Silbernagel K G, Thomeé R, Thomeé P, Karlsson J
Sportrehab--Physical Therapy & Sports Medicine Clinic, Göteborg, Sweden.
Scand J Med Sci Sports. 2001 Aug;11(4):197-206. doi: 10.1034/j.1600-0838.2001.110402.x.
The purpose was to examine the reliability of measurement techniques and evaluate the effect of a treatment protocol including eccentric overload for patients with chronic pain from the Achilles tendon. Thirty-two patients with proximal achillodynia (44 involved Achilles tendons) participated in tests for reliability measures. No significant differences and strong (r=0.56-0.72) or very strong (r=0.90-0.93) correlations were found between pre-tests, except for the documentation of pain at rest (P<0.008, r=0.45). To evaluate the effect of a 12-week treatment protocol for patients with chronic proximal achillodynia (pain longer than three months) 40 patients (57 involved Achilles tendons) with a mean age of 45 years (range 19-77) were randomised into an experiment group (n=22) and a control group (n=18). Evaluations were performed after six weeks of treatment and after three and six months. The evaluations (including the pre-tests), performed by a physical therapist unaware of the group the patients belonged to, consisted of a questionnaire, a range of motion test, a jumping test, a toe-raise test, a pain on palpation test and pain evaluation during jumping, toe-raises and at rest. A follow-up was also performed after one year. There were no significant differences between groups at any of the evaluations, except that the experiment group jumped significantly lower than the control group at the six-week evaluation. There was, however, an overall better result for the experiment group with significant improvements in plantar flexion, and reduction in pain on palpation, number of patients having pain during walking, having periods when asymptomatic and having swollen Achilles tendon. The controls did not show such changes. Furthermore, at the one-year follow-up there were significantly more patients in the experiment group, compared with the control group, that were satisfied with their present physical activity level, considered themselves fully recovered, and had no pain during or after physical activity. The measurement techniques and the treatment protocol with eccentric overload used in the present study can be recommended for patients with chronic pain from the Achilles tendon.
目的是检验测量技术的可靠性,并评估一种包括离心超负荷的治疗方案对跟腱慢性疼痛患者的效果。32例近端跟腱痛患者(44条受累跟腱)参与了可靠性测量测试。除静息痛记录外(P<0.008,r=0.45),预测试之间未发现显著差异,且相关性较强(r=0.56 - 0.72)或非常强(r=0.90 - 0.93)。为评估针对慢性近端跟腱痛(疼痛超过三个月)患者的12周治疗方案的效果,将40例平均年龄45岁(范围19 - 77岁)的患者(57条受累跟腱)随机分为实验组(n = 22)和对照组(n = 18)。在治疗六周后以及三个月和六个月后进行评估。由不了解患者所属组别的物理治疗师进行的评估(包括预测试)包括一份问卷、一系列运动测试、跳跃测试、提踵测试、触诊疼痛测试以及跳跃、提踵和静息时的疼痛评估。一年后也进行了随访。除在六周评估时实验组跳跃高度显著低于对照组外,各评估组间均无显著差异。然而,实验组总体结果更好,在跖屈方面有显著改善,触诊疼痛减轻,行走时疼痛的患者数量减少,无症状期增加,跟腱肿胀减轻。对照组未出现此类变化。此外,在一年随访时,与对照组相比,实验组中有更多患者对其当前身体活动水平满意,认为自己已完全康复,且在身体活动期间或之后无疼痛。本研究中使用的测量技术和离心超负荷治疗方案可推荐用于跟腱慢性疼痛患者。