The effect of eccentric exercise on pain and function in patient with patellar tendinopathy - literature review

Uvod: Patelarna tendinopatija je boleča obraba ligamenta, ki jo povzročijo mikropoškodbe ligamenta. Le-te nastanejo med aktivnostmi, pri katerih je veliko ekscentrične mišične aktivnosti spodnjih udov, kar vodi v degeneracijo vlaken in tendinopatijo. Pojavijo se bolečine na predelu narastišča ligamenta in zmanjšana funkcija spodnjega uda. Ekscentrična vadba se pogosto uporablja kot terapija, vendar njena učinkovitost ni popolnoma raziskana. Namen: Namen diplomske naloge je bil s pregledom literature predstaviti učinkovitost ekscentrične vadbe na zmanjšanje bolečine in izboljšanje funkcije pri pacientih s patelarno tendinopatijo. Metode dela: Literaturo, objavljeno med leti 2000 in 2019, smo iskali po elektronskih podatkovnih zbirkah PubMed, ScienceDirect in Cohrane Library, po iskalnem nizu v angleškem jeziku patellar tendinopathy and eccentric exercise. Rezultati: V analizo smo vključili pet člankov, ki so bili dostopni v polnem besedilu. Rezultati o učinku ekscentrične vadbe na funkcijo in bolečino so si bili med seboj podobni. V raziskavah so se razlikovali programi vadbe, spol, starost, število preiskovancev, količina in pogostosti vadbe. V vseh raziskavah, razen v eni, so ugotovili zmanjšanje bolečine in/ali izboljšanje funkcije pri preiskovancih, ki so izvajali ekscentrično vadbo, v primerjavi s stanjem pred začetkom terapij. Ugotovili so, da je v skupini, ki je izvajala ekscentrično vadbo, 100 % preiskovancev stanje bolečine po terapijah ocenilo na veliko bolje ali bolje. Poročali so o statistično pomembnem izboljšanju bolečine po VAL (p < 0,01) pri preiskovancih, ki so izvajali ekscentrično-koncentrično vadbo. Opazili so tudi izboljšanje rezultata VISA-p (42,2 točke) in zmanjšanje bolečine po VAL (50 točk) pri preiskovancih, ki so izvajali ekscentrično vadbo. Opazili so statistično pomembno razliko (p < 0,01) rezultata VAL med prvo meritvijo in po koncu terapij pri preiskovancih, ki so izvajali program ekscentrične vadbe (3,3 točke manjša bolečina po VAL). Ekscentrična vadba je bila učinkovitejša kot primerjalne terapije, z izjemo ekscentrično-koncentričnega programa vadbe, ki je imel primerljivo uspešnost. Razprava in zaključek: V analiziranih raziskavah je večina avtorjev poročala o učinkovitosti ekscentrične vadbe na zmanjšanje bolečine in izboljšanje funkcije pri preiskovancih s patelarno tendinopatijo. Potrebne so nadaljnje raziskave s poenotenim vadbenim programom in večjim številom preiskovancev.Introduction: Patellar tendinopathy is a painful ligamentous degeneration caused by micro ligament injuries that occur during activities with a lot of eccentric muscle activity of the lower limbs, resulting in fibre degeneration and tendinopathy. There is pain around the ligaments and limited function of the lower limbs. Eccentric exercises are often used as a therapy, but their effectiveness has not been fully studied. Purpose: The purpose of this thesis was to present the effectiveness of eccentric exercises in reducing pain and improving function in patients with patellar tendinopathy by literature review. Methods: Literature published between 2000 and 2019 in the PubMed, ScienceDirect, and Cochrane Library electronic databases was reviewed using the keywords patellar tendinopathy and eccentric exercise. Results: Five studies were included in the analysis and were available in full text. The effect of eccentric training on function and pain was similar. The studies differed in in term of exercise programs, gender, age, number of subjects, volume, and frequency of training. In all studies but one, there was a reduction in pain and/or improvement in function in subjects compared with pre-treatment status. It was found out that 100 % of subject that performed eccentric exercises reported the state of pain level as better or much better. Another research reported statistically important improvement of VAS (p < 0,01) in subject that did eccentric/concentric exercise program. There was improvement in VISA-p score (42,2 points) and reduced pain levels on VAS scale (50 points at subjects who performed eccentric exercise program. With this review we also noticed statistically important difference (p < 0,01) of VAS score between first measurement and after therapy program in subjects who performed eccentric exercises (33 less pain on VAS). Eccentric exercise was more effective than comparable therapies, except for an eccentric/concentric exercise program, which had a comparable effect. Discussion and Conclusion: In the analysed studies, most authors reported the efficacy of eccentric exercises for pain reduction and functional improvement in subjects with patellar tendinopathy. Further studies with a more comparable exercise program and a larger number of subjects are needed