TREATMENT OF АCHILLES TENDINOPATHY BY MEANS OF PHYSICAL THERAPY

Abstract

The purpose of the study was to analyze the effectiveness of the complex of eccentric and isometric exercises developed by us in the complex treatment of Achilles tendinopathy. Materials and methods. The Achilles tendon is a fibrous connective tissue cord formed by the fusion of the tendons of the gastrocnemius and soleus muscles and attached to the calcaneus. Achilles tendinopathy is a chronic progressive disease due to the gradual accumulation of traumatic, inflammatory and dystrophic degenerative lesions that lead to anatomical, structural and functional changes. Various methods of treating tendinopathy are proposed in the national and world literature, but there is no generally accepted methodology, and treatment methods are constantly changing. For example, the trend of using physical therapy for Achilles tendinopathy has recently changed significantly, namely, from prolonged immobilization with extremely gentle treatment of the affected tissue to early loading of the musculotendinous complex with special eccentric and isometric exercises. Paradoxically, according to experts, it is not immobilization and rest that restore dystrophically altered tissues in tendinopathy, but light special physical activity aimed at gradual, slow and gentle stretching of the calf muscles and Achilles tendon. The effectiveness of restoration of the Achilles tendon affected by tendinopathy using eccentric and isometric gymnastics was the purpose of the pedagogical experiment. It was voluntarily attended by 22 patients, who were randomly divided into 2 equivalent groups – the main and control groups – 11 participants each. To conduct the experiment, we developed a set of eccentric and isometric exercises aimed at relaxing the overworked and tense posterior muscles of the affected lower leg and Achilles tendon. The experiment lasted for a month and a half (6 weeks). The difference in the treatment of the patients in the main group was that they immediately began to engage in physical exercises developed by us, in addition to the basic treatment adopted in the medical institution (Rivne City Polyclinic No. 1) and received by patients of both groups. At the final stage of the experiment, the intensity of pain manifestations in the affected Achilles tendon (according to the visual analog pain scale) after moderate physical activity was investigated using two tests: 1. After one and a half kilometer walk at an average pace; 2. After a 10 cm jump test (30 jumps on one affected leg for 15 seconds – 2 jumps per second). In this section, we will analyze only the extreme indicators – the complete absence of pain (0 points) and the presence of intense pain (7–8 points). The following results were obtained: the complete absence of pain in the Achilles tendon, after one and a half kilometer walk, in patients of the main group was 27.3% less (9.1% vs. 36.7%) than in patients of the control group; the absence of pain after the jump test was also 27.3% less in the main group (0% vs. 27.3%). When analyzing the occurrence of intense pain (7-8 points), the following results were obtained after these tests: after dosed walking, pain in the Achilles tendon in patients of the main group was 18.2% less (0% vs. 18.2%), and after the jump test – by 9.1% (9.1% vs. 18.2%) than in the control group. Conclusions. The use of relaxation physical therapy, as part of the complex treatment of Achilles tendinopathy, namely eccentric and isometric exercises, has a positive effect on the restoration of local and general functional disorders of the tendon caused by the disease.