Novel Physical Therapy Protocol Results in Increased Compressive Strain and Improved Outcomes in Insertional Achilles Tendinopathy

Transcription

1 Novel Physical Therapy Protocol Results in Increased Compressive Strain and Improved Outcomes in Insertional Achilles Tendinopathy Meghan Kelly MD PhD, Mary A Bucklin, Ruth Chimenti PhD, Rachel E Olsen, Michael S Richards PhD, John P Ketz MD, Mark R Buckley PhD, A. Samuel Flemister MD University of Rochester School of Medicine Department of Orthopaedics and Rehabilitation, Department of Surgery, Department of Biomedical Engineering

2 Disclosures The authors state that there are no relevant disclosures related to this presentation

3 Insertional Achilles Tendinopathy (IAT) Affects approximately 5% of the general population Increased prevalence in dancers (1%) and runners (18%) Less common than midsubstance Achilles tendinopathy However less responsive to nonsurgical treatment Prior studies have examined treatment with: Heel lifts, PRP injections, extracorporal shockwave therapy and PT

4 Methods Patients with IAT recruited from 2 F&A clinics Underwent baseline assessment for VISA-A and FAAM scores Subset underwent ultrasound elastography measurements (see next slide) PT protocol (12 weeks) Mix of isometric/eccentric exercises Post-protocol repeat ultrasound measurements and VISA-A/FAAM assessment

5 Methods: Ultrasound Elastography Static and Dynamic assessment of tissues Captures movements of tendon in the axial and transverse axis Can measure vascular flow (Richards et al 213) Use in disease states IAT patients - decreased compressive and tensile strain (Chimenti et al 217) Compressive strain force transverse to the tendon fibers Tensile strain axial force in line with the tendon fibers

6 Results: Patient Demographics No significant difference between the patient groups who underwent outcomes only analysis and the subset that underwent ultrasound elastography and outcomes measurements

7 Outcomes measures VISA-A FAAM 2/24 patients demonstrated a clinically significant improvement in outcomes scores

8 Regional Differences Compressive Strain Tensile Strain Heel lowering Compressive Strain (%) p=.41 Tensile Strain (%) p=.38 superficial deep superficial deep Partial Squat Compressive Strain (%) p=.382 Tensile Strain (%) p=.17 superficial deep superficial deep

9 Effect of Physical Therapy Heel lowering Partial Squat Compressive Strain - superficial Compressive Strain (%) * Compressive Strain (%) * visit 1 visit 2 visit 1 visit Tensile Strain - deep Tensile Strain (%) 1..5 * Tensile Strain (%) 4 2. visit 1 visit 2 visit 1 visit 2

10 Conclusions IAT patients Increased transverse compressive strain in the deep Achilles tendon Decreased axial tensile strain in the deep Achilles tendon Physical therapy protocol Increased transverse compressive strain superficial portion Decreased axial tensile strain deep portion 83% demonstrated improved outcomes measures

11 References: Chimenti, RL; Bucklin, M; Kelly, M, et al.: Insertional Achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion. J Orthop Res. 35(4):91-915, 217. Chimenti, RL; Flemister, AS; Ketz, J, et al.: Ultrasound strain mapping of Achilles tendon compressive strain patterns during dorsiflexion. J Biomech. 49: 39-44, 216. Fahlstrom, M; Jonsson, P; Lorentzon, R; Alfredson, H: Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc. 11: , 23 Irwin, TA: Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 31: , 21. Iversen, JV; Bartels, EM; Langberg, H: The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy. Int J Sports Phys Ther. 7: 76-84, 212. Jonsson, P; Alfredson, H; Sunding, K; Fahlstrom, M; Cook, J: New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. Br J Sports Med. 42: , 28. Kedia, M; Williams, M; Jain, L, et al.: The effects of conventional physical therapy and eccentric strengthening for insertional achilles tendinopathy. Int J Sports Phys Ther. 9: , 214. Martin, RL; Irrgang, JJ; Burdett, RG; Conti, SF; Van Swearingen, JM: Evidence of validity for the Foot and Ankle Ability Measure (FAAM). Foot Ankle Int. 26: , 25. McCormack, J; Underwood, F; Slaven, E; Cappaert, T: The Minimum Clinically Important Difference on the Visa-a and Lefs for Patients with Insertional Achilles Tendinopathy. Int J Sports Phys Ther. 1: , 215.