Current status of pharmacological invasive treatments in Achilles tendinopathy

[Resumen] Objetivos: El objetivo es aportar evidencia científica sobre tratamientos invasivos farmacológicos para la tendinopatía Aquilea. Material y métodos: Se realizó una búsqueda en PubMed que abarcó trabajos desde 1984 hasta el 30 de enero de 2018 usando términos como: “Achilles tendinopathy and treatment”. “Corticosteroids” “Heparin”. Stem cell” “Platelet Rich Plama” Resultados: Se obtuvieron artículos sobre el tratamiento del tendón de Aquiles con corticoides, heparina, proloterapia, sustancias esclerosantes, transfusiones de sangre autóloga, células madre, plasma enriquecido en plaquetas y ácido hialurónico. Conclusiones: Los tratamientos invasivos evaluados pueden ser una opción de para la tendinopatía aquilea. No obstante hay que ser cauteloso con ciertos efectos adversos derivados de su uso.[Abstract] Objectives: The objective is to provide quality evidence on pharmacological invasive treatments in Achilles tendinopathy. Methods: A search was made in PubMed that included works from 1984 to January 30, 2018. Terms like “Achilles tendinopathy and treatment”. “Corticosteroids” “Heparin”. Stem cell” “Platelet Rich Plama” were used. Results: Articles about Achilles tendon were obtained with this treatments: corticosteroids, heparin, prolotherapy, sclerosing substance, autologous blood transfusions, stem cells, platelet rich plasma and hyaluronic acid. Conclusions: The invasive treatments evaluated may be an option for Achilles tendinopathy. However, we must be careful with certain adverse effects derived from its us

Current status of the validity and reliability of the sonographic assessment of the Achilles tendon

[Resumen] Objetivo: Conocer la validez y fiabilidad de la ecografía musculo esquelética en la valoración del tendón de Aquiles. Conocer los hallazgos ecográficos típicos en el tendón de Aquiles, tanto sano como lesionado. Material y métodos: Se realizó una revisión bibilográfica desarrollando una búsqueda en PubMed que abarcó trabajos desde 1984 hasta el 30 de enero de 2018 Se usaron los siguientes términos: “Ultrasound achilles tendon”, “Ultrasound triceps surae”, “Achilles tendinopathy ultrasound”. Se incluyeron artículos en base a su calidad metodológica, relevancia científica, aportación de una visión novedosa y su utilidad clínica. Resultados: Se encontraron artículos sobre la validez y fiabilidad de la evaluación del tendón de Aquiles, así como de estructuras próximas, con ecografía músculo esquelética. También se encontraron artículos sobre los hallazgos en la imagen del tendón de Aquiles sano y lesionado. Conclusiones: La literatura parece confirmar que la ecografía músculo esquelética es un método valido y fiable para evaluar la tendinopatía aquilea. Existirían diferencias ecográficas entre tendones sanos y lesionados, y no parece diferenciarse éste entre lesión crónica y desgarro interno. El engrosamiento tendinoso y la neovascularización deberían tenerse al diagnosticar la tendinopatía aquilea, pero su simple presencia no determinaría la severidad clínica.[Abstract] Objective: To determine the validity of skeletal muscle ultrasound in the evaluation of the Achilles tendon. To establish the typical sonographic findings in the Achilles tendon, both healthy and injured. Methods: A bibliographic review was carried out, developing a PubMed search that covered papers from 1984 to January 30, 2018. The following terms were used: “Ultrasound achilles tendón”, “Ultrasound triceps surae”, “Achilles tendinopathy ultrasound”. Articles were included based on their methodological quality, scientific relevance, contribution of novelty and their clinical usefulness. Results: Articles about the validity and reliability of the evaluation of the Achilles tendon, as well as of nearby structures, by skeletal muscle ultrasound were found. There were also articles about the findings in the image of the healthy and injured Achilles tendon. Conclusions: The literature seems to confirm that musculoskeletal ultrasound is a valid and reliable method to evaluate Achilles tendinopathy. There were sonographic differences between healthy and injured tendons, and this evaluation did not seem to differentiate between chronic injury and internal tear. Tendon thickening and neovascularization should be considered during diagnosis of Achilles tendinopathy, but the simple presence of these features would not determine the clinical severit

Myofascial Pain Syndrome in Women with Primary Dysmenorrhea: A Case-Control Study

There is limited information on myofascial trigger points (MTrPs) and specific symptoms of chronic pelvic pain and, more specifically, dysmenorrhea. The objective of this study was to determine whether patients suffering from primary dysmenorrhea present alterations in mechanosensitivity and pain patterns, and greater presence of MTrPs in the abdominal and pelvic floor muscles. A case-control study was carried out with a total sample of 84 participants distributed based on primary dysmenorrhea and contraceptive treatment. The sample was divided into four groups each comprising 21 women. Data on pain, quality of life, and productivity and work absenteeism were collected; three assessments were made in different phases of the menstrual cycle, to report data on pressure pain threshold, MTrP presence, and referred pain areas. One-way ANOVA tests showed statistically significant differences (p 50%) and higher than 70% in women with primary dysmenorrhea, in the menstrual phase, and the internal obturator muscle (100%) in the menstrual phase. Referred pain areas of the pelvic floor muscles increase in women with primary dysmenorrhea.Sección Deptal. de Radiología, Rehabilitación y Fisioterapia (Enfermería)Fac. de Enfermería, Fisioterapia y PodologíaTRUEpu

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia : A Pilot Randomized Clinical Trial

Objective: The aim was to analyze effects of a percutaneous neuromodulation (PNM) treatment on the radial nerve, regarding pain, functionality, electrophysiologic excitability, and morphology, in patients with chronic lateral epicondylalgia (LE). Methods: Twenty-four patients with chronic unilateral elbow pain were recruited for this preliminary study and were divided into two groups: control (n = 12) and PNM group (n = 12). The subjects in the PNM group received percutaneous peripheral neurostimulation with an acupuncture needle that was located next to the nerve with ultrasound guidance. Pain using a numerical rating scale (NRS), functional ability using patient-rated tennis elbow evaluation (PRTEE), radial nerve cross-sectional area measured by ultrasound, and chronaxie and accommodation index (AI) measured by the strength-duration curve were evaluated. Results: Both groups showed no differences in the baseline measurements (all p = 0.001). However, at the end of the treatment, there were significant differences between groups since only the PNM group significantly improved their values compared to their baseline values: level of pain and cross-sectional area (CSA) values showed a significant decrease while the PRTEE scores showed a significant improvement. Then, regarding AI, the PNM group showed significant improvement for the electrophysiologic nerve excitability pattern, reporting normal function in all radial nerves after treatment (p = 0.001). However, chronaxie values always reported similar values with no differences between groups (p >0.05); Conclusion: Ultrasound-PNM technique may be an interesting therapeutic tool for the treatment of chronic LE due to the improvement in the level of pain, functionality, nerve morphology, and excitability in this population

Efficacy of quadriceps vastus medialis dry needling in a rehabilitation protocol after surgical reconstruction of complete anterior cruciate ligament rupture

10 p.Background: Several new rehabilitation modalities have been proposed after anterior cruciate ligament (ACL) reconstruction. Among these, trigger point dry needling (TrP-DN) might be useful in the treatment of myofascial pain syndrome associated with ACL reconstruction to reduce pain intensity, increase knee flexion range and modify the mechanical properties of the quadriceps muscle during late-stage rehabilitation. To date, this is the first randomized clinical trial to support the use of TrP-DN in the early rehabilitation process after ACL reconstruction. The aim of this study was to determine the pain intensity, range of motion (ROM), stability, and functionality improvements by adding quadriceps vastus medialis TrP-DN to the rehabilitation protocol (Rh) provided to subacute ACL reconstructed patients. Methods:This randomized, single-blinded, clinical trial (NCT02699411) included 44 subacute patients with surgical reconstruction of complete ACL rupture. The patients were randomized into 2 intervention groups: Rh (n=22) or Rh+TrP-DN (n=22). Pain intensity, ROM, stability, and functionality were measured at baseline (A0) and immediately (A1), 24hours (A2), 1 week (A3), and 5 weeks (A4) after the first treatment. Results: Comparing statistically significant differences (P .001; Eta2=0.198–0.360) between both groups, pain intensity (at A1), ROM (at A1, A2, and A3), and functionality (at A2, A3, and A4) were increased. Nevertheless, the rest of measurements did not show significant differences (P>.05). Conclusion: Quadriceps vastus medialis TrP-DN in conjunction with a rehabilitation protocol in subacute patients with surgical reconstruction of complete ACL rupture increases ROM (short-term) and functionality (short- to mid-term). Although there was an increase in pain intensity with the addition of TrP-DN, this was not detected beyond immediately after the first treatment. Furthermore, stability does not seem to be modified after TrP-DN.S

Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment in subjects who suffer from cervicobrachial pain: a randomized clinical trial

9 p.Oral ibuprofen (OI) and median nerve neural mobilization (MNNM) are first line treatments for patients who suffer cervicobrachial pain (CP). OI may produce side effects which are not tolerated by all subjects who suffer CP, whereas MNNM has no known side effects. Therefore, the aim of this study was to assess the effectiveness of both treatments (OI vs. MNNM) in CP. Material and methods: This investigation was a blinded parallel randomized clinical trial (NCT02593721). Sixty-two participants diagnosed with CP were recruited and randomly assigned to 2 groups (n = 31), which received MNNM or 1200 mg/day OI treatment for 6 weeks. The numeric rating scale for pain intensity was the primary outcome. The cervical rotation range of motion (CROM) and the upper limb function were the secondary outcomes. Results: The results showed that OI treatment (η2 = 0.612–0.755) was clearly superior to MNNM (η2 = 0.816–0.821) in all assessments (p 0.05). Three subjects were discharged because of OI side effects. Conclusions: Oral ibuprofen may be superior to MNNM for pain reduction and upper limb function increase of subjects with CP. Nevertheless, both treatments were effective. Median nerve neural mobilization may be considered an effective non-pharmaceutical treatment option in subjects with CP. Regarding OI adverse effects, our findings challenge the role of pharmacologic versus manual therapy as possible treatments that may improve pain intensity and upper limb functionality in subjects with CP. Effectiveness of median nerve neural mobilization versus oral ibuprofen treatment... | Request PDF. Available from: https://www.researchgate.net/publication/320554952_Effectiveness_of_median_nerve_neural_mobilization_versus_oral_ibuprofen_treatment_in_subjects_who_suffer_from_cervicobrachial_pain_a_randomized_clinical_trial [accessed Mar 08 2018].S

Immediate Effects of Whole-Body versus Local Dynamic Electrostimulation of the Abdominal Muscles in Healthy People Assessed by Ultrasound: A Randomized Controlled Trial

Dynamic electrostimulation consists of the application of local or global electrostimulation together with physical exercise. This study aimed to investigate the immediate effects of a dynamic electrostimulation session on the thickness of the abdominal musculature, inter-rectus distance, heart rate, blood pressure, and body temperature, and to identify possible differences in its form of application. A total of 120 healthy participants were divided into three groups: the whole-body electrostimulation group, the local electrostimulation group, and the control group without electrical stimulation. All groups performed a single session with the same dynamic exercise protocol. Muscle thickness and inter-rectus distance were evaluated ultrasonographically using the Rehabilitative Ultrasound Imaging technique both at rest and in muscle contraction (the active straight leg raise test) to find the post-intervention differences. The results showed significant differences in immediate post-intervention heart rate, with a smaller increase in the local electrostimulation group compared to the control and whole-body electrostimulation groups. No significant differences were identified between the groups after the interventions in the rest of the variables analyzed. Therefore, a local application, with the same effects as a global application on the abdominal musculature, has fewer contraindications, which makes its use more advisable, especially in populations with cardiorespiratory disorders, for which more research is needed.Sección Deptal. de Radiología, Rehabilitación y Fisioterapia (Enfermería)Fac. de Enfermería, Fisioterapia y PodologíaTRUEProfessional College of Physiotherapists of Castilla y León (Spain).pu

Infrared thermography applied to lower limb muscles in elite soccer players with functional ankle equinus and non-equinus condition

11 p.Gastrocnemius-soleus equinus (GSE) is a foot-ankle complaint in which the extensibility of the gastrocnemius (G) and soleus muscles (triceps surae) and ankle are limited to a dorsiflexion beyond a neutral ankle position. The asymmetric forces of leg muscles and the associated asymmetric loading forces might promote major activation of the triceps surae, tibialis anterior, transverses abdominal and multifidus muscles. Here, we made infrared recordings of 21 sportsmen (elite professional soccer players) before activity and after 30 min of running. These recordings were used to assess temperature modifications on the gastrocnemius, tibialis anterior, and Achilles tendon in GSE and non-GSE participants. We identified significant temperature modifications among GSE and non-GSE participants for the tibialis anterior muscle (mean, minimum, and maximum temperature values). The cutaneous temperature increased as a direct consequence of muscle activity in GSE participants. IR imaging capture was reliable to muscle pattern activation for lower limb. Based on our findings, we propose that non-invasive IR evaluation is suitable for clinical evaluation of the status of these muscles.S

Influence of Unstable Shoes on Women With Lumbopelvic Postpartum Pain: Randomized Clinical Trial

[Abstract] Background: Back pain is a normal symptom during pregnancy and is expected to become worse beyond the first three months after childbirth. Objectives: To determine the effectiveness of wearing unstable shoes instead of conventional shoes, regarding pain intensity, low back mobility and stability, among women with lumbopelvic pain (LPP) during the postpartum period. Design and setting: Prospective, single-blinded, randomized clinical trial conducted at a podiatry and physiotherapy clinical center. Methods: A nine-week program of wearing either unstable shoes (A) or conventional shoes (B) was implemented. The following outcomes were measured in three assessments: pain intensity, using a visual analogue scale (VAS); low-back mobility, using a modified Schober test; and stability, using a pressure platform. Results: The lateral stability speed, anterior stability speed and anterior center of pressure (COP) showed significant (P < 0.05) decreases in the unstable shoes group after nine weeks, in relation to the conventional group. Intra-group measurements showed significant differences (P < 0.05) in VAS between the second and third assessments and between the first and third assessments in both groups. Intra-group evaluations also showed statistically significant differences (P < 0.05) in the lateral stability speed and anterior stability speed. Conclusions: Unstable shoes were effective in decreasing the pain intensity at five and nine weeks in women with postpartum LPP. In addition, their use produced decreases in lateral stability speed, anterior stability speed and anterior COP at nine weeks