Eccentric Strengthening Research Articles

Management of Proximal Hamstring Injuries: Non-operative and Operative Treatment.

To evaluate the current evidence and literature on treatment options for proximal hamstring injuries. Patients with 3-tendon complete tears with greater than 2cm of retraction have worse outcomes and higher complication rates compared to those with less severe injuries. Endoscopic and open proximal hamstring repair both have favorable patient reported outcomes at 5-year follow up. Proximal hamstring repair in patients who are male, with isolated semimembranosus injury, and have proximal hamstring free tendon rupture are more likely to have earlier return to sports. The Parisian Hamstring Avulsion Score (PHAS) is a validated patient-reported outcome measure to predict return to sports. Proximal hamstring injuries may occur in both elite and recreational athletes and may present with varying degrees of chronicity and severity. Injuries occur most commonly during forceful eccentric contraction of the hamstrings and often present with ischial tuberosity tenderness, ecchymosis, and hamstring weakness. Treatment decision-making is dictated by the tendons involved and chronicity. Many proximal hamstring injuries can be successfully treated with non-surgical measures. However, operative treatment of appropriately indicated proximal hamstring tendon injuries can result in significantly better functional outcomes and faster and more reliable return to sports compared to nonoperative treatment. Both endoscopic and open surgical repair techniques show high satisfaction levels and excellent patient-reported outcomes at short- and mid-term follow-up. Postoperative rehabilitation protocols vary across the literature and ongoing study is needed to clarify the optimal program, though emphasis on eccentric hamstring strengthening may be beneficial.

Eccentric Muscle Strengthening Using Maximal Contractions Is Deleterious in Knee Osteoarthritis: A Randomized Clinical Trial.

Objectives: To show the superiority of eccentric versus concentric strengthening in terms of improving quadriceps strength in knee osteoarthritis (OA), a randomized controlled study was conducted to perform 12 sessions of either eccentric or concentric isokinetic muscle strengthening over 6 weeks. Methods: We recruited males and females, aged between 40 and 70 years, with predominantly unilateral femorotibial OA. Exclusion criteria were having a prosthesis, inflammatory arthritis or flare-up of OA, symptomatic patellofemoral OA, cardiovascular or pulmonary disease that could be a contraindication to the study treatment, and any pathology that could cause muscle weakness. The primary endpoint was the between-group difference in change in maximum concentric isokinetic knee extension peak torque (PT) at 60°/s on the OA side at 6 weeks. Secondary endpoints were between-group difference in change in concentric hamstring PT at 60°/s; eccentric quadriceps and hamstring PT at 30°/s; 10 m and 200 m walking speeds; pain and functional status (WOMAC score) at 6 weeks and 6 months. Results: The sample consisted of 11 females and 27 males, with a mean age of 57.7 ± 7.52 years and a body mass index (BMI) of 25.95 ± 3.93 kg/m2. Quadriceps strength increased more at 6 weeks in the concentric than the eccentric group with no statistical difference. There was a rate of 25% major adverse events in the eccentric group. Conclusions: Eccentric training resulted in a smaller improvement in quadriceps strength than concentric training and was associated with a high risk of muscle injury, particularly to the hamstring muscles.

Staying in the Game: Interventions for Managing Achilles Tendinopathy in the In-Season Athlete.

Achilles tendinopathy is a common overuse injury that is traditionally managed with activity modification and a progressive eccentric strengthening program. This narrative review describes the available evidence for adjunctive procedural interventions in the management of midportion and insertional AT, specifically in the athletic population. Safety and efficacy data from available literature on extracorporeal shockwave therapy, platelet-rich plasma, high-volume injectate with or without tendon scraping, and percutaneous needle tenotomy are used to propose an algorithm for treatment of Achilles tendinopathy for the in-season athlete.

Effects of different strength and velocity training programs on physical performance in youth futsal players

Futsal is a high intensity team sport with intermittent actions of short duration, so it is necessary to include different training strategies to improve explosive actions. There is a gap in the scientific literature regarding training programs that improve the performance of young futsal players. The aim of this study was to determine the effects of different strength and velocity training programs on lower body physical performance in youth futsal players. Forty-two youth futsal players were divided into control group (CG, n = 14) and a strength intervention group (SG, n = 14), which included a weekly session for 8 weeks of eccentric strength training, plyometrics and core strengthening, and a velocity intervention group (VG, n = 14), which included a weekly session during 8 weeks of training with linear speed exercises and with change of direction, accelerations with resistance bands and core strengthening. SG significantly improved horizontal jump (HJ) (p:0.02), V-CUT (p:0.91) and change of direction deficit (CODD) (p:0.01). VG showed significant improvements in HJ (p:0.01), in 25 m sprint (p:0.01), in total repeated sprint ability time (p:0.01), in V-CUT (p:0.01) and in CODD (p:0.01). SG showed significant intergroup differences (p:0.01) in COD variables with respect to CG and VG. In conclusion, SG and VG showed significant improvements in lower body performance variables in youth futsal players. In addition, the SG has substantial changes in COD compared to the other two groups, so it has a greater effect.

A Comparative Study Between Eccentric Strengthening and Grip Strengthening for Forearm Weakness in Individuals of Dental Practices

Dental professionals require job-related physical demands that may lead to forearm weakness. This can make tasks involving gripping, lifting, and manipulating objects challenging. Hence, the study aims to investigate the impact of eccentric strengthening and grip strengthening for forearm weakness in individuals of dental practices. In the current study, 53 individuals met the inclusion criteria and provided their consent to participate. The individuals taking part in the study were assigned to two different groups, namely Group A and Group B, Group A(27) received the Eccentric exercise and Group B (26) received the Grip Strength exercise. The results of assessments for categories were assessed with an inch tape to measure the forearm circumference and 1 RM with the dumbbell. Two different sets of exercises were given to groups A and B for 5 days each week over a 4-week period. Individuals in dental practices with forearm weakness showed significant differences in the effectiveness of treatment between Group A and Group B. Both training methods were useful at increasing strength. The study results revealed a significant increase in the functional status of the forearm and optimum strength of grasp in the group A. During the dentists' training, eccentric strength therapy significantly increased their forearm strength.

Effects of Eccentric Versus Concentric Strengthening in Patients With Subacromial Pain Syndrome: A Randomized Controlled Trial.

Subacromial pain syndrome (SPS) is the most common cause of shoulder pain. Therapeutic exercise is the first-line treatment for SPS; however, the ideal exercise type remains unclear. Here, we compared the effects of eccentric and concentric strengthening in patients with SPS. Adding isolated eccentric strengthening to a multimodal physiotherapy program (MPP) would lead to greater improvements in outcomes compared with either MPP alone or adding isolated concentric strengthening to the MPP. Randomized controlled trial. Level 2. A total of 45 patients were randomized to eccentric strengthening (ESG), concentric strengthening (CSG), and control (CG) groups; all groups received the MPP. The strengthening groups also performed group-specific strengthening. Shoulder pain, abduction and external rotation (ER) strength, joint position sense (JPS), the Constant-Murley Score (CMS), and the Disabilities of the Arm, Shoulder and Hand score were collected at baseline, after 12 weeks of treatment, and at week 24. For CMS, ESG exhibited a greater, but not clinically meaningful, improvement than CSG and CG (P < 0.05). Eccentric abduction strength increased in ESG compared with CG. From baseline to follow-up, abduction strength increased in ESG compared with CSG and CG. Eccentric abduction strength increased in CSG compared with CG. JPS at abduction improved in the ESG compared with CG. Other between-group comparisons were not significant (P > 0.05). In SPS, eccentric strengthening provided added benefits, improving shoulder abduction strength and JPS at abduction, and was superior to concentric strengthening for improving shoulder abduction strength. Neither strengthening approach had an additional effect on shoulder function, pain, ER strength, or rotational JPS. Clinicians could implement eccentric strengthening as a motor control retraining for strength and proprioception gain rather than for pain relief and reducing disability.

Effectiveness of Eccentric Strengthening Exercises and Concentric Strengthening Exercises with IFT in Alleviating Symptoms Associated with Osteoarthritis Knee Patients

Background: The most prevalent condition that affects the articular cartilage and subchondral bone is osteoarthritisof the knee. Most cases of knee osteoarthritis are seen in the medial tibiofemoral compartment. There is currentlyno complete recovery for knee osteoarthritis.Purpose: The purpose of this study is to evaluate the effect of eccentric strengthening exercise and concentricstrengthening exercise with IFT in alleviating symptoms associated with OA knee patients.Materials and Methods:36 patients with osteoarthritis of the knee are included in the trial. Before beginning thestudy, an informed permission form was obtained from the subjects. Using the WOMAC scale, the pre- and posttestvalues were calculated.The Concentric group with IFT and the Eccentric group with IFT were created. Thesubjects received concentric exercises and eccentric exercises for 3 days a week and it was continued for 4 weeks.For each session,3 sets and 10 repetition was given.Result: The collected data was statistically analysed using a paired and unpaired t-test. When comparing theeccentric group with the concentric group, the eccentric group indicates significant (p&lt;0.0001)effect in loweringthe pain and improving the function of the knee as assessed by WOMAC scale.Conclusion: According to the research, eccentric strengthening exercises combined with IFT are superior thanconcentric strengthening exercises for lowering pain and enhancing patients’ functional activity.

Skeletal effects of eccentric strengthening exercise: a scoping review

BackgroundConventional progressive concentric strengthening exercise (CSE) to improve bone mineral density (BMD) and bone mineral content (BMC) may not be feasible for populations with chronic musculoskeletal and/or metabolic conditions, such as osteoporosis or obesity. Muscle lengthening exercise, also known as an eccentric strengthening exercise (ESE), may have a special utility for those populations due to greater force generation versus CSE. In fact, greater mechanical loading can be induced on bone at lower resistance levels with ESE. However, effects of ESE on BMD and BMC are unclear. Thus, the purpose of this review was to interrogate the effects of ESE on BMD and BMC.MethodsA literature review was conducted between January 1995 and April 2022 focusing on randomized controlled trials investigating the effects of ESE on BMD and/or BMC in humans. Terms covering the domains of exercise, bone, and populations were searched on PubMed, CINAHL, and Scopus. The methodological quality of each interventional study was rated using Physiotherapy Evidence Database (PEDro) scale. Cohen’s d was calculated to determine the magnitude of the effects of ERE on site-specific outcome measures of BMD and/or BMC.ResultsOut of 1,182 articles initially found, a total of seven full length articles met our inclusion criteria. Of the seven studies, most of the interventions were performed in young (n = 5, PEDro = 5–7) versus middle-aged (n = 1, PEDro = 4) or older (n = 1, PEDro = 6) adults. BMD and BMC generally improved due to ESE; however the effects of ESE on BMD and BMC were non-homogenous. Effect size (d) ranged from 0.10–0.87 in young adults while it was 1.16 in older adults. Effect size (d) could not be calculated for the middle-aged adult study due to critical methodological limitations of the intervention.ConclusionsLarge variability exists for the effectiveness of ESE on BMD/BMC across the human life spectrum. The benefits of ESE on BMD holds promise but rigorous studies are lacking. Further research is needed to examine if the dose, mode, age, and sex-specificity dictate effects of ESE on BMD/BMC.

Secondary Anterior Cruciate Ligament Injury Prevention Training in Athletes: What Is the Missing Link?

After reconstruction, the return to full competition rate of athletes is low, while the re-injury rate remains high despite the completion of a rehabilitation programme. Primary ACL prevention programmes are well developed, yet few research papers focus on secondary ACL injury prevention. The aim of current review is to determine if current ACL secondary prevention training has a positive influence on the re-injury rate, the clinical or functional outcomes, or the risk of re-injury in athletes. Studies investigating secondary prevention of ACL were searched in PubMed and EBSCOhost, followed by a review of the references in the identified articles. The existing evidence suggests that neuromuscular training, eccentric strengthening, and plyometric exercises may have a potential impact on improving biomechanical, functional, and psychological outcomes in athletes; however, the studies on the prevention of second ACL injury in athletes is scarce and inconclusive. Future research is needed to investigate the effectiveness of secondary ACL prevention in reducing the re-injury rates. (PROSPERO Registration number: CRD42021291308).

Current Physical Therapies Available for the Rehabilitation of Tennis Elbow: A Review Article

This literature review article has drawn attention to the current available physical therapies which can be applied in managing Tennis Elbow or lateral epicondylitis (LET) whose prevalence is about 3% in general population and about 20% in elderly population. This condition is characterised by lesions in Extensor Carpi Radialis Brevis muscle leading to painful and debilitating musculoskeletal condition and affecting the overall quality of life of a patient. The review has also discussed the updated pathophysiological findings in this condition. The study has discussed that tennis elbow is degenerative disorder and initially caused by inflammation. The typical pathology found is presence of disorderly arrangement of immature collagen fibers consisting of fibroblastic and vascular components. Finally, the review has discussed several methods of physical therapies to manage tennis elbow. This includes counterforce bracing, Soft tissue techniques, various modalities , various exercises including Wrist extensor eccentric exercise, stabilization exercise, Stretching exercises, Eccentric strengthening exercise and. Overall, the review brings updated guidelines of the exercises and physical rehabilitation therapy points for managing LET or Tennis Elbow. Keywords tennis elbow, musculoskeletal condition, elbow pain, physical therapy

EFFECTS OF DOSE-RESPONSE OF NORDIC HAMSTRING EXERCISE ON MUSCLE PERFORMANCE IN ATHLETES, A RANDOMIZED CONTROLLED TRIAL

Background: The Nordic Hamstring muscle training is effective for eccentric strengthening of the hamstring in a sports population. Due to its high volume, its compliance is low and researchers are working to find out its lowest effective dose. Objectives: To determine the effects of dose-response of Nordic hamstring exercise on hamstring muscle performance. Methods: A randomized controlled trial was conducted from August to November 2020 and comprised of athletes of both genders who were randomized into high (3 times/week, 4 weeks) and low volume (1 time/week, 4weeks) Nordic hamstring exercise groups. The Outcome measures were taken using the single leg hamstring bridge test for hamstring strength, 30-m speed test, agility T-test, anthropometric measurement at 5cm, 10cm, 15cm above the patella. The assessments were taken at baseline, 2nd and 4th weeks. The data were analysed using SPSS 23. Results: There were 30(88.2%) males and 4(11.8%) females with a mean age of 23.41±3.67years and a mean BMI of 18.6±3.16. A significant difference (p&lt;0.001) was observed between both groups for all outcome variables post-exercise protocol at 2nd and 4th week. Conclusion: The Nordic hamstring exercise was effective in improving hamstring muscle performance. The higher dose of Nordic Hamstring Exercise was more effective than the lower dose in improvement in muscle size, strength, speed and agility of the participants after 4 weeks of training. Keywords: Agility, athletes, hamstring injuries, muscle strength, nordic hamstring exercises, speed

Achilles Pain - Track And Field

HISTORY: An 18-year-old, female, Division 1 collegiate track and cross-country athlete presented mid-season with acute on chronic, right posterior ankle pain after running. She was treated the season prior for insertional Achilles tendinopathy with protected weight bearing, manual therapy, eccentric strengthening, night splints, oral and topical NSAIDs, nitroglycerin patches and intra-tendinous prolotherapy. Her pain returned this season with running or direct contact of the Achilles tendon. PHYSICAL EXAMINATION: On inspection there was bilateral pes planus and slight swelling of the Achilles tendon 1-2 cm proximal to the insertion with tenderness to palpation. She had full ankle range of motion with mild pain only on end range of passive dorsiflexion. There was a non-antalgic gait pattern and no pain with toe and heel walking or with heel pumps. Ankle strength was normal and sensation to light touch was intact throughout. DIFFERENTIAL DIAGNOSIS:1. Achilles tendinopathy, recalcitrant2. Achilles paratenonitis3. Retrocalcaneal bursopathy4. Posterior ankle impingement TEST AND RESULTS: Diagnostic musculoskeletal ultrasound showed a normal appearing Achilles tendon without fusiform swelling, hypoechogenicity, fiber disruption, neovascularization or cortical irregularities FINAL/WORKING DIAGNOSIS: Achilles paratenonitis TREATMENT AND OUTCOMES:1. Referral to sports physical therapy for a progressive tendon loading program and return to run program using a weight assisted treadmill2. Despite strength and flexibility gains, the patient was unable to return to run without pain3. We performed an ultrasound guided, percutaneous Achilles paratenon brisement with saline to dissect the tight, adhesive paratenon from the tendon itself4. Additionally, during the same procedure, we performed an ultrasound guided, percutaneous, Achilles tendon scraping to disrupt peritendinous neovessels and neonerves5. After 1 week of protected rest, patient returned to physical therapy and was able to complete a return to run program and return to sport without pain within 1 month.

Preseason Eccentric Strength Is Not Associated with Hamstring Strain Injury: A Prospective Study in Collegiate Athletes.

Established risk factors for hamstring strain injuries (HSI) include older age and prior HSI. However, these are nonmodifiable and have a limited role in injury prevention. Eccentric hamstring strength is a common component of HSI prevention programs, but its association with injury is less clear. This study aimed to determine if eccentric hamstring strength was prospectively associated with HSI among collegiate athletes, while controlling for sex, age, and prior HSI. We hypothesized that athletes with lower eccentric hamstring strength or greater between-limb strength asymmetry at preseason would have an increased risk of HSI. Hamstring eccentric strength measures, maximum total force ( FTotal ) and between-limb asymmetry in maximum force ( FAsym ), were measured at preseason on male and female athletes. HSIs were tracked over the subsequent 12 months. Generalized estimating equations were used to identify univariable and multivariable associations between athlete demographics, eccentric hamstring strength, and HSI risk. Data for 326 athletes (85 female; 30 track, 43 basketball, 160 American football, 93 soccer) were included, and 64 HSIs were observed. Univariable associations between eccentric hamstring strength and subsequent HSI were nonsignificant ( FTotal : odds ratio [OR], 0.99 (95% confidence interval (CI), 0.93-1.05); P = 0.74; FAsym : OR, 1.35 (95% CI, 0.87-2.09); P = 0.23). No relationship between eccentric hamstring strength and HSI ( FAsym : OR, 1.32 (95% CI, 0.84-2.08); P = 0.23) was identified after adjusting for confounders including sex, age, and prior HSI. No association between preseason eccentric hamstring strength and risk of subsequent HSI was identified after controlling for known risk factors and sex among collegiate athletes. Eccentric hamstring strengthening may continue to serve as a preventative approach to HSI, but it does not provide additional insight into HSI risk beyond factors such as age and prior HSI.

Evidence-Based Hamstring Injury Prevention and Risk Factor Management: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background: Hamstring injuries are common among athletes. Considering the potentially prolonged recovery and high rate of recurrence, effective methods of prevention and risk factor management are of great interest to athletes, trainers, coaches, and therapists, with substantial competitive and financial implications. Purpose: To systematically review the literature concerning evidence-based hamstring training and quantitatively assess the effectiveness of training programs in (1) reducing injury incidence and (2) managing injury risk factors. Study Design: Systematic review and meta-analysis; Level of evidence, 1. Methods: A computerized search of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus with manual screening of selected reference lists was performed in October 2020. Randomized controlled trials investigating methods of hamstring injury prevention and risk factor management in recreational, semiprofessional, and professional adult athletes were included. Results: Of 2602 articles identified, 108 were included. Eccentric training reduced the incidence of hamstring injury by 56.8% to 70.0%. Concentric hamstring strength increased with eccentric (mean difference [MD], 14.29 N·m; 95% CI, 8.53-20.05 N·m), concentric, blood flow–restricted, whole-body vibration, heavy back squat, FIFA 11+ (Fédération Internationale de Football Association), and plyometric training methods, whereas eccentric strength benefited from eccentric (MD, 26.94 N·m; 95% CI, 15.59-38.30 N·m), concentric, and plyometric training. Static stretching produced greater flexibility gains (MD, 10.89°; 95% CI, 8.92°-12.86°) than proprioceptive neuromuscular facilitation (MD, 9.73°; 95% CI, 6.53°-12.93°) and dynamic stretching (MD, 6.25°; 95% CI, 2.84°-9.66°), although the effects of static techniques were more transient. Fascicle length increased with eccentric (MD, 0.90 cm; 95% CI, 0.53-1.27 cm) and sprint training and decreased with concentric training. Although the conventional hamstring/quadriceps (H/Q) ratio was unchanged (MD, 0.03; 95% CI, –0.01 to 0.06), the functional H/Q ratio significantly improved with eccentric training (MD, 0.10; 95% CI, 0.03-0.16). In addition, eccentric training reduced limb strength asymmetry, while H/Q ratio and flexibility imbalances were normalized via resistance training and static stretching. Conclusion: Several strategies exist to prevent hamstring injury and address known risk factors. Eccentric strengthening reduces injury incidence and improves hamstring strength, fascicle length, H/Q ratio, and limb asymmetry, while stretching-based interventions can be implemented to improve flexibility. These results provide valuable insights to athletes, trainers, coaches, and therapists seeking to optimize hamstring training and prevent injury.

Success Rate of Non-Operative Treatment of Insertional Achilles Tendinitis

Category:Hindfoot; OtherIntroduction/Purpose:Insertional Achilles tendinitis (IAT) is a common orthopedic condition that can be treated conservatively or surgically. While non-operative treatment is thought to be beneficial in approximately 50-70% of cases, the precise success rate of non-operative treatment is not fully defined in the current literature. The purpose of this study is to define the success rate of modern non-operative treatment of IAT more precisely.Methods:A retrospective chart review was performed to identify patients who received either surgical or non-surgical treatment of IAT with a single fellowship-trained foot and ankle surgeon at an academic medical center between September 2015 and June 2019. A total of 133 patients (137 ankles) were identified. The success rate of non-operative treatment, defined as the lack of need for surgical treatment within two years of initial diagnosis of IAT, was recorded. Patients with IAT were treated with scheduled anti-inflammatory medications, physical therapy with a focus on eccentric strengthening and Achilles stretching and, when needed, controlled ankle motion (CAM) boot, short leg casting, or Platelet-Rich Plasma injections for refractory cases. A demographic and comorbidity comparison was performed between groups. Statistical analysis was performed using two-tailed Student t-test and Chi-squared test.Results:There was no difference in treatment method between those successfully treated conservatively and those who went on to fail conservative management and require surgery. At first encounter, patients who later received surgery were significantly more likely to have higher VAS pain scores (surgery=6.54, conservative=5.10; p=.045) and lower SF-12 physical scores (surgery=25.16, conservative=35.61; p<.001). The overall success rate of non-operative treatment was 78.57% and the average time from initial diagnosis to surgery was 198.83 days (range, 28-486).Conclusion:Based on the results of this study, the success rates of non-operative treatment for IAT may be higher than what is traditionally thought, at just under 80%. Further, patients with worse VAS and SF-12 physical scores were significantly more likely to fail conservative management. Orthopedic surgeons should use this information to provide more accurate counseling on the most appropriate treatment strategies for IAT.

Early versus delayed lengthening exercises for acute hamstring injury in male athletes: a randomised controlled clinical trial

BackgroundTo evaluate the efficacy of early versus delayed introduction of lengthening (ie, eccentric strengthening) exercises in addition to an established rehabilitation programme on return to sport duration for acute hamstring...

Novel interventions for recalcitrant patella tendinopathy: Results may favour autologous blood injection (ABI) over radial-extra-corporeal shockwave therapy (r-ESWT) – A prospective cohort study

BackgroundPatella tendinopathy is a common condition in a number of sports and can have a significant impact on activity and quality of life. Whilst rehabilitation leads to improvements in the majority of cases, a number of adjunct treatments are available for resistant cases with limited evidence supporting the use of one treatment over another.Hypothesis/Purpose: To compare the outcomes for patients with chronic patella tendinopathy, following either radial-Extra-Corporeal Shockwave Therapy (r-ESWT) or Autologous Blood Injection (ABI) Study designProspective cohort study. Methods28 consecutive patients with chronic patella tendinopathy, treated with radial-ESWT (n = 14) or ABI (n = 14), with minimum three-month follow-up. Mean age 34.2 years, mean duration of symptoms 32.8 months. Patients received either three sessions of radial-Extra-Corporeal Shockwave Therapy (one session per week for 3 weeks), or two ultrasound-guided Autologous Blood Injections (2 injections performed 2–4 weeks apart). All patients received standardised after-care, including continuation of a structured home exercise programme of flexibility and progressive loading (eccentric strengthening) exercises. Main Outcome Measures were Victoria Institute of Sport – Patella questionnaire (VISA-P), plus 0–10 Visual Analogue Scale (VAS) for self-reported levels of “average pain”. ResultsThere were statistically significant improvements in self-reported measures of pain/function following either procedure at 6-weeks and at 3-months, but only in the ABI group at 6-months. At 3-months: VISA-P was improved from 32.4% ± 11.7%–60.0% ± 20.7% (p < 0.01) in the ABI group, and from 34.2% ± 14.6%–48.9% ± 17.8% (p < 0.001) in the r-ESWT group. ConclusionsPatients with chronic patella tendinopathy improved at 6-weeks and 3-months following either ABI or r-ESWT procedure, with significant benefits at 6-months seen only in the ABI group. Between group analysis demonstrated improved outcomes favouring ABI compared to r-ESWT at the 6-month timepoint using VISA-P, and at all time-points using VAS as outcome measures. The small sample sizes in this pragmatic study are however noted, which limit interpretation, and larger more robust studies are required to investigate this further. This pragmatic prospective cohort study demonstrates improvements following either r-ESWT or ABI procedures, with results potentially favouring ABI over r-ESWT for patients with chronic patella tendinopathy.

Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Is Shockwave Therapy With Eccentric Strengthening Superior to Eccentric Rehabilitation Alone for Treatment of Insertional Achilles Tendinopathy?

Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Is Shockwave Therapy With Eccentric Strengthening Superior to Eccentric Rehabilitation Alone for Treatment of Insertional Achilles Tendinopathy?

Shock Wave Therapy Associated with Eccentric Strengthening vs Isolated Eccentric Strengthening for Achilles Insertional Tendinopathy Treatment: A Double Blinded Randomized Clinical Trial

Category:Sports; OtherIntroduction/Purpose:Lack of consensus inhibits Achilles insertional tendinopathy (AIT) management. The condition is usually treated with eccentric exercises (EE), despite its absence of satisfactory and standing results. Shock wave therapy (SWT) was presented as an alternative, but it is still supported by a paucity of studies that shows moderate outcomes. The purpose of this study is to determine if the association of shock wave therapy (SWT) with the eccentric exercises (EE) protocol improve rates of pain and function in patients with AIT.Methods:This was a single-centre, double blind, placebo-controlled, in parallel groups, randomized clinical trial. 119 patients diagnosed with AIT, were evaluated, and enrolled in the study from February 2017 to February 2019. They were divided in two treatment groups, SWT associated to EE (SWT group) and EE associated to sham (CON group). Three sessions of radial shockwaves (or sham) separated by 2 weeks and eccentric training for three months were applied. The primary outcome was the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) at 24 weeks. Secondary outcomes included the Visual Analogue Scale (VAS), Algometry, the Foot and Ankle Outcome Score (FAOS) and the 12 Item Short Form Health Survey (SF-12).Results:Both groups showed significant improvement with the corresponding treatment in the study period. However, there were no between-group differences (all ps > 0.05) in any of the outcomes. At the 24th week evaluation, the SWT group exhibited a mean VISA-A of 63.2 (CI 8.0) and the CON group of 62.3 (CI 6.9), p=0.876. Failures were higher in the SWT (38.3% to 11.5%, p=0.002) and recurrences were superior in the CON side (34.6% to 17.0%, p=0.047). There were no complications.Conclusion:Extracorporeal shockwave therapy does not potentialize the effects of eccentric strengthening in the management of Achilles insertional tendinopathy.

Exercise for rotator cuff tendinopathy.

Rotator cuff tendinopathy is among the main causes of shoulder pain. It is characterized by lesions without rupture caused by overload, work-related repetitive strain injury, or metabolic changes such as diabetes affecting one or more tendons, which cause pain, morphological alterations, and disability. This study aimed to evaluate the effects of exercise-based therapy on shoulder pain reduction and functioning improvement in patients with rotator cuff tendinopathy. This was a systematic review. Data were collected from randomized controlled trials retrieved from PubMed, Biblioteca Virtual em Saúde, PEDro, Web of Science, Scopus, and CENTRAL metasearch engines. The PEDro scale was used to evaluate the methodological quality of the selected studies. Eccentric exercise, conventional exercise, scapular and rotator cuff muscle strengthening, rotator cuff strengthening plus pectoralis major strengthening, high-load training, and low-load training were effective for the outcomes investigated in this study. Furthermore, goniometry, visual analogue scales, the Constant Murley score, the Disabilities of the Arm, Shoulder and Hand questionnaire, and the Shoulder Pain and Disability Index were constantly used to measure pain and functioning. Therapeutic exercises should be performed in this population, and new randomized controlled trials should be conducted with the goal of achieving the same outcome. The International Classification of Functioning, Disability and Health should be increasingly used in studies addressing patient functioning.