Die Rolle der optimalen Belastung

Zusammenfassung

CHRONISCHE ENTZÜNDUNG DER ACHILLES- UND PATELLASEHNE Lange Zeit schien festzustehen, dass Übungsprogramme mit isolierter exzentrischer Belastung bei Tendinopathien zu guten klinischen Ergebnissen führen. Dieses Paradigma steht inzwischen jedoch in Frage: Aktuelle Forschungsergebnisse zu morphologischen und pathologischen Eigenschaften von Sehnen weisen darauf hin, dass exzentrisches Training womöglich nicht immer der alleinige Heilsbringer ist.

• Literatur

• 1 Alfredson H. The chronic painful Achilles and patellar tendon: Research on basic biology and treatment. Scand. J. Med. Sci. Sports 2005; 15: 252-259
• 2 Larsson ME, Kall I, Nilsson-Helander K. Treatment of patellar tendinopathy – a systematic review of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc 2012; 20: 1632-1646
• 3 Malliaras P, Barton CJ, Reeves ND. et al. Achilles and patellar tendinopathy loading programmes: A systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med 2013; 43: 267-286
• 4 Couppe C, Svensson RB, Silbernagel KG. et al. Eccentric or concentric exercises for the treatment of tendinopathies?. JOSPT 2015; 1-25
• 5 Seynnes OR, Erskine RM, Maganaris CN. et al. Training-induced changes in structural and mechanical properties of the patellar tendon are related to muscle hypertrophy but not to strength gains. J Appl Physiol Aug 2009; 107 (02) 523-530
• 6 Kongsgaard M, Reitelseder S, Pedersen TG. et al. Region specific patellar tendon hypertrophy in humans following resistance training. Acta Physiol (Oxf.) 2007; 191 (02) 111-121
• 7 Couppe C, Kongsgaard M, Aagaard P. et al. Differences in tendon properties in elite badminton players with or without patellar tendinopathy. Scand J Med Sci Sports 2013; 23 e89–95
• 8 Maeda E, Shelton JC, Bader DL. et al. Time dependence of cyclic tensile strain on collagen production in tendon fascicles. Biochem Biophys Res Commun 2007; 362: 399-404
• 9 Arampatzis A, Karamanidis K, Albracht K. Adaptational responses of the human Achilles tendon by modulation of the applied cyclic strain magnitude. J Exp Biol 2007; 210: 2743-2753
• 10 Arampatzis A, Peper A, Bierbaum S. et al. Plasticity of human Achilles tendon mechanical and morphological properties in response to cyclic strain. J Biomech 2010; 43: 3073-3079
• 11 Young MA, Cook JL, Purdam CR. et al. Eccentric decline squat protocol offers superior results at 12 months compared with traditional eccentric protocol for patellar tendinopathy in volleyball players. BJSM 2005; 39: 102-105
• 12 Frohm A, Halvorsen K, Thorstensson A. Patellar tendon load in different types of eccentric squats. Clin Biomech 2007; 22: 704-711
• 13 Kongsgaard M, Aagaard P, Roikjaer S. et al. Decline eccentric squats increases patellar tendon loading compared to standard eccentric squats. Clin Biomech 2006; 21: 748-754
• 14 Rathleff MS, Molgaard CM, Fredberg U. et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2014
• 15 Andersen LL, Magnusson SP, Nielsen M. et al. Neuromuscular activation in conventional therapeutic exercises and heavy resistance exercises: implications for rehabilitation. Phys Ther 2006; 86: 683-697
• 16 Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: Balancing the response to loading. Nat Rev Rheumatol 2010; 6: 262-268
• 17 Kjaer M, Heinemeier KM. Eccentric exercise: acute and chronic effects on healthy and diseased tendons. J Appl Physiol 2014; 116: 1435-1438
• 18 Farup J, Rahbek SK, Vendelbo MH. et al. Whey protein hydrolysate augments tendon and muscle hypertrophy independent of resistance exercise contraction mode. Scand J Med Sci Sports. 2013
• 19 Frohm A, Saartok T, Halvorsen K. et al. Eccentric treatment for patellar tendinopathy: A prospective randomised short-term pilot study of two rehabilitation protocols. BJSM 2007; 41 e7
• 20 Jonsson P, Alfredson H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: A prospective randomised study. BJSM 2005; 39: 847-850
• 21 Kongsgaard M, Kovanen V, Aagaard P. et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports 2009; 19: 790-802
• 22 Beyer R, Kongsgaard M, Hougs Kjaer B. et al. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: A randomized controlled trial. AJSM. 2015
• 23 Visnes H, Hoksrud A, Cook J. et al. No effect of eccentric training on jumper’s knee in volleyball players during the competitive season: A randomized clinical trial. Clin J Sport Med 2005; 15: 227-234
• 24 Silbernagel KG, Thomee R, Eriksson BI. et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: A randomized controlled study. AJSM 2007; 35: 897-906
• 25 Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: Balancing the response to loading. Nat Rev Rheumatol 2010; 6: 262-268
• 26 Khan KM, Cook JL, Bonar F. et al. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 1999; 27: 393-408
• 27 Maffulli N, Testa V, Capasso G. et al. Similar histopathological picture in males with Achilles and patellar tendinopathy. Med Sci Sports Exerc 2004; 36: 1470-1475
• 28 Fahlstrom M, Jonsson P, Lorentzon R. et al. Chronic Achilles tendon pain treated with eccentric calf-muscle training 1. Knee Surg Sports Traumatol Arthrosc 2003; 11: 327-333
• 29 Jonsson P, Alfredson H, Sunding K. et al. New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: Results of a pilot study. BJSM 2008; 42: 746-749
• 30 de Vos RJ, Weir A, Visser RJ. et al. The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: A randomised controlled trial. BJSM 2007; 41 e5
• 31 Petersen W, Welp R, Rosenbaum D. Chronic Achilles tendinopathy: A prospective randomized study comparing the therapeutic effect of eccentric training, the AirHeel brace, and a combination of both. AJSM 2007; 35: 1659-1667
• 32 Roos EM, Roos HP, Lohmander LS. et al. Knee Injury and Osteoarthritis Outcome Score (KOOS) – development of a self-administered outcome measure. JOSPT 1998; 28: 88-96
• 33 Yelland MJ, Sweeting KR, Lyftogt JA. et al. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: A randomised trial. BJSM 2011; 45: 421-428
• 34 Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE. et al. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. J Foot Ankle Res 2012; 5: 15
• 35 Al-Abbad H, Simon JV. The effectiveness of extracorporeal shock wave therapy on chronic achilles tendinopathy: A systematic review. Foot Ankle Int 2013; 34: 33-41
• 36 Andres BM, Murrell GA. Treatment of tendinopathy: What works, what does not, and what is on the horizon. Clin Orthop Relat Res 2008; 466: 1539-1554
• 37 Coombes BK, Bisset L, Brooks P. et al. Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: A randomized controlled trial. JAMA 2013; 309: 461-469