Desequilíbrios musculares entre flexores dorsais e plantares do tornozelo após tratamento conservador e acelerado da ruptura do tendão calcâneo

Resistance Exercises in Early Functional Rehabilitation for Achilles Tendon Ruptures Are Poorly Described: A Scoping Review

OBJECTIVES

To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions.

DESIGN

Scoping review.

LITERATURE SEARCH

We searched the MEDLINE, Embase, CINAHL, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases.

STUDY SELECTION CRITERIA

Randomized controlled trials, cohort studies, and case series (10 or more participants) that reported using resistance exercise in the immobilization period in the first 8 weeks of treatment for acute Achilles tendon rupture were included.

DATA SYNTHESIS

Completeness of exercise description was assessed with the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier exercise descriptor framework.

RESULTS

Thirty-eight studies were included. Fifty-one resistance exercises were extracted and categorized as isometric exercises (n = 20), heel raises (n = 6), strengthening with external resistance (n = 13), or unspecified (n = 12). A median of 8 (interquartile range, 6-10) of a possible 19 CERT items was reported. The amount of items described of the 13 Toigo and and Boutellier exercise descriptors ranged from 0 to 11.

CONCLUSION

A variety of resistance exercises targeted at the ankle plantar flexors were used as part of early functional rehabilitation after Achilles tendon rupture. However, most studies provided inadequate description of resistance exercise interventions. J Orthop Sports Phys Ther 2020;50(12):681-691. Epub 23 Oct 2020. doi:10.2519/jospt.2020.9463.

Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review

BACKGROUND

Early functional rehabilitation is frequently discussed in treating Achilles tendon rupture. A consistent definition of what constitutes early functional rehabilitation has not been established across the literature, despite studies supporting its efficacy. A standardized definition would be helpful to pool data across studies, allow for between-study comparisons, and ultimately work toward developing clinical guidelines.

PURPOSE

To define early functional rehabilitation (including when it is initiated and what it entails) when used to treat Achilles tendon rupture and to identify outcome measures for evaluating the effect of treatment.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

Ovid MEDLINE, EMBASE, PEDro, CINAHL, and Cochrane databases were searched for relevant studies. Eligibility criteria for selecting studies consisted of randomized controlled trials, cohort studies, and case series (≥10 participants) including weightbearing or exercise-based interventions within 8 weeks after Achilles tendon rupture.

RESULTS

A total of 174 studies published between 1979 and 2018 were included. Studies were rated a median (interquartile range [IQR]) of 17 (15-20) on the Downs & Black checklist and included 9098 participants. Early functional rehabilitation incorporated weightbearing (95%), range of motion (73%), and isometric/strengthening exercises (50%). Weightbearing was initiated within the first week, whereas exercise (eg, ankle range of motion, strengthening, whole-body conditioning) was initiated in the second week. Initiation of exercises varied based on whether treatment was nonsurgical (mean, 3.0 weeks; IQR, 2.0-4.0 weeks) or simple (mean, 2.0 weeks; IQR, 0.0-2.3 weeks) or augmented surgical repair (mean, 0.5 weeks; IQR, 0.0-2.8 weeks) (P = .017). Functional outcomes including ankle range of motion (n = 84) and strength (n = 76) were reported in 130 studies. Other outcome domains included patient-reported outcomes (n = 89), survey-based functional outcomes (n = 50), and tendon properties (n = 53).

CONCLUSION

Early functional rehabilitation includes weightbearing and a variety of exercise-based interventions initiated within the first 2 weeks after acute Achilles tendon rupture/repair. Because early functional rehabilitation has lacked a standardized definition, interventions and outcome measures are highly variable, and pooling data across studies should be done with attention paid to what was included in the intervention and how treatment was assessed.

Efeitos das Correntes diadinâmicas de Bernard sobre a nociceptividade e edema no trauma tendíneo de ratos

INTRODUÇÃO: O tratamento fisioterapêutico é utilizado para minimizar prejuízos do processo inflamatório. Destaca-se o uso da eletroterapia, sendo as Correntes diadinâmicas de Bernard (CDB) um dos recursos possíveis, porém com poucas evidências na literatura. OBJETIVO: Analisar os efeitos das CDB sobre a nociceptividade e edema no trauma tendíneo de ratos. MATERIAIS E MÉTODOS: A amostra foi composta por 18 ratos Wistar, divididos em: grupo controle (GC); grupo do polo negativo (GP-); e grupo do polo positivo (GP+). Os animais tiveram seu tendão calcâneo direito, traumatizado com energia de 0,4 J. Para avaliar a nociceptividade, utilizou-se o analgesímetro digital tipo "Von Frey", o qual se aplicou no tendão lesado. E para avaliar o edema utilizou-se um paquímetro. O tratamento foi realizado com as correntes DF, CP e LP (3 minutos cada), diariamente, em cindo sessões de terapia. RESULTADOS: Na avaliação da nociceptividade, houve diferença significativa com o momento pós-lesão, somente nas duas últimas avaliações no GP+. Na avaliação do edema obteve-se retorno aos valores basais apenas para GP+. CONCLUSÃO: Somente o polo positivo das diadinâmicas de Bernard foi eficaz em diminuir a nociceptividade e o edema em ratos submetidos a trauma no tendão de calcâneo.