La tendinitis rotuliana es una lesión en el tendón que conecta la rótula (patela) con la tibia. El tendón rotuliano trabaja con los músculos de la. “GONARTROSIS BILATERAL, CONDROMALACIA ROTULIANA, DISFUNCIÓN FEMOROPATELAR Y BURSITIS PREROTULIANA”. Kinesiotape para la condropatia o condromalacia rotuliana. en la tendinopatía rotuliana. Tendinitis Rotuliana, Sports Therapy, Kinesiology Taping, Natural.
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Br J Sports Med ; This non-randomised pilot study investigated the effect of eccentric quadriceps training on 17patients conrdomalacia tendons with painful chronic patellar tendinopathy. Two different eccentric exercise regimens were used by subjects with a long condromallacia of rotulianq activity more than six months.
The eccentrictraining was performed twice daily, with three sets of 15 repetitions, for 12 weeks. Primary outcomemeasures were a mm visual analogue scale VASwhere the subject recorded the amount of painduring activity, and b return to previous activity.
Follow up was at 12 weeks, with a further limited followup at 15 months. Good clinical results were obtained in the group who trained on the decline board, with sixpatients nine tendons returning to sport and showing a significantly reduced amount of pain over the12 week period. Mean VAS scores fell from At 15 months, four patients fivetendons reported satisfactory results mean VAS In the standard squat group the results were poor,with only one athlete returning to previous activity.
Mean VAS scores in this group were In a small group of patients with patellar tendinopathy, eccentric squats on a decline boardproduced encouraging results in terms of pain reduction and return to function in the short term. Eccentricexercise using standard single leg squats condromxlacia a similar sized group appeared to be a less effective form ofrehabilitation in reducing pain and returning subjects to previous levels of activity. Patellar tendinopathy is often a resistant and recurrentcondition that primarily affects athletes in jumpingsports.
Treatment is initially condromalaciaa, and eccentricexercise is currently accepted as an important part ofappropriate conservative therapy. Trunk flexion, side to side load sparing,and calf tension may all reduce the load placed on the knee. Purdam et al5 have suggested that this effect canbe minimised, and dotuliana on the patellar tendon maximised, byperforming a squat on a decline.
As there has been nopublished research on the standard squat and the 25declinesquat in the treatment of patellar tendinopathy, we investi-gated the effect of these techniques in the treatment of thiscondition. The aim of this pilot study was to identify differences inpain reduction and recovery of function, using an eccentricsingle leg squat programme, on a flat surface and on adecline, in patients with patellar tendinopathy. All were examined by one orthopaedic surgeon HA.
The inclusion criteria were: N pain in the proximal patellar tendon bilteral increased loadN tenderness to palpationN imaging changes at the proximal attachment of thetendon hilateral the patella ultrasonography or magneticresonance imaging N having rested for more than three months without effecton the tendon painAll patients had been treated with non-steroidal anti-inflammatory drugs. One subject had had hydrocortisoneinjected as part of conservative treatment.
Ethics approvalwas obtained from the University of Umea, Sweden and allsubjects provided informed consent. InterventionSubjects in this pilot study were not randomised because ofthe later development and inclusion of the decline exercisetechnique.
Thus, the first nine consecutive subjects present-ing for evaluation and agreeing to participate in the studywere prescribed eccentric squats with the ankle joint in astandard position fig 1. The next eight subjects wereprescribed eccentric squats on a 25decline board fig 2. Both groups undertook an exercise programme twice daily,consisting of three sets of 15 repetitions on a single leg, for12 weeks.
Those subjects with bilateral tendinopathy com-pleted the programme separately for each leg. Subjects wereinstructed to complete the exercises with the trunk upright. Both groups were instructed rotluiana perform the exercise by slowlyflexing the knee to 90of flexion, and, as far as possible, toperform eccentric loading of the quadriceps muscles only andto return to the starting position using the non-injured side.
Subjects were asked to increase the load with weights in abackpack once the condromakacia could be completed without pain. Load was increased so that exercises were always performedwith some pain or discomfort. Subjects were not allowed to continue their competitivesporting activity during the first eight weeks of the trialperiod. After four weeks of the eccentric training regimen,they were allowed to complement it with slow jogging on flatground, cycling, and water activities, if these could beperformed without sharp pain in the patellar tendon.
Aftereight weeks the patients were allowed to gradually return toprevious activity. Outcome measuresVisual analogue scale point VAS scores were recordedat baseline and at completion of the 12 weeks, to record theamount of pain during patellar tendon loading activitythatis, volleyball players during volleyball, soccer players duringsoccer, etc.
A further follow up was conducted at 15 months in thedecline squat group of all tendons not managed surgically. Patient ability to return to previous pre-injury activitylevel was also recorded.
Statistical analysisSubject characteristics of both groups were tabulated usingdescriptive statistics. VAS scores recorded before and after theeccentric programme were analysed for each group using aWilcoxon matched pairs test Statistica Release 6, ;Statsoft Inc. Two tailed significance was set at p,0.
Because of limitations in study design, no between groupcomparison was performed. Bilatersl baseline,there were no significant differences in height, weight, andduration of symptoms between groups table 1.
All subjectswere competitive in a range of sports before presentation table 2. Visual analogue scaleTable 3 shows descriptive results.
No significant changewas found in the standard squat group for the same period oftraining mean VAS scores Return to activitySix subjects nine tendons in the decline group had returnedto pre-injury activity levels in their sports.
The remainingsubjects had not been able to return to their previous activitylevel and were referred for surgical treatment. In thestandard squat group, only one subject one tendon hadbeen able to return to previous activity level.
The remainingeight subjects nine tendons were also referred for surgicaltreatment. Figure 1 Standard squattechnique. Figure 2 Decline squattechnique. Four of the six subjects five of ninetendons described in the decline group above were stillactive at pre-injury levels. One subject two tendons reported no symptoms in his patellar tendons, yet wasunable to continue comdromalacia sport because of the development ofbilateral patellofemoral pain syndrome after jump training.
Colour Doppler ultrasonography of condrkmalacia patellar tendonsshowed them to be normal. A further subject two tendons had condromalaciia relapse of significant patellar tendon pain mean VASscore 68 and had tried an alternative treatment within thefollow up period. Colour Doppler ultrasonography in rotulians caseshowed changes consistent with patellar tendinopathy. The overall mean SD of the VAS scores at 15 months forthe five remaining tendons in the decline group was We and others have also noted this in our clinicalpractices.
Thus, we sought modes by which eccentric exercisemay have greater efficacy when applied to patellar tendino-pathy. ocndromalacia
Idiopathic Chondromalacia Patellae
This pilot study is the first report of the effect ofeccentric exercise performed as a decline squat in thetreatment of painful patellar tendinopathy. However, it mustbe clearly recognised that, by its nature, bilaheral is non-randomisedand contains low numbers. In this study, subjects performing the eccentric squat onthe decline board showed good clinical results, with adecreased amount of pain during activity VAS score and areturn to previous activity level.
Most subjects whoperformed the standard squat had unsatisfactory clinicalresults over the 12 week treatment period. We speculate thatthe effectiveness of the decline squat may be the result of thedecline board reducing calf muscle tension, allowing betterisolation of the knee extensor bilaterao. We consider that from the results of this small pilot study,further clinical studies are warranted to test the efficacy ofthe exercise.
Such studies should use larger numbers, arandomised study design, and more specific outcomemeasures such as the VISA. Biomechanical studies comparing the cpndromalacia loads on theknee extensor mechanism with a standard and decline squatwould also be of benefit.
Idiopathic Chondromalacia Patellae – Knee & Sports – Orthobullets
Limitations of this studyThis study did not use a randomised design, as subjects whopresented first were given squat exercise without a declineboard, because at that time the decline squat had not beendeveloped. However, we were cautious not to change anyother aspects of the study design for the decline boardintervention.
The subject numbers of the study are small,particularly at the 15 month follow up. Outcome measuresshould be extended to include a more specific outcomemeasure such as the VISA scoring system developedspecifically for patellar tendinopathy. However, as the number of patients includedwas small, the data should be interpreted cautiously.
Randomised studies comparing different models of squatexercise are needed. Conservative treatment of patellartendinopathy. Physical Therapy in Sport ;2: Br J Sports Med; Kinetics of the parallel squat. A comparison of tibiofemoral joint forcesand electromyography activity during open and closed kinetic chain exercises.
Am J Sports Med ; Discriminative ability of functional loadingtests for adolescent jumpers knee.
Bilatsral Therapy in Sport ;4: Evaluation of eccentric exercise in treatment of patellartendinitis. J Sci Med Sport ;1: Table 3 Mean visual analogue scores VAS for standard and decline squat groups atbaseline and follow upStandard squat Decline squatBaseline12 weekfollow up Baseline12 weekfollow up15 monthfollow upVAS pain score Take home messagePatellar tendinopathy may be treated more effectively byapplication of eccentric exercise with the use of a declineboard.
The nilateral probably enables better isolation of theknee extensor mechanism in squat exercises. Treatment of patellar tendinopathy with the decline squat www. Receive free email alerts when new articles cite this article. Sign up in theNotes http: Tendinopatia Rotuliana Modelo de Actuacion Documents. Lesiones deportivas tendinitis rotuliana Sports.
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