Crowley Liam, Vallance Patrick, Clark Ross, Perraton Luke, Garofolini Alessandro, Malliaras Peter
Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia; Physio and Fitness Clinic, Melbourne, Australia.
Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia; Physio and Fitness Clinic, Melbourne, Australia.
Musculoskelet Sci Pract. 2022 Dec;62:102671. doi: 10.1016/j.msksp.2022.102671. Epub 2022 Oct 4.
Insertional Achilles tendinopathy (IAT) is a common and painful musculoskeletal condition. The management of IAT commonly involves strengthening of the plantarflexors, although there is currently a paucity of research investigating plantarflexor neuromuscular performance specific to people with IAT.
To compare plantarflexor neuromuscular performance between men with IAT and controls, and to investigate the relationship between plantarflexor neuromuscular performance and patient reported outcome measures for men with IAT.
Case control.
34 men with IAT (age 43.7 years [SD 10.02], weight 89.6 kg [16.3]) were matched with 34 healthy men (age 42.8 years [SD 8.9], weight 87.2 kg [9.7]). Participants underwent a plantarflexion maximal voluntary isometric contraction (MVIC) task, and a target force matching task. Neuromuscular variables from these tasks include; MVIC, rate of torque development (RTD), electromechanical delay (EMD), and muscle force steadiness. Participants also completed questionnaires regarding; pain and function, and psychological factors.
The IAT group had reduced MVIC (p < 0.01) and RTD, (p < 0.01) compared to controls, however no significant difference in plantarflexor force steadiness (p = 0.08), or EMD (p = 0.71) was observed. Low strength correlations were detected between the VISA-A and RTD (r = 0.37, p = 0.04), kinesiophobia and EMD (r = 0.45, p = 0.03).
This study established impairments in plantarflexor strength and RTD among people with IAT. Plantarflexor force steadiness and EMD is not altered in IAT, which is in contrast to evidence from mid-portion Achilles tendinopathy. Plantarflexor RTD was the only neuromuscular outcome measure linked to symptom severity, which may indicate it is an important rehabilitation finding.
插入性跟腱病（IAT）是一种常见且疼痛的肌肉骨骼疾病。IAT的治疗通常包括加强跖屈肌，尽管目前针对IAT患者的跖屈肌神经肌肉功能的研究较少。
比较IAT男性患者与对照组之间的跖屈肌神经肌肉功能，并研究IAT男性患者的跖屈肌神经肌肉功能与患者报告的结局指标之间的关系。
病例对照研究。
34名IAT男性患者（年龄43.7岁[标准差10.02]，体重89.6千克[16.3]）与34名健康男性（年龄42.8岁[标准差8.9]，体重87.2千克[9.7]）进行匹配。参与者进行了跖屈最大自主等长收缩（MVIC）任务和目标力匹配任务。这些任务中的神经肌肉变量包括：MVIC、扭矩发展速率（RTD）、机电延迟（EMD）和肌肉力量稳定性。参与者还完成了关于疼痛和功能以及心理因素的问卷调查。
与对照组相比，IAT组的MVIC（p < 0.01）和RTD（p < 0.01）降低，但跖屈肌力量稳定性（p = 0.08）或EMD（p = 0.71）未观察到显著差异。在VISA - A与RTD之间（r = 0.37，p = 0.04）、恐动症与EMD之间（r = 0.45，p = 0.03）检测到低强度相关性。
本研究证实了IAT患者存在跖屈肌力量和RTD受损。IAT患者的跖屈肌力量稳定性和EMD未改变，这与跟腱中部肌腱病的证据相反。跖屈肌RTD是与症状严重程度相关的唯一神经肌肉结局指标，这可能表明它是一项重要的康复发现。
