exercises (Grade 2) were performed for another four weeks. The VAS (Visual Analog Scale), pressure algometer, the PRTEE (Patient-Rated Tennis Elbow Evaluation) and a grip strength dynamometer were used to measure outcomes. The measurements were performed at baseline, at the end of four weeks and at the end of eight weeks.
Investigation of the pain scores revealed that all VAS scores (p < 0.05, ES = 1.35; 0.72; 0,73 activity, rest, and night respectively) and pressure algometer results were improved both during basic (p < 0.05, ES = 0.91) and advanced exercises (p < 0.05, ES = 0,41). PRTEE scores were found to be improved in patients with LET after basic and advanced exercises (p > 0.001, ES = 1.15; p > 0.001, ES = 1.56 respectively). The grip strength only changed after basic exercises (p = 0.003, ES = 0.56).
The basic exercises were beneficial for both pain and function. However, advanced exercises are required for obtaining further improvements in terms of pain, function, and grip strength.
Purpose
To investigate the outcome of ultrasound (US)-guided intratissue percutaneous electrolysis (EPI
®
) and eccentric exercise in the treatment of patellar tendinopathy during a long-term ...follow-up.
Methods
Forty patients with patellar tendinopathy were prospectively evaluated over a 10-year follow-up period. Pain and function were evaluated before treatment, at 3 months and at 2, 5 and 10 years using the Victorian Institute of Sport Assessment–Patella (VISA-P) score, the Tegner score and Blazina’s classification. According to VISA-P score at baseline, patients were also dichotomized into Group 1 (<50 points) and Group 2 (≥50 points). There were 21 patients in Group 1 and 19 in Group 2. Patient satisfaction was measured according to the Roles and Maudsley score.
Results
The VISA-P score improved globally by 41.2 points (
p
< 0.01) after a mean 4.1 procedures. In Group 1, VISA-P score improved from 33.1 ± 13 to 78.9 ± 14.4 at 3-month and to 88.8 ± 10.1 at 10-year follow-up (
p
< 0.001). In Group 2, VISA-P score improved from 69.3 ± 10.5 to 84.9 ± 9 at 3-month and to 96.0 ± 4.3 at 10-year follow-up (
p
< 0.001). After 10 years, 91.2 % of the patients had a VISA-P score >80 points. The same level (80 % of patients) or the Tegner score at no more than one level lower (20 % of patients) was restored, and 97.5 % of the patients were satisfied with the procedure.
Conclusion
Treatment with the US-guided EPI
®
technique and eccentric exercises in patellar tendinopathy resulted in a great improvement in knee function and a rapid return to the previous level of activity after few sessions. The procedure has proved to be safe with no recurrences on a long-term basis.
Level of evidence
Therapeutic study, Level IV.
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