Eckenrode Brian J, Stackhouse Scott K
Arcadia University, Department of Physical Therapy, Glenside, PA.
Int J Sports Phys Ther. 2015 Jun;10(3):354-62.
Achilles tendinopathy is a common overuse injury sustained by athletes including runners. The use of noxious electrical stimulation for the treatment of chronic tendinopathies is a novel treatment intervention, which may alter pain perception and serve as adjunct technique in the recovery of painfree function. The purpose of this case report is to demonstrate the use of noxious electrical stimulation for the treatment of chronic, bilateral Achilles tendinopathy that was resistant to conservative treatment using plantarflexor eccentric exercise.
A 27-year old male runner was referred to physical therapy with a 7-year history of bilateral Achilles tendinopathy. He scored a 73/80 on the Lower Extremity Functional Scale (LEFS) and a 64% on the Victorian Institute of Sports Assessment-Achilles (VISA-A). Pain pressure threshold testing of the Achilles tendon was performed, followed by a single session of noxious electric stimulation to bilateral Achilles tendons, and the subject was instructed to continue with eccentric gastroc-soleus complex strengthening as previously performed.
Pain pressure threshold testing was performed to the mid-portion of the posterior Achilles tendon. The left Achilles tendon mean was 10.50kg and right Achilles tendon was 8.33kg prior to the noxious stimulation intervention. Twenty-four hours after the noxious stimulation treatment, improvements in mean pain threshold testing were found for both the left (16.31kg) and right (12.36kg) Achilles tendons. At one month after the physical therapy noxious stimulation session, the subject was able to progress his workouts to include sprints and interval training. His LEFS improved to 76/80 and his VISA-A improved to 96%.
The case illustrates the successful pain reduction and return to progressive sports activity in a runner with chronic Achilles tendinopathy. The utilization of noxious electric stimulation may have altered the pain perception of the nervous system as evidenced by the improvement in pain pressure threshold testing. Future studies on the application of noxious electric stimulation on chronic Achilles tendinopathy may help support the benefit of this intervention on pain and function.
Therapy, Level 4.
跟腱病是包括跑步者在内的运动员常见的过度使用损伤。使用有害电刺激治疗慢性肌腱病是一种新型治疗干预措施，它可能会改变疼痛感知，并作为无痛功能恢复的辅助技术。本病例报告的目的是展示使用有害电刺激治疗慢性双侧跟腱病，这种跟腱病对使用跖屈离心运动的保守治疗有抵抗性。
一名27岁的男性跑步者因双侧跟腱病7年病史被转诊至物理治疗。他在下肢功能量表（LEFS）上得分为73/80，在维多利亚运动评估-跟腱（VISA-A）上得分为64%。对跟腱进行了疼痛压力阈值测试，随后对双侧跟腱进行了单次有害电刺激，并且指示该受试者继续像之前那样进行腓肠肌-比目鱼肌复合体的离心强化训练。
对跟腱后部中间部分进行了疼痛压力阈值测试。在有害刺激干预前，左侧跟腱平均值为10.50千克，右侧跟腱为8.33千克。有害刺激治疗24小时后，左侧（16.31千克）和右侧（12.36千克）跟腱的平均疼痛阈值测试均有改善。在物理治疗有害刺激疗程后一个月，该受试者能够将其训练进展到包括短跑和间歇训练。他的LEFS提高到76/80，VISA-A提高到96%。
该病例说明了一名患有慢性跟腱病的跑步者成功减轻疼痛并恢复到渐进性体育活动。有害电刺激的使用可能改变了神经系统的疼痛感知，疼痛压力阈值测试的改善证明了这一点。未来关于有害电刺激应用于慢性跟腱病的研究可能有助于支持这种干预对疼痛和功能的益处。
治疗，4级。
