A 3-Arm Randomized Trial for Achilles Tendinopathy: Eccentric Training, Eccentric Training Plus a Dietary Supplement Containing Mucopolysaccharides, or Passive Stretching Plus a Dietary Supplement Containing Mucopolysaccharides

Abstract

BackgroundTendinopathy is an overuse tendon injury that occurs in loaded tendons and results in pain and functional impairment. Although many treatments for painful tendons are described, the scientific evidence for most of the conservative and surgical treatments is not always conclusive.ObjectivesThis study was designed to evaluate the efficacy of 3 different interventions in patients with Achilles tendinopathy. The interventions include the combination of 2 physical therapy programs (eccentric training [EC] or passive stretching [PS]) with a supplement containing mucopolisaccharides. The efficacy of the interventions was evaluated depending on the stage of the disease.MethodsFifty-nine patients were randomly assigned to 1 of 3 treatment groups, and classified according to the disease stage: reactive versus degenerative tendinopathy. Treatment groups were EC; EC + a dietary supplement containing mucopolisaccharides, type I collagen, and vitamin C (MCVC); and a passive stretching program + MCVC. Patients were evaluated at baseline, 6 weeks, and 12 weeks with the Victorian Institute of Sports Assessment-Achilles questionnaire for function, a visual analog scale for pain, and ultrasound characterization for the evolution of tendon structure.ResultsA significant improvement in Victorian Institute of Sports Assessment-Achilles questionnaire score, pain at rest, and pain during activity were detected in all 3 treatment groups at 6 and 12 weeks’ follow-up when compared with baseline. In patients with reactive tendinopathy, the reduction in pain at rest was greater in the groups who took the supplemental MCVC than in the EC alone group (P < 0.05).ConclusionsMCVC seems to be therapeutically useful for management of tendinopathies, providing some additional benefit to physical therapy. This is especially evident in early stages of the disease, when the tendon does not present severe matrix and vascular changes.ClinicalTrials.gov identifierNCT01691716.

Fortalecimento Muscular Excêntrico No Tratamento Da Tendinopatia De Aquiles: Uma Revisão Sistemática

“…Em pelo menos um dos grupo foi realizado o EFE, e todos os estudos obtiveram pontuação superior a 6 na escala de qualidade PEDro com média de 7. Todos os estudo cumpriram com os critérios 10 e 11 referentes as informações metodológicas estatísticas, no entanto falharam em critérios de validade interna como Alocação aleatória 39 , similaridade no início do tratamento 40 , acompanhamento apropriado 41,42 e análise por intuito de tratar 43,44 . Todos os estudos fracassaram em pelo menos um critério de cegueira, critérios 5, 6 e 7.…”

“…Quanto a estrutura do tendão lesionado, três estudos 39,41,43 avaliaram a morfologia do tendão e apenas um 39 não observou alterações significativas. Esses resultados podem ser explicados pelo fato do EFE afetar principalmente a atividade metabólica dos fibroblastos com maior produção e deposição ordenada de fibras de colágeno do tipo 1 e redução do fluido intratendíneo o que facilita a remodelação tecidual, como resultado tem-se um tendão mais propicio a suportar e transferir cargas 29,50 .…”

“…Vale ressaltar conforme observado nos estudos 39,41,46 que a associação do EFE com outras modalidades potencializou os efeitos do tratamento. Os estudos apontam que a dor característica da TA é decorrente…”

Healing of Achilles tendon partial tear following focused shockwave: a case report and literature review

“…Recently, many reports focused on eccentric training4,5 and other treatments like thermal and electrical therapies, massage techniques, steroid injections, and instillation of platelet-rich plasma have all been described as potentially useful non-operative interventions 6…”

Healing of Achilles Tendon Partial Tear Following Focused Shockwave: A Case Report and Literature Review

“…3 Recently, many reports focused on eccentric training 4,5 and other treatments like thermal and electrical therapies, massage techniques, steroid injections, and instillation of platelet-rich plasma have all been described as potentially useful non-operative interventions. 6 Extracorporeal shockwave therapy (ESWT) has been widely used for the treatment of calcific lesions and tendinopathy in recent years.…”