Department of Orthopedics, University Hospital RWTH Aachen, Aachen, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany.
Sports Health. 2020 Jul/Aug;12(4):373-381. doi: 10.1177/1941738119893996. Epub 2020 Jan 31.
Apart from eccentric exercises (EE), isometric exercises (ISO) might be a treatment option for Achilles tendinopathy. Shear wave elastography (SWE) provides information for diagnosis and for monitoring tissue elasticity, which is altered in symptomatic tendons.
Isometric exercises will have a beneficial effect on patients' outcome scores. Based on SWE, insertional and midportion tendon parts will differ in their elastic properties according to current symptoms.
Randomized clinical trial.
Level 2.
Group 1 (EE; n = 20; 12 males, 8 females; mean age, 52 ± 8.98 years) and group 2 (EE + ISO; n = 22; 15 males, 7 females; mean age, 47 ± 15.11 years) performed exercises for 3 months. Measurement points were before exercises were initiated as well as after 1 and 3 months using the Victorian Institute of Sports Assessment-Achilles (VISA-A) score, American Orthopaedic Foot & Ankle Society score, and SWE (insertion and midportion).
Both groups improved significantly, but there were no significant interindividual differences (VISA-A; = 0.362) between group 1 (n = 15; +15 VISA-A) and group 2 (n = 15; +15 VISA-A). The symptomatic insertion (symptomatic, 136.89 kPa; asymptomatic, 174.68 kPa; = 0.045) and the symptomatic midportion of the Achilles tendon (symptomatic, 184.40 kPa; asymptomatic, 215.41 kPa; = 0.039) had significantly lower Young modulus compared with the asymptomatic tendons. The midportion location had significantly higher Young modulus than the insertional part of the tendon ( = 0.005).
Isometric exercises do not have additional benefit when combined with eccentric exercises, as assessed over a 3-month intervention period. SWE is able to distinguish between insertional and midportion tendon parts in a symptomatic and asymptomatic state.
The present study shows no additional effect of ISO when added to baseline EE in treating Achilles tendinopathy. Different elastic properties of the insertional and midportion tendon have to be taken into consideration when rating a tendon as pathologic.
除了离心运动（EE）之外，等长运动（ISO）可能是治疗跟腱病的一种选择。剪切波弹性成像（SWE）提供了诊断和监测组织弹性的信息，而在有症状的跟腱中，组织弹性会发生改变。
等长运动将对患者的结果评分产生有益的影响。根据 SWE，根据当前症状，插入部和中部跟腱的弹性特性会有所不同。
随机临床试验。
2 级。
第 1 组（EE；n = 20；12 名男性，8 名女性；平均年龄 52 ± 8.98 岁）和第 2 组（EE + ISO；n = 22；15 名男性，7 名女性；平均年龄 47 ± 15.11 岁）进行了 3 个月的运动。测量点是在开始运动之前以及 1 个月和 3 个月后进行，使用维多利亚运动评估-跟腱（VISA-A）评分、美国矫形足踝协会（AOFAS）评分和 SWE（插入部和中部）进行测量。
两组均有显著改善，但组间无显著差异（VISA-A；= 0.362），第 1 组（n = 15；增加 15 分 VISA-A）和第 2 组（n = 15；增加 15 分 VISA-A）。症状插入部（症状，136.89 kPa；无症状，174.68 kPa；= 0.045）和症状中部跟腱（症状，184.40 kPa；无症状，215.41 kPa；= 0.039）的杨氏模量明显低于无症状跟腱。中部位置的杨氏模量明显高于腱插入部（= 0.005）。
在 3 个月的干预期间，与单独使用离心运动相比，等长运动结合使用并没有额外的益处。SWE 能够区分有症状和无症状状态下的插入部和中部跟腱。
本研究表明，在治疗跟腱病时，添加 ISO 并不能增强基线 EE 的效果。在评估跟腱为病理性时，必须考虑插入部和中部跟腱的不同弹性特性。
