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Qureshi AU, Hameed M, Umar M, Yasir U, Abbas Z, Jamil S, Masroor L, Arshad A, Tahir S, Ibrahim Raza M. A Comparative Study of the Graston Technique and Alfredson Protocol in the Management of Achilles Tendinopathy. Cureus 2024; 16:e62249. [PMID: 39006664 PMCID: PMC11244946 DOI: 10.7759/cureus.62249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The Achilles tendon, the largest and strongest tendon in the human body, is frequently injured by overuse; this condition is known as Achilles tendinopathy (AT). It serves as a link between the heel bone and the calf muscles and is necessary for motions, such as walking, sprinting, and jumping. Evidence is presented to support the efficacy of the Graston technique and Alfredson protocol for pain reduction and improvement of function and calf muscle strength. The objective of this study is to compare the efficacy of the Graston technique versus the Alfredson protocol in patients with AT. Methods and data collection: After obtaining approval from the ethical review board of the Rawalpindi Medical University, all patients fulfilling the inclusion criteria are divided into two groups, A and B, by generating random identity numbers using Microsoft Excel for allocation. Group A comprises patients who undergo treatment with the Graston technique as conventional therapy with Alfredson protocol (12-week calf muscle eccentric exercises), while those in group B follow a Graston technique with sole heel lift. Individuals in the eccentric exercises group follow an Alfredson method-based 12-week eccentric exercise plan for their leg muscles. The workouts need to be done twice a day, seven days a week for 12 weeks. The plan includes two exercises: the first done with the knee straightened to work the gastrocnemius and the second done with the knee bent to work the soleus. Three sets of 15 repetitions with no rest interval for each exercise are completed twice a day on the affected limb to yield functional improvement. RESULTS The results showed that both the Alfredson protocol and the Graston technique were effective in managing AT symptoms. The study involved dividing 32 participants into two groups who received either treatment for four weeks. The main way to measure improvement was a score called the Villalta-Scanlon Achilles Tendonitis Index score. In both groups, these scores showed significant improvement (with a p-value less than 0.001, which means that the results are very statistically significant). For Group A (who received the Alfredson protocol), the average Villalta-Scanlon Achilles Tendonitis Index score before treatment was 29.25. This score increased to 31.25 at mid-treatment and 34.38 after the full four weeks of treatment. Group B (who received the Graston technique) started with an average Villalta-Scanlon Achilles Tendonitis Index score of 22.94. Their scores also increased throughout the treatment, reaching 34.94 at mid-treatment and 42.88 after four weeks. These findings provide evidence that both treatments can improve AT symptoms, with some suggestions that the Graston technique might be even more effective based on the higher average Villalta-Scanlon Achilles Tendonitis Index scores after treatment. CONCLUSIONS The Graston technique shows promising results, particularly in the mid- and post-treatment phases, indicating its potential efficacy in comparison to the Alfredson protocol in the treatment of AT.
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Affiliation(s)
| | - Muddsar Hameed
- Department of Clinical Psychology, Shifa Tameer-e-Millat University, Islamabad, PAK
| | - Muhammad Umar
- Department of Physiotherapy, Rawalpindi Medical University, Rawalpindi, PAK
| | - Umer Yasir
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, PAK
| | - Zamurd Abbas
- Department of Medicine, International European University, Bishkek, KGZ
| | - Sarem Jamil
- Department of Anatomy, Khyber Medical College, Peshawar, PAK
| | - Linta Masroor
- Department of Orthopaedics, Shifa Tameer-e-Millat University, Islamabad, PAK
| | - Arusa Arshad
- Department of Medicine, Fazaia Medical College, Islamabad, PAK
| | - Saima Tahir
- Department of Medicine, International European University, Bishkek, KGZ
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McDevitt AW, Young JL, Cleland JA, Hiefield P, Snodgrass SJ. Physical therapy interventions used to treat individuals with biceps tendinopathy: a scoping review. Braz J Phys Ther 2024; 28:100586. [PMID: 38219522 PMCID: PMC10825607 DOI: 10.1016/j.bjpt.2023.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/23/2023] [Accepted: 12/17/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Shoulder pain related to pathology of the long head of the biceps tendon (LHBT) can be debilitating. Chronic LHBT tendinopathy is a common condition that is difficult to treat. Little consensus exists regarding the optimal approach to treating individuals with LHBT tendinopathy. OBJECTIVE To systematically scope the literature to identify and present the available information regarding physical therapist interventions used for the management of individuals with LHBT tendinopathy including types of interventions used or recommended. METHODS A scoping review of physical therapist interventions used to treat LHBT was conducted of the CINAHL, Embase, Medline, and SportDiscus databases. Full text records reporting physical therapist-based interventions in individuals with proximal LHBT pathology were included. Articles not written in English were excluded. RESULTS Of the 4059 records identified, 14 articles met the inclusion criteria. Interventions used to treat LHBT tendinopathy identified in quantitative studies included: extracorporeal shock wave therapy, polarized light, ultrasound, low-level laser, iontophoresis, general exercise, eccentric training, stretching, dry needling, and joint mobilization. Interventions described in literature reviews, clinical commentaries, and a Delphi study included: therapeutic modalities, manual therapy, exercise, dry needling, and patient education. CONCLUSION This scoping review reported interventions primarily based on therapeutic modalities in quantitative studies while literature reviews, clinical commentaries, and a Delphi study described the addition of manual therapy, patient education, exercise, and dry needling. Overall, there is a dearth of evidence detailing the conservative management of LHBT tendinopathy.
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Affiliation(s)
- Amy W McDevitt
- University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, United States of America; Discipline of Physiotherapy, The University of Newcastle, Callaghan, Australia.
| | - Jodi L Young
- Bellin College, Doctor of Science in Physical Therapy Program, Green Bay, WI, United States of America
| | - Joshua A Cleland
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Doctor of Physical Therapy Program, Boston, MA, United States of America
| | - Paisley Hiefield
- University of Colorado Anschutz Medical Campus, Department of Physical Medicine and Rehabilitation, Physical Therapy Program, Aurora, CO, United States of America
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, Australia
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Cooper K, Alexander L, Brandie D, Brown VT, Greig L, Harrison I, MacLean C, Mitchell L, Morrissey D, Moss RA, Parkinson E, Pavlova AV, Shim J, Swinton PA. Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. Health Technol Assess 2023; 27:1-389. [PMID: 37929629 PMCID: PMC10641714 DOI: 10.3310/tfws2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Tendinopathy is a common, painful and functionally limiting condition, primarily managed conservatively using exercise therapy. Review questions (i) What exercise interventions have been reported in the literature for which tendinopathies? (ii) What outcomes have been reported in studies investigating exercise interventions for tendinopathy? (iii) Which exercise interventions are most effective across all tendinopathies? (iv) Does type/location of tendinopathy or other specific covariates affect which are the most effective exercise therapies? (v) How feasible and acceptable are exercise interventions for tendinopathies? Methods A scoping review mapped exercise interventions for tendinopathies and outcomes reported to date (questions i and ii). Thereafter, two contingent systematic review workstreams were conducted. The first investigated a large number of studies and was split into three efficacy reviews that quantified and compared efficacy across different interventions (question iii), and investigated the influence of a range of potential moderators (question iv). The second was a convergent segregated mixed-method review (question v). Searches for studies published from 1998 were conducted in library databases (n = 9), trial registries (n = 6), grey literature databases (n = 5) and Google Scholar. Scoping review searches were completed on 28 April 2020 with efficacy and mixed-method search updates conducted on 19 January 2021 and 29 March 2021. Results Scoping review - 555 included studies identified a range of exercise interventions and outcomes across a range of tendinopathies, most commonly Achilles, patellar, lateral elbow and rotator cuff-related shoulder pain. Strengthening exercise was most common, with flexibility exercise used primarily in the upper limb. Disability was the most common outcome measured in Achilles, patellar and rotator cuff-related shoulder pain; physical function capacity was most common in lateral elbow tendinopathy. Efficacy reviews - 204 studies provided evidence that exercise therapy is safe and beneficial, and that patients are generally satisfied with treatment outcome and perceive the improvement to be substantial. In the context of generally low and very low-quality evidence, results identified that: (1) the shoulder may benefit more from flexibility (effect sizeResistance:Flexibility = 0.18 [95% CrI 0.07 to 0.29]) and proprioception (effect sizeResistance:Proprioception = 0.16 [95% CrI -1.8 to 0.32]); (2) when performing strengthening exercise it may be most beneficial to combine concentric and eccentric modes (effect sizeEccentricOnly:Concentric+Eccentric = 0.48 [95% CrI -0.13 to 1.1]; and (3) exercise may be most beneficial when combined with another conservative modality (e.g. injection or electro-therapy increasing effect size by ≈0.1 to 0.3). Mixed-method review - 94 studies (11 qualitative) provided evidence that exercise interventions for tendinopathy can largely be considered feasible and acceptable, and that several important factors should be considered when prescribing exercise for tendinopathy, including an awareness of potential barriers to and facilitators of engaging with exercise, patients' and providers' prior experience and beliefs, and the importance of patient education, self-management and the patient-healthcare professional relationship. Limitations Despite a large body of literature on exercise for tendinopathy, there are methodological and reporting limitations that influenced the recommendations that could be made. Conclusion The findings provide some support for the use of exercise combined with another conservative modality; flexibility and proprioception exercise for the shoulder; and a combination of eccentric and concentric strengthening exercise across tendinopathies. However, the findings must be interpreted within the context of the quality of the available evidence. Future work There is an urgent need for high-quality efficacy, effectiveness, cost-effectiveness and qualitative research that is adequately reported, using common terminology, definitions and outcomes. Study registration This project is registered as DOI: 10.11124/JBIES-20-00175 (scoping review); PROSPERO CRD 42020168187 (efficacy reviews); https://osf.io/preprints/sportrxiv/y7sk6/ (efficacy review 1); https://osf.io/preprints/sportrxiv/eyxgk/ (efficacy review 2); https://osf.io/preprints/sportrxiv/mx5pv/ (efficacy review 3); PROSPERO CRD42020164641 (mixed-method review). Funding This project was funded by the National Institute for Health and Care Research (NIHR) HTA programme and will be published in full in HTA Journal; Vol. 27, No. 24. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kay Cooper
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Lyndsay Alexander
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - David Brandie
- Sportscotland Institute of Sport, Airthrey Road, Stirling, UK
| | | | - Leon Greig
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Isabelle Harrison
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Colin MacLean
- Library Services, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Laura Mitchell
- NHS Grampian, Physiotherapy Department, Ellon Health Centre, Schoolhill, Ellon, Aberdeenshire, UK
| | - Dylan Morrissey
- William Harvey Research Institute, School of Medicine and Dentistry, Queen Mary University of London, Mile End Hospital, Bancroft Road, London, UK
| | - Rachel Ann Moss
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Eva Parkinson
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | | | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Garthdee Road, Aberdeen, UK
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Merry K, MacPherson M, Vis-Dunbar M, Whittaker JL, Grävare Silbernagel K, Scott A. Identifying characteristics of resistance-based therapeutic exercise interventions for Achilles tendinopathy: A scoping review. Phys Ther Sport 2023; 63:73-94. [PMID: 37536026 DOI: 10.1016/j.ptsp.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE This scoping review describes resistance-based therapeutic exercise intervention characteristics for Achilles tendinopathy (AT) treatment (e.g., therapeutic dose, underlying mechanisms targeted by exercise) and assesses participant reporting characteristics. METHODS Seven electronic databases were searched; studies delivering a resistance exercise-focused treatment for individuals with AT were included. The Template for Intervention Description and Replication (TIDieR) and the ICON 2019 'Recommended standards for reporting participant characteristics in tendinopathy research' checklists framed data extraction, and study quality was assessed using the Mixed Methods Appraisal Tool 2018 version. RESULTS 68 publications (describing 59 studies and 72 exercise programs) were included. Results demonstrate that therapeutic exercise interventions for AT are well reported according to the TIDieR checklist, and participant characteristics are well reported according to the ICON checklist. Various underlying therapeutic mechanisms were proposed, with the most common being increasing tendon strength, increasing calf muscle strength, and enhancing collagen synthesis. CONCLUSIONS While evidence suggests that resistance-based therapeutic exercise interventions are effective in treating AT, more reporting on program fidelity, adherence, and compliance is needed. By summarizing currently published AT exercise programs and reporting key intervention characteristics in a single location, this review can assist clinicians in developing individualized resistance training programs for people with AT.
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Affiliation(s)
- Kohle Merry
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Megan MacPherson
- Virtual Health Team, Fraser Health Authority, Surrey, BC, Canada.
| | - Mathew Vis-Dunbar
- Library, The University of British Columbia, Kelowna, British Columbia, Canada.
| | - Jackie L Whittaker
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Canada, Vancouver, BC, Canada.
| | | | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
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Çil ET, Serif T, Şaylı U, Subaşı F. The effectiveness of "Dijital Steps" web based telerehabilitation system for patient with hindfoot pain: A randomised controlled trial. Foot (Edinb) 2023; 56:102040. [PMID: 37209492 DOI: 10.1016/j.foot.2023.102040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/31/2023] [Accepted: 05/06/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate and compare effective therapeutic options for hindfoot pain, develop and investigate the effectiveness of tele-rehabilitation systems, and ensure patients perform their exercises and preventive measures regularly and accurately, while monitoring results. METHODS Hindfoot pain (HP) patients (N = 77 with 120 feet) were admitted to this study and divided into two pathologies; Plantar Fasciitis and Achilles Tendinopathy. Patients in each pathology were randomized into three different rehabilitation programs-web-based telerehabilitation (PF-T & AT-T), -hands-on healing techniques combined with exercise (PF-C & AT-C)-unsupervised home exercise (PF-H & AT-H) program. Disability, activity restrictions, first-step pain, dorsiflexion-plantar flexion range of motion and kinesiophobia scores were recorded. The outcomes of the study groups were collected pre-post intervention (8thweek). Telerehabilitation system was developed via user-driven innovation and tested before using formally. RESULTS Each group had significant improvements in pain, disability, functional status and kinesiophobia (p < 0.001). In terms of functional status, PF-C had a statistically significant difference from others (p < 0.001). There was no difference between the groups for the pain scores in both pathologies. (p > 0.001). However, web-based telerehabilitation (PF-T & AT-T) were found to be more effective on kinesiophobia compared to the other groups (p < 0.001). CONCLUSIONS The presented web-based telerehabilitation system for management of hindfoot pain is an effective way and might be preferred instead of unsupervised home exercise specially for kinesiophobia. Additionally, Foot and ankle stretching and strengthening exercises protocols, myofascial releasing and mulligan concept manual therapy are effective modalities in terms of ROM, VISA-A, FAAM, FFI, TSK and VAS scores for hindfoot pain. The results indicated that three promised different rehabilitation protocols could be an effective strategy for HP.
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Affiliation(s)
- Elif Tuğçe Çil
- Yeditepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey.
| | - Tacha Serif
- Yeditepe University, Faculty of Engineering, Department of Computer Engineering, Istanbul, Turkey
| | - Uğur Şaylı
- Sonomed-OsteoAcademy Medical Center Istanbul, Turkey
| | - Feryal Subaşı
- Yeditepe University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey
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Arora NK, Sharma S, Sharma S, Arora IK. Physical modalities with eccentric exercise are no better than eccentric exercise alone in the treatment of chronic achilles tendinopathy: A systematic review and meta-analysis. Foot (Edinb) 2022; 53:101927. [PMID: 36037777 DOI: 10.1016/j.foot.2022.101927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND To investigate the available evidence and conduct a systematic review with meta-analysis to determine the effectiveness of physical modalities combined with eccentric exercise (PMEE) with eccentric exercise (EE) alone for improvements in pain and function in individuals with chronic Achilles tendinopathy (AT) at short-term (4 weeks) and long-term (12-16 weeks) follow-ups. MATERIALS AND METHODS A systematic literature review identified 8 papers (from 6404 possible inclusions) that allowed the comparison of PMEE with EE alone, in the treatment of chronic AT. We extracted the mean and standard deviations for Victorian Institute of Sports Assessment Achilles Tendinopathy (VISA-A), Numerical Pain Rating Scale (NPRS), and load-induced pain (NRS). Standardized mean difference (SMD) of the included variables was presented, and all the studies had low risk of bias. RESULTS Non-significant results were achieved for short-term (pooled SMD = 0.03; 95% CI= -0.46 to 0.53, p = 0.89, I2 = 60%) and long- term follow-ups (pooled SMD =0.43; 95% CI= -0.05 to 0.92, p = 0.08, I2 = 82%) of VISA-A. Short-term (pooled SMD = -0.16; 95% CI= -0.72 to 0.40, p = 0.57, I2 = 40%) and long-term (pooled SMD = -0.39;95% CI= -1.11 to 0.32, p = 0.28, I2 = 62%) follow-up analysis of NPRS and long-term(pooled SMD = -0.46; 95% CI= -1.08 to 0.15, p = 0.14, I2 = 74%) follow-up of load induced pain also demonstrated non-significant improvements when comparing two groups. CONCLUSION Meta- analysis of the results published in the 8 papers that met theinclusion criteria showed no significant differences between PMEE and EE, in terms of load-induced pain (NRS) and numerical pain rating scales (NPRS) at 4 and 12-16 weeks. Thus, the meta-analysis reflects the other cited published work that PMEE shows no greater advantage than EE in the treatment of Chronic Achilles Tendinopathy.
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Affiliation(s)
- Nitin Kumar Arora
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India; Hochschule fur Gesundheit Bochum, 44801, Germany
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India.
| | - Shalini Sharma
- Department of Physiotherapy, Geri Care Home, Melbourne, Victoria, Australia
| | - Ishant Kumar Arora
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, Acentral University, New Delhi, India
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Jayaseelan DJ, Sault JD, Fernandez-de-Las-Penas C. Manual therapy should not be on the sideline in the game of treating tendinopathy. J Man Manip Ther 2022; 30:309-314. [PMID: 35253631 PMCID: PMC9487951 DOI: 10.1080/10669817.2022.2047269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Tendinopathy is a common but difficult condition to manage in the orthopedic and sports settings. Despite strong evidence supporting exercise and load-management, a substantial proportion of individuals with the condition do not achieve a satisfactory long-term outcome. Tendinopathy can be associated with a number of impairments, including mobility deficits, muscle performance impairments, pain, and possible altered central pain processing - all of which are indications for manual therapy. Manual therapy has not been well described in the management of tendinopathy, even though its indications match the impairments associated with the condition. In this clinical perspective, the role of manual therapy in the management of tendinopathy is explored, with the intention of expanding possible treatment strategies for this challenging condition.
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Affiliation(s)
- Dhinu J. Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC, USA,CONTACT Dhinu J. Jayaseelan Department of Health, Human Function and Rehabilitation Sciences, The George Washington University, Washington, DC, USA
| | - Josiah D. Sault
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - Cesar Fernandez-de-Las-Penas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcon, Spain
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McDevitt AW, Cleland JA, Addison S, Calderon L, Snodgrass S. Physical Therapy Interventions for the Management of Biceps Tendinopathy: An International Delphi Study. Int J Sports Phys Ther 2022; 17:677-694. [PMID: 35693861 PMCID: PMC9159730 DOI: 10.26603/001c.35256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Shoulder pain related to the long head of the biceps tendon (LHBT) tendinopathy can be debilitating and difficult to treat especially in athletes who often elect for surgical intervention. Conservative management is recommended but there are limited established guidelines on the physical therapy (PT) management of the condition. Hypothesis/Purpose The purpose of this study was to establish consensus on conservative, non-surgical physical therapy interventions for individuals with LHBT tendinopathy using the Delphi method approach. Study Design Delphi Study. Methods Through an iterative process, experts in the PT field rated their agreement with a list of proposed treatment interventions and suggested additional interventions during each round. Agreement was measured using a four-point Likert scale. Descriptive statistics including median and percentage agreement were used to measure agreement. Data analysis at the end of Round III produced, by consensus, a list of PT interventions recommended for the management of individuals with LHBT tendinopathy. Consensus was defined as an a priori cutoff of ≥75% agreement. Results The respondent group included 29 international experts in the PT management of individuals with shoulder pain. At the conclusion of the study 61 interventions were designated as recommended based on consensus amongst experts and 9 interventions were not recommended based on the same criteria, 15 interventions did not achieve consensus. Conclusion There is a lack of well-defined, PT interventions used to treat LHBT tendinopathy. Expert respondents reached consensus on multimodal interventions including exercise, manual therapy and patient education to manage LHBT tendinopathy. Level of Evidence 5.
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Affiliation(s)
- Amy W McDevitt
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus; The University of Newcastle
| | - Joshua A Cleland
- Department of Public Health and Community Medicine, Doctor of Physical Therapy Program, Tufts University School of Medicine
| | - Simone Addison
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
| | - Leah Calderon
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus
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Burton I, McCormack A. Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:2561142. [PMID: 38655173 PMCID: PMC11023730 DOI: 10.1155/2022/2561142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/26/2022] [Accepted: 02/11/2022] [Indexed: 04/26/2024]
Abstract
The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy, (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.
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Affiliation(s)
- Ian Burton
- MSK Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, NHS Grampian, Aberdeen, UK
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Savva C, Karagiannis C, Korakakis V, Efstathiou M. The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review. J Man Manip Ther 2021; 29:276-287. [PMID: 33769226 PMCID: PMC8491707 DOI: 10.1080/10669817.2021.1904348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. Results: The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain's disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. Conclusion: Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.
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Affiliation(s)
- Christos Savva
- Department of Health Science, European University, Nicosia, Cyprus
| | | | | | - Michalis Efstathiou
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
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WALDHELM A, PUCKETT A, SCHWARZ N, GUBLER C. Effects of lower extremity rotation on muscle activity during heel-raise exercise. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Savva C, Kleitou M, Efstathiou M, Korakakis V, Stasinopoulos D, Karayiannis C. The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report. J Bodyw Mov Ther 2020; 26:214-219. [PMID: 33992247 DOI: 10.1016/j.jbmt.2020.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/08/2020] [Accepted: 08/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND/PURPOSE Cervical and thoracic spine manipulation has been found to reduce tendon pain and disability in lateral epicondylalgia and rotator cuff tendinopathy. Based on these findings, the application of lumbar spine manipulation may also provide similar improvements in Achilles tendinopathy (AT). Therefore, the purpose of this study was to evaluate the effect of lumbar spine manipulation on pain and disability in a patient experiencing AT. CASE DESCRIPTION A 44 years old male ex-football player presented with a 20-year history of persistent Achilles tendon pain (ATP) consistent with AT diagnosis. The patient attended 12 treatment sessions receiving a high-velocity, low amplitude lumbar spine manipulation. Outcome measures were collected at baseline, 2 weeks, 4 weeks, 3 months and 6 months and included pain in visual analogue scale, the American Orthopedic Foot and Ankle Score, the 36-Item Short Form Health Survey and the Victorian Institute of Sport Assessment-Achilles questionnaire. Pressure pain threshold was also assessed using an electronic pressure algometer. OUTCOMES Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation. CONCLUSION These findings have demonstrated the positive effects of lumbar spine manipulation on ATP and disability. Further studies, specifically clinical trials investigating the effect of lumbar spine manipulation or combining this technique with exercises and functional activities are suggested.
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Affiliation(s)
- Christos Savva
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.
| | - Michalis Kleitou
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
| | - Michalis Efstathiou
- Department of Life and Health Science, 46 Makedonitissas Avenue, Engomi, University of Nicosia, Cyprus
| | | | - Dimitris Stasinopoulos
- Department of Physiotherapy, 11521, Aleksandras Avenue, University of West Attica, Athens, Greece
| | - Christos Karayiannis
- Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus
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Bahari M, Hadadi M, Vosoughi AR, Kordi Yoosefinejad A, Sobhani S. Cross-cultural adaptation, reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A). Disabil Rehabil 2020; 44:983-991. [PMID: 32664757 DOI: 10.1080/09638288.2020.1781268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Achilles tendinopathy is a prevalent overuse injury among athletes and in those with a sedentary lifestyle. Current evidence indicates that the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire is a valid, reliable and disease-specific outcome measure for assessing the clinical symptoms in patients with Achilles tendinopathy. The objective of this study was to translate and cross-culturally adapt the VISA-A questionnaire into Persian (VISA-A-P) and evaluating its psychometric properties. MATERIALS AND METHODS Cultural adaptation of VISA-A-P was conducted according to Beaton's guideline. The final version of VISA-A-P was handed to 61 patients for analysis of psychometric properties. Test-retest reliability, internal consistency, concurrent validity, item-total correlation, and floor/ceiling effect were evaluated in patients with Achilles tendinopathy. To assess test-retest reliability, 35 patients refilled the VISA-A-P twice within 5-7 days. Known-group validity was evaluated using 50 healthy individuals. RESULTS VISA-A-P showed excellent test-retest reliability (ICC = 0.90), excellent internal consistency (Cronbach's alpha = 0.95), strong correlation with FAAM, and moderate to strong correlation with FAOS questionnaires. There was a significant difference between the average score of patients (34.55 ± 18.24) and the healthy group (73.1 ± 20.10). VISA-A-P showed neither ceiling nor floor effect. CONCLUSIONS The VISA-A-P is a reliable and valid instrument for measuring the symptoms in Persian speaking populations with Achilles tendinopathy.Implications for rehabilitationAchilles tendinopathy is a debilitating overuse injury that insidiously affects tendoAchilles.VISA-A-P revealed acceptable validity and reliability and it could be used by Persian speaking clinicians and researchers to assess pain and function in people with Achilles tendinopathy.
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Affiliation(s)
- Milad Bahari
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hadadi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Reza Vosoughi
- Orthopedic Foot and Ankle Surgeon, Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Kordi Yoosefinejad
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sobhan Sobhani
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Radovanović G, Wolfarth B, Legerlotz K. Interleukin‐6 levels drop after a 12 week long physiotherapeutic intervention in patients with Achilles tendinopathy—a pilot study. TRANSLATIONAL SPORTS MEDICINE 2019. [DOI: 10.1002/tsm2.95] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Goran Radovanović
- Department of Training and Movement Sciences Humboldt‐Universität zu Berlin Berlin Germany
- Department of Performance, Neuroscience, Therapy and Health Medical School Hamburg Hamburg Germany
| | - Bernd Wolfarth
- Department of Sports Medicine Humboldt-Universität zu Berlin Berlin Germany
- Charité University Medicine Berlin Germany
| | - Kirsten Legerlotz
- Department of Training and Movement Sciences Humboldt‐Universität zu Berlin Berlin Germany
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Jayaseelan DJ, Post AA, Mischke JJ, Sault JD. JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT. Int J Sports Phys Ther 2017; 12:133-143. [PMID: 28217424 PMCID: PMC5294940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND & PURPOSE Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise. CASE DESCRIPTION A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms. OUTCOMES The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up. DISCUSSION Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function. LEVEL OF EVIDENCE Therapy, Level 4.
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Affiliation(s)
- Dhinu J Jayaseelan
- The George Washington University Program in Physical Therapy, Washington, DC, USA
| | - Andrew A Post
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
| | - John J Mischke
- University of Montana, School of Physical Therapy and Rehabilitation Sciences, Missoula, MT, USA
| | - Josiah D Sault
- University of Illinois Hospital and Health Sciences System, Chicago, IL, USA
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