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manuelletherapie 2007; 11(1): 2-9
DOI: 10.1055/s-2007-962844
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Effektivität von exzentrischem Training bei chronischer Achillodynie[1]

Effectiveness of Eccentric Muscle Training in Chronic AchillodyniaO. Lindner1
  • 1Zentrum für Physiotherapie Bellaria, CH-Zürich
Further Information

Publication History

Publication Date:
12 February 2007 (online)

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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.

Schlüsselwörter

chronische Achillodynie - Tendinopathie - Tendinitis - exzentrisches Training

Key words

chronic achillodynia - tendinopathy - tendinitis - eccentric muscle training

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

Literatur

  • 1 Äström M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings.  Clin Orthop Relat Res. 1995;  316 151-164
    PubMedGoogle Scholar
  • 2 Äström M. On the nature and etiology of chronic Achilles tendinopathy (Thesis). Lund/Sweden; University of Lund 1997
    Google Scholar
  • 3 Alfredson H, Pietila T, Lorentzon R. Chronic Achilles tendinitis and calf muscle strength.  Am J Sports Med. 1996;  24 829-833
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 7 Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment.  Clin Sports Med. 2003;  22 727-741
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Allenmark C. Partial Achilles tendon tears.  Clin Sports Med. 1992;  11 759-769
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 11 Van den Berg F. Angewandte Physiologie. Bd. 1: Das Bindegewebe des Bewegungsapparates verstehen und beeinflussen. Stuttgart; Thieme 1999
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 13 Cook J l, Khan K M, Purdam C. Achilles tendinopathy.  Man Ther. 2002;  7 121-130
    CrossrefPubMedGoogle Scholar
  • 14 DeMaio M, Paine R, Drez D J. Achilles tendonitis.  Orthopedics. 1995;  18 195-204
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 16 Galloway M T, Jokl P, Dayton O W. Achilles tendon overuse injuries.  Clin Sports Med. 1992;  11 771-772
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 18 Hochschild J. Strukturen und Funktionen begreifen. Funktionelle Anatomie - Therapierelevante Details. Bd. 2: LWS, Becken und Hüftgelenk, untere Extremität. Stuttgart; Thieme 2002
    Google Scholar
  • 19 Humble R N, Nugent L L. Achilles’ tendonitis. An overview and reconditioning model.  Clin Podiatr Med Surg. 2001;  18 233-254
    PubMedGoogle Scholar
  • 20 James S L, Bates B T, Osternig L R. Injuries to runners.  Am J Sports Med. 1978;  6 40-50
    PubMedGoogle Scholar
  • 21 Jarvinen M. Epidemiology of tendon injuries in sports.  Clin Sports Med. 1992;  11 493-504
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 23 Khan K M, Cook J L. Overuse tendon injuries: where does the pain come from?.  Sports Med Arthrosc Rev. 2000;  8 17-31
    CrossrefPubMedGoogle Scholar
  • 24 Kvist M. Achilles tendon injuries in athletes.  Sports Med. 1994;  18 173-201
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    Google Scholar
  • 30 Rees J D, Wilson A M, Wolman R L. Current concepts in the management of tendon disorders.  Rheumatology (Oxford). 2006;  20
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 32 Sandmeier R, Renström P AFH. Diagnosis and treatment of chronic tendon disorders in sports.  Scand J Med Sci Sports. 1997;  7 96-106
    PubMedGoogle Scholar
  • 33 Schepsis A A, Leach R E. Surgical management of Achilles tendinitis.  Am J Sports Med. 1987;  15 308-315
    CrossrefPubMedGoogle Scholar
  • 34 Schepsis A A, Jones H, Haas A L. Achilles tendon disorders in athletes.  Am J Sports Med. 2002;  30 287-305
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 37 Stanish W D. Overuse injuries in athletes: a perspective.  Med Sci Sports Exerc. 1984;  16 1-7
    PubMedGoogle Scholar
  • 38 Stanish W D, Rubinovich R M, Curwin S. Eccentric exercise in chronic tendonitis.  Clin Orthop. 1986;  208 65-68
    PubMedGoogle Scholar
  • 39 Teitz C C, Garrett W E, Miniaci Jr A. et al . Tendon problems in athletic individuals.  Instr Course Lect. 1997;  46 569-582
    PubMedGoogle Scholar

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

Olav Lindner

Zentrum für Physiotherapie Bellaria

Bellariastr. 38

CH-8038 Zürich

Email: olindner@physio-bellaria.ch

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