Effektivität von exzentrischem Training bei chronischer Achillodynie[1]

Zusammenfassung

Achillessehnenbeschwerden sind ein häufig auftretendes Problem bei sportlich aktiven Menschen. Nicht selten werden sie chronisch. Die Arbeit befasst sich mit den physiotherapeutischen Behandlungsmöglichkeiten chronischer Achillessehnenbeschwerden, die einem exzentrischen Training zugrunde liegen. Die systematische Literatursuche ergab positive Hinweise auf die Effektivität des Trainings sowie die Behandlungsstrategie und -intensität.

Abstract

Achilles tendon complaints are a common problem in sportsmen and women. Not infrequently they become chronic. This article deals with the physiotherapeutic treatment of chronic Achilles tendon complaints based on eccentric muscle training. The systematic literature review found positive evidence of the training’s effectiveness and gives an indication of treatment strategy and intensity.

chronische Achillodynie - Tendinopathie - Tendinitis - exzentrisches Training

chronic achillodynia - tendinopathy - tendinitis - eccentric muscle training

Literatur

• 1 Äström M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings.  Clin Orthop Relat Res. 1995;  316 151-164
• 2 Äström M. On the nature and etiology of chronic Achilles tendinopathy (Thesis). Lund/Sweden; University of Lund 1997
• 3 Alfredson H, Pietila T, Lorentzon R. Chronic Achilles tendinitis and calf muscle strength.  Am J Sports Med. 1996;  24 829-833
• 4 Alfredson H, Pietila T, Jonsson P. et al . Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.  Am J Sports Med. 1998;  26 360-366
• 5 Alfredson H, Pietila T, Öhberg L. et al . Achilles tendinosis and calf muscle strength. The effect of short-term immobilization after surgical treatment.  Am J Sports Med. 1998;  26 166-171
• 6 Alfredson H, Thorsen K, Lorentzon R. In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain.  Knee Surg Sports Traumatol Arthrosc. 1999;  7 378-381
• 7 Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment.  Clin Sports Med. 2003;  22 727-741
• 8 Alfredson H, Öhberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial.  Knee Surg Sports Traumatol Arthrosc. 2005;  13 338-344
• 9 Allenmark C. Partial Achilles tendon tears.  Clin Sports Med. 1992;  11 759-769
• 10 Almekinders L C, Temple J D. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature.  Med Sci Sports Exerc. 1998;  30 1183-1190
• 11 Van den Berg F. Angewandte Physiologie. Bd. 1: Das Bindegewebe des Bewegungsapparates verstehen und beeinflussen. Stuttgart; Thieme 1999
• 12 Clement D B, Taunton J E, Smart G W. Achilles tendinitis and peritendinitis: etiology and treatment.  Am J Sports Med. 1984;  12 179-184
• 13 Cook J l, Khan K M, Purdam C. Achilles tendinopathy.  Man Ther. 2002;  7 121-130
• 14 DeMaio M, Paine R, Drez D J. Achilles tendonitis.  Orthopedics. 1995;  18 195-204
• 15 Fahlström Jr M, Jonsson P, Lorentzon R. et al . Chronic Achilles tendon pain treated with eccentric calf-muscle training.  Knee Surg Sports Traumatol Arthrosc. 2003;  11 327-333
• 16 Galloway M T, Jokl P, Dayton O W. Achilles tendon overuse injuries.  Clin Sports Med. 1992;  11 771-772
• 17 Hirschmüller A, Baur H, Müller S. et al . Quantifizierung der Kraftfähigkeit und der neuromuskulären Effizienz bei Gesunden und Läufern mit chronischen Achillessehnenbeschwerden.  Dt Zeitschrift f Sportmedizin. 2005;  2 39-44
• 18 Hochschild J. Strukturen und Funktionen begreifen. Funktionelle Anatomie - Therapierelevante Details. Bd. 2: LWS, Becken und Hüftgelenk, untere Extremität. Stuttgart; Thieme 2002
• 19 Humble R N, Nugent L L. Achilles’ tendonitis. An overview and reconditioning model.  Clin Podiatr Med Surg. 2001;  18 233-254
• 20 James S L, Bates B T, Osternig L R. Injuries to runners.  Am J Sports Med. 1978;  6 40-50
• 21 Jarvinen M. Epidemiology of tendon injuries in sports.  Clin Sports Med. 1992;  11 493-504
• 22 Khan K M, Cook J L, Bonar F. et al . Histopathology of common tendinopathies. Update and implications for clinical management.  Sports Med. 1999;  27 393-408
• 23 Khan K M, Cook J L. Overuse tendon injuries: where does the pain come from?.  Sports Med Arthrosc Rev. 2000;  8 17-31
• 24 Kvist M. Achilles tendon injuries in athletes.  Sports Med. 1994;  18 173-201
• 25 Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.  Knee Surg Sports Traumatol Arthrosc. 2001;  9 42-47
• 26 Öhberg L, Lorentzon R, Alfredson H. Neovascularisation in Achilles tendons with painful tendinosis but not in normal tendons: an ultrasonographic investigation.  Knee Surg Sports Traumatol Arthrosc. 2001;  9 233-238
• 27 Öhberg L, Alfredson H. Sclerosing therapy in chronic Achilles tendon insertional pain - results of a pilot study.  Knee Surg Sports Traumatol Arthrosc. 2003;  11 339-343
• 28 Öhberg L, Alfredson H. Effects on neovascularisation behind the good results with eccentric training in chronic mid-portion Achilles tendinosis?.  Knee Surg Sports Traumatol Arthrosc. 2004;  12 465-470
• 29 Orava S. Injuries due to sports: a clinical statistical study of nontraumatic overuse injuries of the musculoskeletal system of athletes and keep-fit athletes (Thesis). Oulu/Finland; University of Oulu 1980
• 30 Rees J D, Wilson A M, Wolman R L. Current concepts in the management of tendon disorders.  Rheumatology (Oxford). 2006;  20
• 31 Roos E M, Engstrom M, Lagerquist A. et al . Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy - a randomized trial with 1-year follow-up.  Scand J Med Sci Sports. 2004;  14 286-295
• 32 Sandmeier R, Renström P AFH. Diagnosis and treatment of chronic tendon disorders in sports.  Scand J Med Sci Sports. 1997;  7 96-106
• 33 Schepsis A A, Leach R E. Surgical management of Achilles tendinitis.  Am J Sports Med. 1987;  15 308-315
• 34 Schepsis A A, Jones H, Haas A L. Achilles tendon disorders in athletes.  Am J Sports Med. 2002;  30 287-305
• 35 Shalabi A, Kristoffersen-Wilberg M, Svensson L. et al . Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy - results in decreased tendon volume and intratendinous signal as evaluated by MRI.  Am J Sports Med. 2004;  32 1286-1296
• 36 Silbernagel K G, Thomee R, Thomee P. et al . Eccentric overload training for patients with chronic Achilles tendon pain - a randomised controlled study with reliability testing of the evaluation methods.  Scand J Med Sci Sports. 2001;  11 197-206
• 37 Stanish W D. Overuse injuries in athletes: a perspective.  Med Sci Sports Exerc. 1984;  16 1-7
• 38 Stanish W D, Rubinovich R M, Curwin S. Eccentric exercise in chronic tendonitis.  Clin Orthop. 1986;  208 65-68
• 39 Teitz C C, Garrett W E, Miniaci Jr A. et al . Tendon problems in athletic individuals.  Instr Course Lect. 1997;  46 569-582

1 Die Arbeit wurde im Rahmen des SVOMP-Nachdiplomstudiums 2003 - 2006 zum Dipl.-Manualtherapeuten OMT SVOMP erstellt.