Das Management der Mid-Portions-Achillessehnentendinopathie in der Physiotherapie – eine systematische Literaturrecherche

Zusammenfassung

Hintergrund Die Mid-Portions-Achillessehnentendinopathie (MPAT) ist ein Beschwerdebild, welches häufig sowohl bei Sportlern als auch bei Nicht-Sportlern auftritt. Während gute Evidenz zur Wirksamkeit von Wadentraining besteht, existiert keine aktuelle Literaturarbeit zur Ermittlung der Wirksamkeit von Physiotherapie, die das Gesamtspektrum physiotherapeutischer Möglichkeiten berücksichtigt.

Fragestellung Welche Rolle spielen manuelle Techniken und aktive Herangehensweisen beim physiotherapeutischen Management von MPAT bezogen auf Schmerz, Funktion und Lebensqualität?

Methoden Die Recherche erfolgte in den Datenbanken MEDLINE, Cinahl, SPORTDiscuss, PEDro und Cochrane, ergänzend in Journalen, grauer Literatur und über eine Handsuche. Inkludiert werden sollten ausschließlich randomisierte kontrollierte Studien (RCTs). Es folgte eine narrative Synthese. Die Beurteilung der Evidenz unterschiedlicher physiotherapeutischer Herangehensweisen erfolgte nach der „Body-of-Evidence-Matrix“ des NHMRC Australiens.

Ergebnisse 19 RCTs mit insgesamt 792 Patienten wurden inkludiert. In jeder dieser Studien kam ein exzentrisches Training (ET) zur Anwendung, wobei das Alfredson-Protokoll das am häufigsten genutzte war. Zum einen wurden die Wirkungsweisen unterschiedlicher Formen eines ET miteinander verglichen. Des Weiteren fanden Vergleiche zwischen ET und anderen Trainingsformen, zwischen ET und Wadendehnungen, zwischen ET und therapeutischem Ultraschall und zwischen ET und diversen nicht physiotherapeutischen Therapieformen statt. Keine inkludierte Studie befasste sich mit der alleinigen oder ergänzenden Wirksamkeit von manuellen Herangehensweisen.

Diskussion Die größte Evidenz existiert für ein ET insbesondere nach dem Alfredson-Protokoll. Auch wenn für Tendinopathien häufig ein Heavy-Slow-Resistance-Training empfohlen wird, ist die Beweislage für die Behandlung von MPAT noch dürftig. Andere Übersichtsarbeiten, die sich ausschließlich mit der Wirksamkeit von Wadentraining beschäftigten, kamen auf vergleichbare Ergebnisse. Wichtige Kriterien beim Training scheinen Intensität, Progression, Geschwindigkeit bzw. Spannungsdauer und der Umgang mit Schmerz zu sein.

Schlussfolgerung Eine aktive Therapie in Form eines exzentrischen Wadentrainings oder eines Heavy-Slow-Resistance-Trainings sind nach aktueller Beweislage die empfehlenswertesten Therapieformen bei MPAT. Nach dieser Arbeit gehend existiert keine Evidenz zur alleinigen oder ergänzenden Wirksamkeit von manuellen Techniken bei diesem Beschwerdebild.

Abstract

Tendinopathy of the mid-portion of the Achilles tendon is common in athletes and non-athletes. From a physiotherapeutic view, calf muscle training is the most recommended kind of treatment. However, there is no current systematic review evaluating the efficacy of physiotherapy in due consideration of the entire spectrum of therapeutic options. A systematic review of the literature in several databases and journals revealed 19 relevant studies. Good evidence was found for eccentric training compared to no therapy, satisfactory evidence for eccentric training compared to concentric training, satisfactory to good evidence for the same effect by using eccentric training and heavy slow resistance training, poor evidence for the same effect by using eccentric training and stretching, and poor to good evidence that eccentric training may have the same effect as several therapies applied by physicians. The Alfredson protocol and heavy slow resistance training may be the most recommendable types of calf muscle training. There is no high-quality evidence for the efficacy of other hands off or hands on treatment options.

Schlüsselwörter

Achillessehnentendinopathie - Wadentraining - aktive Maßnahmen - passive Maßnahmen

Key words

Achilles tendinopathy - eccentric load - heavy slow resistance - hands on - hands off

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