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

Achilles tendinopathy and eccentric exercise, a narrative review

[Resumen] Objetivos: El objetivo principal de esta revisión bibliográfica es conocer la aplicación más eficaz según la ciencia de ejercicio excéntrico (EE) a la hora de manejar la TA. Los objetivos secundarios son conocer las diferencias entre sexos al recibir el tratamiento de ejercicio excéntrico en la TA y conocer el mecanismo de acción del EE en la TA. Material y Métodos: Se realizó una búsqueda bibliográfica en la base de datos PubMed. Se usaron los siguientes términos: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. Se seleccionaron artículos que aportaban calidad metodológica, relevancia científica, o una visión novedosa. Resultados: Se encontraron artículos que apoyan la aplicación de EE como tratamiento de la TA y la dosificación recomendada. Se encontraron varios artículos que teorizan sobre los efectos del EE en la TA. Se encontró un artículo que diferencia los efectos del EE en hombres y en mujeres en la TA. Conclusiones: El EE sería el tratamiento de elección en una TA. El protocolo de Alfedson cuenta con la mayoría de los apoyos científicos. En el futuro será necesario realizar estudios de mayor calidad metodológica sobre diferentes opciones de ejercicio. No quedan claros cuáles son los mecanismos de acción del EE en la TA. Queda demostrado que los efectos del EE en las mujeres son limitados en comparación con los hombres.[Abstract] Objectives: The main objective of this bibliographical review is to know the most effective application according to the science of eccentric exercise (EE) when it comes to managing Aquilles Tendinopathy (AT). The secondary objectives are to know the differences between the sexes when receiving the treatment of eccentric exercise in the AT and to know the mechanism of action of EE in the AT. Methods: A literature search was made in the PubMed database. The following terms were used: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. We selected articles that provided methodological quality, scientific relevance, or a novel vision. Results:We found articles that support the application of EE as a treatment for AT and the recommended dosage. We found several articles that theorize about the effects of EE on AT. An article was found that differentiates the effects of EE in men and women in AT. Conclusions: EE is the treatment of choice in AT. The Alfedson protocol has the most scientific support. In the future it will be necessary to carry out studies of higher methodological quality on different exercise options. It is not clear what are the mechanisms of EE action in the TA. It is shown that the effects of EE in women are limited compared to me

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

Footwear used by older people and a history of hyperkeratotic lesions on the foot : a prospective observational study

4 p.Inadequate footwear, painful and hyperkeratotic lesions (HL) are an extremely common problems amongst older people. Such problems increase the risk of falls, hamper mobility, reduction of quality of life, dignity, and ability to remain independent. The etiology of painful and feet conditions is poorly understood. To discover footwear preferences of older people, pain tolerance may favor presence of HL for the use of inadequate footwear in old age. A sample of 100 participants with a mean age of 74.90 ± 7.01 years attended an outpatient clinic where self-reported demographic data, frequency with which they checked their feet were recorded and measurements were taken of foot sensitivity. Additionally, all participants’ shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials. Only 12% of the sample population checked their feet every day, 37% revealed symptoms of neuropathy, 14% used optimal shoes, and 61% presented HL. In a bivariate analysis, no significant differences were observed. HL are associated with inadequate footwear, loss of sensitivity, and low frequency of foot health checks.S

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

Analysis of the isometric activation of the gluteus medius and the intrinsic musculature of the sole in the prevention of injuries in elite basketball players: a pilot study

[Resumen] Introducción: El valgo dinámico de rodilla es uno de los principales factores de riesgo de lesión de deportes de impacto como el Baloncesto. Mejorar los sistemas de análisis de identificación de los factores de riesgo y los protocolos de prevención de lesiones se ha convertido en uno de los objetivos principales del fisioterapeuta deportivo, con el objetivo de disminuir el riesgo de lesión del deportista. Material y Métodos: Se analizó la distribución de las presiones plantares y los ángulos de alineación de los segmentos corporales en el plano frontal durante el Single-Leg-Squat Test en 10 sujetos deportistas de élite, con el objetivo de y observar la modificación a corto plazo asociada a la activación isométrica del glúteo medio y la musculatura intrínseca de la planta del pie. Resultados: Variaciones significativas en el aumento de la presión plantar del primer metatarsiano se registraron tras la activación del glúteo medio y de la musculatura intrínseca del pie. No se obtuvieron resultados significativos en la modificación de los ángulos de alineación en el plano frontal. Conclusiones: Un aumento de la presión plantar de la cabeza del primer metatarsiano puede relacionarse con una mayor estabilidad del miembro, mediante la activación del glúteo medio y de la musculatura intrínseca del pie. Son necesarios estudios con muestras más amplias que correlacionen los datos obtenidos en una muestra más homogénea.[Abstract] Introduction: Dynamic knee valgus is one of the main injury risk factors of impact sports such as basketball. Systems improvement for the analysis of identification of risk factors and injury prevention protocols has become one of the main objectives of the sports physiotherapist, with the aim of reducing the risk of athletes injury. Material and Methods: The distribution of plantar pressures and the angles of alignment of the body segments in the frontal plane during the Single-Leg-Squat Test in 10 elite athletes was analyzed, with the objective of observing the modification in short-term associated with the isometric activation of the gluteus medius and the intrinsic plantar musculature of the foot. Results: Significant variations in the increase of plantar pressure of the first metatarsal were recorded after activation of the gluteus medius and the intrinsic plantar muscles of the foot. No significant results were obtained in the modification of the alignment angle in the frontal plane. Conclusions: An increase in the plantar pressure of the head of the first metatarsal can be related to greater stability of the limb, through activation of the gluteus medius and the intrinsic plantar muscles of the foot. Studies with larger samples that correlate the data obtained in a more homogeneous sample are necessary

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