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Vol. 53. Issue 197.
Pages 19-27 (January 2018)
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Vol. 53. Issue 197.
Pages 19-27 (January 2018)
Gestió de la càrrega en la tendinopatia: progressió clínica de les tendinopaties d’Aquil·les i rotular
Load management in tendinopathy: Clinical progression for Achilles and patellar tendinopathy
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Alfons Mascaróa, Miquel Àngel Cosb, Antoni Morralc, Andreu Roigb, Craig Purdamd, Jill Cooke
a Facultat d??Infermeria i Fisioteràpia, Universitat de Lleida, Lleida, Espanya
b Centre d??Alt Rendiment (CAR), Sant Cugat del Vallès, Barcelona, Espanya
c Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Espanya d Australian Institute of Sport, Canberra, Austràlia
d Australian Institute of Sport, Canberra, Austràlia
e Faculty of Health Sciences, La Trobe University, Victoria, Austràlia
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Sovint la tendinopatia afecta els tendons d’Aquil·les i rotular. Les lesions d’aquests tendons poden afectar severament les activitats esportives, recreatives i de la vida diària. A les dues darreres dècades, els exercicis excèntrics han esdevingut la intervenció conservadora principal per tractar les tendinopaties d’Aquil·les i rotular. Els exercicis excèntrics poden no ser efectius per a tots els pacients afectats per tendinopaties (esportistes i no esportistes). És possible que, en els esportistes, la càrrega que genera el treball excèntric sobre el múscul i el tendó sigui insuficient. Un programa de rehabilitació que tingui per objectiu augmentar la tolerància del tendó a la càrrega ha d’incloure, òbviament, exercicis de força, però també ha d’afegir exercicis de velocitat i exercicis que augmentin la capacitat d’emmagatzemar i alliberar energia. Aquest article presenta un protocol de rehabilitació de les tendinopaties d’Aquil·les i rotular. Consisteix en exercicis simples i pràctics dissenyats per incorporar càrrega progressiva al tendó: mitjançant treball isomètric, força, força funcional, velocitat i exercicis pliomètrics que augmenten la capacitat d’emmagatzemar i alliberar energia del tendó. Aquest treball és el primer pas per dissenyar un assaig clínic aleatoritzat i multicèntric que permeti valorar-ne l’eficàcia.

Palabras clave:
Tendinopatia; Tendinopatia d??Aquil·les; Tendinopatia rotular; Exercici; Càrrega; Teràpia física

Achilles and patellar tendons are commonly affected by tendinopathy. Injury to these tendons can severely impact upon sports, recreational and everyday activities. Eccentric musculotendinous loading has become the dominant conservative intervention strategy for Achilles and patellar tendinopathy over the last two decades. Eccentric loading involves isolated, slow lengthening muscle contractions. Systematic reviews have evaluated the evidence for eccentric muscle loading in Achilles and patellar tendinopathy, concluding that outcomes are promising but high-quality evidence is lacking. Eccentric loading may not be effective for all patients (athletes and non-athletes) affected by tendinopathy. It is possible that in athletes, eccentric work is an inadequate load on the muscle and tendon. A rehabilitation program aiming to increase tendon load tolerance must obviously include strength exercises, but should also add speed and energy storage and release. The aim of this paper is to document a rehabilitation protocol for Achilles and patellar tendinopathy. It consists of simple and pragmatic exercises designed to incorporate progressive load to the tendon: isometric work, strength, functional strength, speed and jumping exercises to adapt the tendon to the ability to store and release energy. This article would be the first step for an upcoming multicentre randomized controlled trial to investigate its efficacy.

Keywords:
Tendinopathy; Achilles; Patellar; Exercise; Load; Physical therapy

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