Head John, Mallows Adrian, Debenham James, Travers Mervyn J, Allen Lorraine
School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, Essex, UK.
School of Physiotherapy, The University of Notre Dame, Fremantle, WA, Australia.
Musculoskeletal Care. 2019 Dec;17(4):283-299. doi: 10.1002/msc.1428. Epub 2019 Nov 25.
Achilles tendinopathy is a common type of overuse condition, with isolated eccentric loading (ECL) programmes being the principal conservative treatment of choice. However, alternative protocols, involving different contraction types, have more recently been investigated. The purpose of the present review was to examine the evidence from studies comparing two or more different types of loading programmes in relation to patient-reported outcomes for people with Achilles tendinopathy.
A systematic review was undertaken, and the risk of bias of included papers were assessed using the Cochrane Risk of Bias tool. An electronic search of CINAHL, MEDLINE, Embase and SPORTDiscus was undertaken from their inception to May 2018. The eligibility criteria for selecting studies were randomized controlled or clinical controlled trials investigating two or more different loading programmes for chronic (>3 months) Achilles tendinopathy.
Seven articles were included in the review. Low-quality evidence exists that a do-as-tolerated modification of the Alfredson programme is more effective than the standardized programme at improving function in the short term. Very-low-quality evidence suggests that ECL is superior at reducing pain levels than concentric in isolation, but no more effective at improving pain or disability than concentric-eccentric programmes.
There is conflicting evidence regarding the superiority of ECL over other contraction types, challenging the current approach to managing Achilles tendinopathy. There is also evidence that do-as-tolerated repetition volumes are more effective at improving function in the short term compared with those recommended by the standardized Alfredson protocol.
跟腱病是一种常见的过度使用性疾病，单独的离心负荷（ECL）训练方案是主要的保守治疗选择。然而，最近人们对涉及不同收缩类型的替代方案进行了研究。本综述的目的是研究比较两种或更多不同类型负荷训练方案对跟腱病患者报告结局影响的研究证据。
进行了一项系统综述，并使用Cochrane偏倚风险工具评估纳入论文的偏倚风险。对CINAHL、MEDLINE、Embase和SPORTDiscus进行了从其创建到2018年5月的电子检索。选择研究的纳入标准是针对慢性（>3个月）跟腱病研究两种或更多不同负荷训练方案的随机对照试验或临床对照试验。
该综述纳入了7篇文章。存在低质量证据表明，阿尔弗雷德森方案的耐受量调整在短期内改善功能方面比标准化方案更有效。极低质量证据表明，单独的离心负荷在降低疼痛水平方面优于向心收缩，但在改善疼痛或功能障碍方面并不比向心-离心训练方案更有效。
关于离心负荷相对于其他收缩类型的优越性存在相互矛盾的证据，这对目前跟腱病的治疗方法提出了挑战。也有证据表明，与标准化阿尔弗雷德森方案推荐的重复量相比，耐受量重复量在短期内改善功能方面更有效。
