Programa de ejercicios excéntricos en tendinopatías para atletas de alto rendimiento.

Contenido principal del artículo

Autores

Pamela Guadalupe Castro Maldonado https://orcid.org/0000-0001-6595-7573

Resumen

Introducción: En 2017, en la Ciudad de México, se realizó una estadística sobre las principales patologías en atletas de alto rendimiento. Basado en los hallazgos encontrados, se revisan los conceptos, tratamientos y abordajes, con relación a las tendinopatías. Se describen protocolos de ejercicios excéntricos, que demostraron la eficacia del ejercicio excéntrico. La eficacia de este tipo de ejercicio, se debe a la respuesta de los tendones al entrenamiento excéntrico. La tendinopatía, nombre colectivo para tendinitis, tendinosis y paratendinitis, es el síndrome clínico, que describe las lesiones por uso excesivo del tendón. Se caracteriza por una combinación de dolor, inflamación difusa o localizada y pérdida de la función, daño térmico y respuestas compresivas adaptativas. Objetivo: Establecer la eficacia de los protocolos de ejercicios excéntricos, desde su concepción hasta su aplicación, a padecimientos de tendinopatía y enunciar la ventaja que tienen sobre otros tipos de ejercicios. Metodología: Se describen los protocolos de ejercicios excéntricos, que demostraron la eficacia del ejercicio excéntrico. La eficacia de este tipo de ejercicio, se debe a la respuesta de los tendones al entrenamiento excéntrico. Resultados: En esta revisión bibliográfica, se reportan que los programas de ejercicios excéntricos, bien diseñados, mejoran significativamente a los pacientes con tendinopatías y los resultados se mantienen a medio-largo plazo. Conclusiones: La revisión de la literatura que aquí se presenta arroja luz sobre los beneficios que tienen los ejercicios excéntricos, especialmente, en el proceso metabólico y en las propiedades mecánicas en el tendón, lo cual, específicamente, ayuda a la evolución favorable de estas patologías.

Palabras clave:

Detalles del artículo

Licencia

Creative Commons License
Esta obra está bajo licencia internacional Creative Commons Reconocimiento-NoComercial 4.0.

Los autores conservan los derechos de autor y ceden a la revista el derecho de la primera publicación, con el trabajo registrado con la Licencia Creative Commons Atribución-NoComercial 4.0 Internacional., que permite a terceros utilizar lo publicado siempre y cuando mencionen la autoría del trabajo y a la primera publicación en esta revista.

Se recomienda a los autores incluir su trabajo en redes sociales como Researchgate y repositorios institucionales una vez publicado el artículo o hecho visible en la página de la revista, sin olvidar incluir el identificador de documento digital y el nombre de la revista.

 

Referencias

1. ACKERMANN, P.; PHISITKUL, P.; PEARCE, C. 2018. Treatment of Achilles tendinopathy: state of the art. Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine. 3(6):367–376. https://doi.org/10.1136/jisakos-2018-000202

2. ALFREDSON H, THORSEN K, LORENTZON R. 1999. In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain. Knee Surg Sports Traumatol Arthrosc. 7:378-81.

3. ANDRIOLO, L.; ALTAMURA, S.; REALE, D.; CANDRIAN, C.; ZAFFAGNINI, S.; FILARDO, G. 2019. Nonsurgical Treatments of Patellar Tendinopathy: Multiple Injections of Platelet-Rich Plasma Are a Suitable Option: A Systematic Review and Meta-analysis. American Journal of Sports Medicine. 47(4):1001–1018. https://doi.org/10.1177/0363546518759674

4. ARAMPATZIS, A.; KARAMANIDIS, K.; ALBRACHT, K. 2007. Adaptational responses of the human Achilles tendon by modulation of the applied cyclic strain magnitude. The Journal of Experimental Biology. 210:2743–2753. https://doi.org/10.1242/jeb.003814

5. BARCELONA, F.C. 2012. Guía de la práctica clínica de les tendinopaties: diagnóstic, tractament i prevenció. Apunts. Medicina de l’Esport. 47(176):143–168. https://doi.org/10.1016/j.apunts.2012.09.001

6. BLAZINA, M.; KERLAN, R.; JOBE, F.; CARTER, V.; CARLSON, G. 1973. Jumper’s knee. The Orthopedic Clinics of North America. 4(3):665–678.

7. BLEY, B.; ABID, W. 2015. Imaging of tendinopathy: A physician’s perspective. Journal of Orthopaedic and Sports Physical Therapy. 45(11):826–828. https://doi.org/10.2519/jospt.2015.0113

8. BOSTRØM, K.; MAEHLUM, S.; SMÅSTUEN, M.; STORHEIM, K. 2019. Clinical comparative effectiveness of acupuncture versus manual therapy treatment of lateral epicondylitis: Feasibility randomized clinical trial. Pilot and Feasibility Studies. 5(1):1–10. https://doi.org/10.1186/s40814-019-0490-x

9. CANEDO-GARCÍA, A.; PACHECO-SANZ, D.I.; GARCÍA-SÁNCHEZ, J.N. 2019. La actividad físico-deportiva y los programas intergeneracionales. In: Padilla, D.; Aguilar, J.; López, R. (eds). Salud y Ciclo Vital. 1st ed. Dykinson, S.L. p.319–331. https://doi.org/10.2307/j.ctvfb6z2h.31

10. CANNELL, L. 1982. The effects of an eccentric-type exercise versus a concentric-type exercise in the management of chronic patellar tendonitis. The University of British Columbia. 70p.

11. CANNELL, L.; TAUNTON, J.; CLEMENT, D.; SMITH, C., KHAN, K. 2001. A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper’s knee in athletes: Pilot study. British Journal of Sports Medicine. 35(1):60–64. https://doi.org/10.1136/bjsm.35.1.60

12. CARDOSO, T.; PIZZARI, T.; KINSELLA, R.; HOPE, D.; COOK, J. 2019. Current trends in tendinopathy management. Best Practice and Research: Clinical Rheumatology. 33(1):122–140. https://doi.org/10.1016/j.berh.2019.02.001

13. CHENG, H.; WU, S.; KAO, M. 2005. Cardiopulmonary responses to isokinetic concentric/eccentric exercise of the quadriceps in healthy young adults. 10:S28–S36.

14. COOK, J.; KHAN, K.; MAFULLI, N.; PURDAM, C. 2000. Overuse Tendinosis, Not Tendinitis Part 2: Applying the New Approach to Patellar Tendinopathy. The Physician and Sportsmedicine. 28(6):31–46. https://doi.org/10.1080/00913847.2000.11439512

15. COOK, J.; STASINOPOULOS, D.; BRISMÉE, J.M. 2018. Insertional and mid-substance Achilles tendinopathies: eccentric training is not for everyone–updated evidence of non-surgical management. Journal of Manual and Manipulative Therapy. 26(3):119–122. https://doi.org/10.1080/10669817.2018.1470302

16. CROISIER, J.; FORTHOMME, B.; FOIDART-DESALLE, M.; GODON, B.; CRIELAARD, J. 2001. Treatment of recurrent tendinitis by isokinetic eccentric exercises. Isokinetics and Exercise Science. 9(2-3):133-141. https://doi.org/10.3233/IES-2001-0077

17. CURWIN, S.; STANISH, W. 1984. Tendinitis: its etiology and treatment. Collamore Press. 189p.

18. DAVIES, C. 2003. Self-treatment of lateral epicondylitis (tennis elbow): Trigger point therapy for triceps and extensor muscles. Journal of Bodywork and Movement Therapies. 7(3):165–172. https://doi.org/10.1016/S1360-8592(02)00071-2

19. DEJACO, B.; HABETS, B.; VAN LOON, C.; VAN GRINSVEN, S.; VAN CINGEL, R. 2017. Eccentric versus conventional exercise therapy in patients with rotator cuff tendinopathy: a randomized, single blinded, clinical trial. Knee Surgery, Sports Traumatology, Arthroscopy. 25(7):2051–2059. https://doi.org/10.1007/s00167-016-4223-x

20. DIMITRIOS, S. 2017. The effectiveness of eccentric – concentric training and isometric contractions on pain and disability in Achilles tendinopathy. A case report. Physical Therapy in Sport. 28:e3. https://doi.org/10.1016/j.ptsp.2017.08.014

21. EL HAWARY, R.; STANISH, W.; CURWIN, S. 1997. Rehabilitation of tendon injuries in sport. Sports Medicine. 24:347–358. https://doi.org/10.2165/00007256-199724050-00006

22. FILLION, P. 1991. Treatment of Lateral Epicondylitis. American Journal of Occupational Therapy. 45(4):340–343. https://doi.org/10.5014/ajot.45.4.340

23. FLÓREZ, M.; ECHAVARRI, C.; PAVÓN DE PAZ, M. 2003. Programas de ejercicios en tendinopatías. Rehabilitación. 37(6):354–362. https://doi.org/10.1016/s0048-7120(03)73406-9

24. FUTBOL CLUB BARCELONA, SERVEIS MÈDICS. 2012. Guía de práctica clínica de las tendinopatías: diagnóstico. Apunts: Medicina de l’esport. 47(176):143-68.

25. GARNIER, Y.; PAIZIS, C.; LEPERS, R. 2019. Corticospinal changes induced by fatiguing eccentric versus concentric exercise. European Journal of Sport Science. 19(2):166–176. https://doi.org/10.1080/17461391.2018.1497090

26. GÓMEZ DÍAZ, J. 2016. Eficacia de los ejercicios excéntricos en tendinopatías rotulianas. Revisión bibliográfica. Archivos de Medicina Del Deporte. 33(1):59–66.

27. GRÄVARE SILBERNAGEL, K.; BRORSSON, A.; LUNDBERG, M. 2011. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: A 5-year follow-up. American Journal of Sports Medicine. 39(3):607–613. https://doi.org/10.1177/0363546510384789

28. GROSS, M. 1992. Chronic Tendinitis: Pathomechanics of Injury, Factors Affecting the Healing Response, and Treatment. Journal of Orthopaedic & Sports Physical Therapy. 16(6):248–261. https://doi.org/10.2519/jospt.1992.16.6.248

29. HEINEMEIER, K.; LANGBERG, H.; OLESEN, J.; KJAER, M. 2003. Role of TGF-B1 in relation to exercise-induced type I collagen synthesis in human tendinous tissue. Journal of Applied Physiology. 95:2390–2397. https://doi.org/10.1152/japplphysiol.00403.2003

30. HOLDEN, S.; LYNG, K.; GRAVEN-NIELSEN, T.; RIEL, H.; OLESEN, J.; LARSEN, L.; RATHLEFF, M. 2020. Isometric exercise and pain in patellar tendinopathy: A randomized crossover trial. Journal of Science and Medicine in Sport. 23(3):208–214. https://doi.org/10.1016/j.jsams.2019.09.015

31. HONG, Q.; DURAND, M.; LOISEL, P. 2003. Treatment of lateral epicondylitis: where is the evidence? Joint Bone Spine. 71(5):369–373. https://doi.org/10.1016/S1297-319X(03)00167-2

32. JAYASEELAN, D.; MISCHKE, J.; STRAZZULLA, R. 2019. Eccentric exercise for Achilles tendinopathy: A narrative review and clinical decision-making considerations. Journal of Functional Morphology and Kinesiology. 4(2):34. https://doi.org/10.3390/jfmk4020034

33. JENSEN, K.; DI FABIO, R. 1989. Evaluation of Eccentric Exercise in Treatment of Patellar Tendinitis. Physical Therapy. 69(3):211–216. https://doi.org/10.1093/ptj/69.3.211

34. JURADO, A.; MEDINA-PORQUERES, I. 2008. Tendón: valoración y tratamiento en fisioterapia. Editorial Paidotribo. 598p.

35. KARLSSON, J.; KÄLEBO, P.; GOKSÖR, L.; THOMEE, R.; SWÄRD, L. 1992. Partial rupture of the patellar ligament. The American Journal of Sports Medicine. 20:390–395. https://doi.org/10.1177/036354659202000404

36. KHAN, K.; BONAR, F.; DESMOND, P.; COOK, J.; YOUNG, D.; VISENTINI, P.; FEHRMANN, M.; KISS, Z.; O’BRIEN, P.; HARCOURT, P.; DOWLING, R.; O’SULLIVAN, R.; CRICHTON, K.; TRESS, B.; WARK, J. 1996. Patellar tendinosis (jumper’s knee): Findings at histopathologic examination, US, and MR imaging. Victorian Institute of Sport Tendon Study Group. Radiology. 200:821–827. https://doi.org/10.1148/radiology.200.3.8756939

37. KHAN, K.M.; COOK, J.L.; TAUNTON, J.E.; BONAR, F. 2000. Overuse tendinosis, not tendinitis part 1: a new paradigm for a difficult clinical problem. Phys Sportsmed. 28(5):38-48. https://doi.org/10.3810/psm.2000.05.890

38. KNOBLOCH, K.; KRAEMER, R.; JAGODZINSKI, M.; ZEICHEN, J.; MELLER, R.; VOGT, P. 2007. Eccentric training decreases paratendon capillary blood flow and preserves paratendon oxygen saturation in chronic achilles tendinopathy. Journal of Orthopaedic and Sports Physical Therapy. 37(5):269–276. https://doi.org/10.2519/jospt.2007.2296

39. KONGSGAARD, M.; REITELSEDER, S.; PEDERSEN, T.; HOLM, L.; AAGAARD, P.; KJAER, M.; MAGNUSSON, S. 2007. Region specific patellar tendon hypertrophy in humans following resistance training. Acta Physiologica (Oxford, England). 191:111–121. https://doi.org/10.1111/j.1748-1716.2007.01714.x

40. LANGBERG, H. 2013. Tendinopathy: more questions than answers. British Journal of Sports Medicine. 47(9):e2. https://doi.org/10.1136/bjsports-2013-092459.18

41. MAFFULLI, N.; WALLEY, G.; SAYANA, M.; LONGO, U.; DENARO, V. 2008. Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disability and Rehabilitation. 30(20-22):1677–1684. https://doi.org/10.1080/09638280701786427

42. MAUTNER, K.; MALANGA, G.; COLBERG, R. 2011. Optimization of ingredients, procedures and rehabilitation for platelet-rich plasma injections for chronic tendinopathy. Pain Management. 1(6):523–532. https://doi.org/10.2217/pmt.11.56

43. MCHUGH, M.P.; CONNOLLY, D.A.; ESTON, R.G.; GLEIM, G.W. 2000. Electromyographic analysis of exercise resulting in symptoms of muscle damage. Journal of Sports Sciences. 18:163-172.

44. MILLAR, N.; HUEBER, A.; REILLY, J.; YINGHUA, XU.; FAZZI, U.; MURRELL, G.; MCINNES, I. 2010. Inflammation is present in early human tendinopathy. American Journal of Sports Medicine. 38(10):2085–2091. https://doi.org/10.1177/0363546510372613

45. NIESEN-VERTOMMEN, S.; TAUNTON, J.; CLEMENT, D.; MOSHER, R. 1992. The Effect of Eccentric Versus Concentric Exercise in the Management of Achilles Tendonitis. Clinical Journal of Sport Medicine. 2:109-113. https://doi.org/10.1097/00042752-199204000-00006

46. NIRSCHL, R.P. 1992. Elbow tendinosis/tennis elbow. Clin Sport Med. 11:851-70.

47. O’NEILL, S.; BARRY, S.; WATSON, P. 2019. Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy: The role of soleus. Physical Therapy in Sport. 37.69–76. https://doi.org/10.1016/j.ptsp.2019.03.002

48. PAAVOLA, M.; KANNUS, P.; JÄRVINEN, M. 2005. Epidemiology of tendon problems in sport. In: Maffulli, N.; Renström, P.; Leadbetter, W.B. (eds). Tendon Injuries. Springer (London). p.32-39. https://doi.org/10.1007/1-84628-050-8_5

49. PAAVOLA, M.; KANNUS, P.; PAAKKALA, T.; PASANEN, M.; JÄRVINEN, M. 2000. Long-term prognosis of patients with achilles tendinopathy: An observational 8-year follow-up study. American Journal of Sports Medicine. 28(5):634–642. https://doi.org/10.1177/03635465000280050301

50. PARK, Y.H.; KIM, T.J.; CHOI, G.W.; KIM, H. 2019. Achilles tendinosis does not always precede Achilles tendon rupture. Knee Surgery, Sports Traumatology, Arthroscopy. 27(10):3297–3303. https://doi.org/10.1007/s00167-018-5172-3

51. PAULUS, J.; CROISIER, J.; KAUX, J.; BURY, T. 2019. Eccentric versus Concentric - Which Is the Most Stressful Cardiovascularly and Metabolically? Current Sports Medicine Reports. 18(12):477–489. https://doi.org/10.1249/JSR.0000000000000666

52. PUDDU, G.; IPPOLITO, E.; POSTACHINNI, F. 1976. A classification of Achilles tendon disease. Am J Sport Med. 4:145-50.

53. REINKING, M. 2012. Tendinopathy in athletes. Physical Therapy in Sport. 13(1):3–10. https://doi.org/10.1016/j.ptsp.2011.06.004

54. ROIG, M.; O’BRIEN, K.; KIRK, G.; MURRAY, R.; MCKINNON, P.; SHADGAN, B.; REID, W. 2009. The effects of eccentric versus concentric resistance training on muscle strength and mass in healthy adults: A systematic review with meta-analysis. British Journal of Sports Medicine. 43(8):556–568. https://doi.org/10.1136/bjsm.2008.051417

55. RUARO, B.; CUTOLO, M.; ALESSANDRI, E.; ZAOTTINI, F.; PICASSO, R.; PISTOIA, F.; FERRARI, G.; MARTINOLI, C. 2019. Don’t forget the jumper’s knee in the young sportsman: evaluation of patellar tendinopathy with a high frequency ultrasound probe. Reumatismo. 71(3):160–162. https://doi.org/10.4081/reumatismo.2019.1231

56. SCHMIKLI, S.L.; BACKX, F.J.G.; KEMLER, H.J.; VAN MECHELEN, W. 2009. National survey on sports injuries in the Netherlands: target populations for sports injury prevention programs. Clinical Journal of Sport Medicine. 19(2):101-106. https://doi.org/10.1097/JSM.0b013e31819b9ca3

57. SCOTT, A.; BACKMAN, L.; SPEED, C. 2015. Tendinopathy: Update on Pathophysiology. Journal of Orthopaedic & Sports Physical Therapy. 45(11):833–841. https://doi.org/10.2519/jospt.2015.5884

58. SEYNNES, O.; ERSKINE, R.; MAGANARIS, C.; LONGO, S.; SIMONEAU, E.; GROSSET, J.; NARICI, M. 2009. Training-induced changes in structural and mechanical properties of the patellar tendon are related to muscle hypertrophy but not to strength gains. Journal of Applied Physiology. 107(2):523–530. https://doi.org/10.1152/japplphysiol.00213.2009

59. STANISH, W.D.; RUBINOVICH, R.; CURWIN, S. 1986. Eccentric exercise in chronic tendinitis. Clin Othop. 208:65-8.

60. STEFANSSON, S.; BRANDSSON, S.; LANGBERG, H.; ARNASON, A. 2019. Using Pressure Massage for Achilles Tendinopathy: A Single-Blind, Randomized Controlled Trial Comparing a Novel Treatment Versus an Eccentric Exercise Protocol. Orthopaedic Journal of Sports Medicine. 7(3):1–10. https://doi.org/10.1177/2325967119834284

61. STERGIOULAS, A.; STERGIOULAS, M.; AARSKOG, R.; LOPES-MARTINS, R.; BJORDAL, J. 2008. Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy. American Journal of Sports Medicine. 36(5):881–887. https://doi.org/10.1177/0363546507312165

62. STEVENS, M.; TAN, C. 2014. Effectiveness of the alfredson protocol compared with a lower repetition-volume protocol for midportion achilles tendinopathy: A randomized controlled trial. Journal of Orthopaedic and Sports Physical Therapy. 44(2):59–67. https://doi.org/10.2519/jospt.2014.4720

63. SUER, M.; ABD-ELSAYED, A. 2019. Tendinopathy. In Abd-Elsayed A. (eds). Pain. Springer (Cham). p.707-710. https://doi.org/10.1007/978-3-319-99124-5_151

64. SUSSMILCH-LEITCH, S.; COLLINS, N.; BIALOCERKOWSKI, A.; WARDEN, S.; CROSSLEY, K. 2012. Physical therapies for Achilles tendinopathy: Systematic review and meta-analysis. Journal of Foot and Ankle Research. 5(1). https://doi.org/10.1186/1757-1146-5-15

65. TARPADA, S.; MORRIS, M.; LIAN, J.; RASHIDI, S. 2018. Current advances in the treatment of medial and lateral epicondylitis. Journal of Orthopaedics. 15(1):107–110. https://doi.org/10.1016/j.jor.2018.01.040

66. TORRECILLAS, J.; SEGURA, M. 2019. Influencia en la participación en actividades de ocio sobre la calidad de vida de las personas con diversidad funcional. In Padilla, D.; Aguilar, J.; López, R. (eds). Salud y Ciclo Vital. 1st ed. Dykinson, S.L. p.51–58. https://doi.org/10.2307/j.ctvfb6z2h.7

67. VALLEJO, A.; SCHROEDER, E.; ZHENG, L.; JENSKY, N.; SATTLER, F. 2006. Cardiopulmonary responses to eccentric and concentric resistance exercise in older adults. Age and Ageing. 35(3):291–297. https://doi.org/10.1093/ageing/afj082

68. VAN RIJN, D.; VAN DEN AKKER-SCHEEK, I.; STEUNEBRINK, M.; DIERCKS, R.; ZWERVER, J.; VAN DER WORP, H. 2019. Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis. Clinical Journal of Sport Medicine. 29(3):181–187. https://doi.org/10.1097/JSM.0000000000000520

Descargas

La descarga de datos todavía no está disponible.