著者: Xan F Courville, Marcus P Coe, Paul J Hecht
雑誌名: Foot Ankle Int. 2009 Nov;30(11):1132-42. doi: 10.3113/FAI.2009.1132.
Abstract/Text
PMID
19912730 Foot Ankle Int. 2009 Nov;30(11):1132-42. doi: 10.3113/F･･･
著者: Jean-François Kaux, Bénédicte Forthomme, Caroline Le Goff, Jean-Michel Crielaard, Jean-Louis Croisier
雑誌名: J Sports Sci Med. 2011 Jun 1;10(2):238-53. Epub 2011 Jun 1.
Abstract/Text
Tendinopathy is characterized by pain in the tendon and impaired performance sometimes associated with swelling of the tendon. Its diagnosis is usually clinical but ultrasonography and magnetic resonance imaging can refine the diagnosis. Tendinopathy is highly prevalent and is one of the most frequently self reported musculoskeletal diseases in physical workers and sports people. Nevertheless, it is very difficult to carry out general epidemiologic studies on tendinopathy because of the varying sports cultures and sports habits in different countries. The aetiology of tendinopathy seems to be multi-factorial, involving intrinsic and extrinsic factors. The role of inflammation is still debated but the absence of inflammatory cells does not mean that inflammatory mediators are not implicated. Different theories have been advanced to explain pain and chronicity mechanisms, but these mechanisms remain largely unknown. "Conventional "treatments are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are not completely satisfactory and the recurrence of symptoms is common. Currently, eccentric training remains the treatment of choice for tendinopathy, even though some studies are contradictory. Moreover, many interesting new treatments are now being developed to treat tendinopathy, but there is little evidence to support their use in clinical practice. Key pointsThe word "tendinopathy "is the correct term for the clinical diagnosis of pain accompanied by impaired performance, and sometimes swelling in the tendon.The aetiology of tendinopathy seems to be a multi-factorial process, involving promoting factors that are intrinsic or extrinsic, working either alone or in combination.US (with color Doppler) and MRI are usually prescribed when tendinopathy is unresponsive to treatment and entails lingering symptoms.Eccentric training is currently considered to be the most efficient treatment for tendinopathy; nevertheless, in order to be effective, this treatment needs specific modalities: slow speed, low intensity and gradual intensification, with minimum 20 to 30 sessions of exercises often being needed.Many interesting new treatments are now being developed to treat tendinopathy, but currently there is little evidence to support their use in clinical practice.
PMID
24149868 J Sports Sci Med. 2011 Jun 1;10(2):238-53. Epub 2011 Ju･･･
著者: D B Clement, J E Taunton, G W Smart
雑誌名: Am J Sports Med. 1984 May-Jun;12(3):179-84.
Abstract/Text
One hundred nine runners were treated conservatively without immobilization for overuse injury to the Achilles tendon. Treatment strategies were directed toward rehabilitation of the gastrocnemius/soleus muscle-tendon unit, control of inflammation and pain, and control of biomechanical parameters. One fair, 12 good, and 73 excellent results were reported, with a mean recovery time of 5 weeks. Followup was incomplete in 23 cases. The three most prevalent etiological factors were overtraining (82 cases), functional overpronation (61 cases), and gastrocnemius/soleus insufficiency (41 cases). The authors speculate that runners are susceptible to Achilles tendinitis with peritendinitis due to microtrauma produced by the eccentric loading of fatigued muscle, excess pronation producing whipping action of the Achilles tendon, and/or vascular blanching of the Achilles tendon produced by conflicting internal and external rotatory forces imparted to the tibia by simultaneous pronation and knee extension. Virtually all cases of Achilles tendon injury appear to result from structural or dynamic disturbances in normal lower leg mechanics and require active treatment regimens which attempt to establish normal function to prevent recurrence.
PMID
6742297 Am J Sports Med. 1984 May-Jun;12(3):179-84.
著者: Timothy P C Kane, Muhammad Ismail, James D F Calder
雑誌名: Am J Sports Med. 2008 Jun;36(6):1160-3. doi: 10.1177/0363546508314423. Epub 2008 Mar 21.
Abstract/Text
BACKGROUND: Topical glyceryl trinitrate (GTN) therapy has been advocated in the treatment of Achilles tendinopathy. The mechanism of action is unknown but may be related to modulation of local nitric oxide levels.
HYPOTHESIS: Topical GTN therapy for noninsertional Achilles tendinopathy will significantly enhance clinical improvement and will be associated with increased collagen synthesis within the tendon.
STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1.
METHODS: Forty patients were recruited. Twenty underwent standard nonoperative physical therapy, and 20 underwent physical therapy and topical GTN daily. Clinical outcome was assessed using the Ankle Osteoarthritis Scale (AOS) visual analog score. Patients who failed to improve with conservative measures and who underwent surgical decompression had histological and immunohistochemical examination of samples from the Achilles tendon.
RESULTS: Glyceryl trinitrate did not offer any additional clinical benefit over standard nonoperative treatment for noninsertional Achilles tendinopathy. After 6 months of treatment, there was no significant difference in scores between the groups for pain (3.0 vs 3.1, P = .42) or disability (2.15 vs 2.25, P = .38). Histological examination did not show any difference in neovascularization, collagen synthesis, or stimulated fibroblasts between the 2 groups. There was no evidence of modulation of nitric oxide synthase, a marker of nitric oxide production, in those tendons treated with GTN.
CONCLUSION AND CLINICAL RELEVANCE: This study has failed to support the clinical benefit of GTN patches previously described in the literature. In the available tissue samples, there did not appear to be any histological or immunohistochemical change in Achilles tendinopathy treated with GTN compared with those undergoing standard nonoperative therapy.
PMID
18359821 Am J Sports Med. 2008 Jun;36(6):1160-3. doi: 10.1177/03･･･
著者: Sethu Mani-Babu, Dylan Morrissey, Charlotte Waugh, Hazel Screen, Christian Barton
雑誌名: Am J Sports Med. 2015 Mar;43(3):752-61. doi: 10.1177/0363546514531911. Epub 2014 May 9.
Abstract/Text
BACKGROUND: There is accumulating evidence for the effectiveness of extracorporeal shock wave therapy (ESWT) when treating lower limb tendinopathies including greater trochanteric pain syndrome (GTPS), patellar tendinopathy (PT), and Achilles tendinopathy (AT).
PURPOSE: To evaluate the effectiveness of ESWT for lower limb tendinopathies.
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: PubMed (Medline), Embase, Web of Knowledge, Cochrane, and CINAHL were searched from inception to February 2013 for studies of any design investigating the effectiveness of ESWT in GTPS, PT, and AT. Citation tracking was performed using PubMed and Google Scholar. Animal and non-English language studies were excluded. A quality assessment was performed by 2 independent reviewers, and effect size calculations were computed when sufficient data were provided.
RESULTS: A total of 20 studies were identified, with 13 providing sufficient data to compute effect size calculations. The energy level, number of impulses, number of sessions, and use of a local anesthetic varied between studies. Additionally, current evidence is limited by low participant numbers and a number of methodological weaknesses including inadequate randomization. Moderate evidence indicates that ESWT is more effective than home training and corticosteroid injection in the short (<12 months) and long (>12 months) term for GTPS. Limited evidence indicates that ESWT is more effective than alternative nonoperative treatments including nonsteroidal anti-inflammatory drugs, physical therapy, and an exercise program and equal to patellar tenotomy surgery in the long term for PT. Moderate evidence indicates that ESWT is more effective than eccentric loading for insertional AT and equal to eccentric loading for midportion AT in the short term. Additionally, there is moderate evidence that combining ESWT and eccentric loading in midportion AT may produce superior outcomes to eccentric loading alone.
CONCLUSION: Extracorporeal shock wave therapy is an effective intervention and should be considered for GTPS, PT, and AT particularly when other nonoperative treatments have failed.
© 2014 The Author(s).
PMID
24817008 Am J Sports Med. 2015 Mar;43(3):752-61. doi: 10.1177/03･･･
