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Vol. 53. Issue 197.
Pages 19-27 (January - March 2018)
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Vol. 53. Issue 197.
Pages 19-27 (January - March 2018)
Original article
Load management in tendinopathy: Clinical progression for Achilles and patellar tendinopathy
Gestión de la carga en las tendinopatías: progresión clínica para tendinopatías de Aquiles y rotuliana
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Alfons Mascaróa,
Corresponding author
amascaro.crb@telefonica.net

Corresponding author.
, Miquel Àngel Cosb, Antoni Morralc, Andreu Roigb, Craig Purdamd, Jill Cooke
a Faculty of Physical Therapy, Lleida University, Lleida, Spain
b High Performance Centre (CAR) Sant Cugat, Barcelona, Spain
c Blanquerna School of Health Science, Ramon Llull University, Barcelona, Spain
d Australian Institute of Sport, Canberra, Australia
e Faculty of Health Sciences, La Trobe University, Victoria, Australia
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Figures (1)
Tables (3)
Table 1. Treatments and considerations for different tendinopathy stages.27
Table 2. Numeric pain scale and its correlation with training intensity.
Table 3. Example daily monitoring and evolution of pain.
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Additional material (1)
Abstract

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
Resumen

Las tendinopatías de Aquiles y rotuliana son muy frecuentes. Las lesiones en estos tendones pueden afectar severamente a las actividades deportivas, recreativas y cotidianas. En las últimas 2 décadas, los ejercicios excéntricos se han convertido en la principal intervención conservadora para tratar las tendinopatías de Aquiles y rotuliana. Los ejercicios excéntricos no son efectivos en todos los pacientes afectados por tendinopatías (atletas y no atletas). Es posible que en atletas, la carga que genera el trabajo excéntrico sobre el músculo y el tendón sea insuficiente. Un programa de rehabilitación que tenga por objetivo aumentar la tolerancia del tendón a la carga debe, obviamente, incluir ejercicios de fuerza, pero también debe agregar ejercicios de velocidad y ejercicios que aumenten la capacidad para almacenar y liberar energía. Este trabajo muestra un protocolo de rehabilitación para las tendinopatías de Aquiles y rotuliana. Consiste en ejercicios simples y pragmáticos diseñados para incorporar carga progresiva al tendón: mediante trabajo isométrico, fuerza, fuerza funcional, velocidad y ejercicios pliométricos que aumenten en el tendón la capacidad de almacenar y liberar energía. Este trabajo es el primer paso para diseñar un ensayo clínico aleatorizado y multicéntrico que permita evaluar su eficacia.

Palabras clave:
Tendinopatía
Aquiles
Rotuliana
Ejercicio
Carga
Terapia física

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