Kim Myoung-Hwee, Martin Wille, Quarmby Andrew, Stoll Josefine, Engel Tilman, Cassel Michael
University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany.
Front Sports Act Living. 2024 Jul 25;6:1414633. doi: 10.3389/fspor.2024.1414633. eCollection 2024.
Considering the neuromuscular alterations in Achilles tendinopathy (AT), sensorimotor training (SMT) might be beneficial to restore the neuromuscular capacity of the muscle-tendon complex and thereby improve patients' functions and alleviate symptoms. However, there is still a lack of knowledge concerning the effects of SMT on improving functional (e.g., strength) and pain outcomes in this population. Thus, the purpose of this study was to synthesize current evidence to analyze the efficacy of SMT in people with AT.
A systematic electronic search was performed in PubMed, Web of Science, and Cochrane Central Register of Controlled Trials from inception to December 2023. Studies applying SMT in people with AT investigating functional or clinical pain outcomes were considered. Protocols had to incorporate balance, stabilization, proprioception, or vibration training. Patients with insertional or mid-portion AT (≥18 years age) diagnosed with clinical or sonographic evaluation were included.
The search yielded 823 records. A total of three randomized controlled trials were considered eligible for the analysis. Each trial used a different SMT protocol: balance training, balance with stabilization training, or whole-body vibration training (WBVT) with other co-interventions. Most functional and pain parameters improved compared to baseline. The first study reported a decrease in pain and an increase in performance (i.e., countermovement jump height) and endurance (i.e., number of heel-raises) by 12-week use of a balance training in addition to isometric, concentric/eccentric, and eccentric exercises. The second study evaluated the four weeks effect of SMT (balance and stabilization training plus eccentric exercises) in addition to passive physiotherapy (deep frictions, ice, ultrasound), resulting in an increased plantarflexion peak torque and reduced pain levels. The third study investigating WBVT reported at 12 weeks an increase in flexibility and a decrease in tendon pain.
SMT in addition to other co-interventions (i.e., eccentric, isometric, concentric/eccentric training, physiotherapy) showed improvements in strength, performance, muscle flexibility, and alleviated clinical outcomes of pain. SMT might therefore be useful as part of a multimodal treatment strategy protocol in patients suffering from AT. However, due to the small number of studies included and the diversity of SMT protocols, the current evidence is weak; its additional effectiveness should be evaluated.
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=467698, Identifier CRD42023467698.
考虑到跟腱病（AT）中的神经肌肉改变，感觉运动训练（SMT）可能有助于恢复肌腱复合体的神经肌肉能力，从而改善患者功能并减轻症状。然而，关于SMT对改善该人群功能（如力量）和疼痛结局的影响仍缺乏相关知识。因此，本研究的目的是综合现有证据，分析SMT对AT患者的疗效。
从创刊至2023年12月，在PubMed、科学网和Cochrane对照试验中心注册库进行了系统的电子检索。纳入了在AT患者中应用SMT并调查功能或临床疼痛结局的研究。方案必须包含平衡、稳定、本体感觉或振动训练。纳入经临床或超声评估诊断为插入部或中部AT（≥18岁）的患者。
检索共获得823条记录。共有三项随机对照试验被认为符合分析条件。每项试验使用了不同的SMT方案：平衡训练、平衡与稳定训练或全身振动训练（WBVT）并辅以其他联合干预措施。与基线相比，大多数功能和疼痛参数均有所改善。第一项研究报告称，除等长、向心/离心和离心运动外，通过12周的平衡训练，疼痛减轻，运动表现（即反向纵跳高度）和耐力（即提踵次数）增加。第二项研究评估了SMT（平衡和稳定训练加离心运动）联合被动物理治疗（深部摩擦、冰敷、超声）四周的效果，结果显示跖屈峰值扭矩增加，疼痛水平降低。第三项研究对WBVT的调查显示，在12周时柔韧性增加，肌腱疼痛减轻。
SMT联合其他联合干预措施（即离心、等长、向心/离心训练、物理治疗）可改善力量、运动表现、肌肉柔韧性，并减轻疼痛的临床结局。因此，SMT可能作为AT患者多模式治疗策略方案的一部分发挥作用。然而，由于纳入研究数量较少且SMT方案多样，目前的证据较弱；其额外的有效性应进一步评估。
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=467698，标识符CRD42023467698。
