Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
The Role of AchilloTrain® & AchilloTrain® Pro in the Management of Achilles Tendinopathy ® ® AchilloTrain and AchilloTrain Pro are elastic ankle supports featuring calcanear and paraAchilean silicon inserts and an ideal anatomical adaptation to rear foot and tibio-tarsal joint. This is particularly important because the form of the viscoelastic inserts determines function and efficiency of the massage performed by the support during rehabilitation of Achilles tendinopathy. Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowths seen in the tendon’s response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. ® ® AcilloTrain and AchilloTrain Pro are indicated in conjunction with all above options and also, in case of symptoms persistence with surgery, in the post-operative phase Tendons transmit forces generated from muscle to bone making joint movements possible. Mechanical load regulates the collagen synthesis and determines the structure –with specific hierarchical association levels – of tendons. Overload and overuse are factors triggering the derangement of tendon structure and pain. Achilles tendonitis is due to microtraumata resulting from repetitive overloading. Severity is related to duration and intensity of various activities. The onset mechanism of Achilles tendonitis is similar to that observed in epicondylitis and patello-femoral pain syndrome. In all cases the histological evaluation shows: (1) cellular activation and increase in cell numbers, (2) increase in ground substance, (3) collagen disarray and [1]. (4) neovascularisation . Proximal to their insertion tendons are relatively hypovascular. (The blood supply of the calcaneal tendon. J Bone Joint Surg Br 1989; 71:100-1). This hypovascularity may predispose the tendon to hypoxic degeneration. Pain comes from nociceptive neuropeptide substance P, calcitonin-gene-related-peptide and glutamate- found in high levels in painful tendons (but not in normal tendons). Tendons are enclosed by loose connective sheaths in continuity with muscle sheaths. The peritendinous sheath can be also exposed to inflammatory disease such as tenosynovitis. The cause of true tendon pain however is nearly always confined to the Achilles tendon itself. Many treatment options are offered to patients with painful tendons. There are no randomized or prospective studies that compare different conservative and surgical treatment regimens. Conservative treatment is recommended as the [1] [2]. [3]. . initial strategy by most authors ® ® AchilloTrain and AchilloTrain Pro have been designed to support the management of Achilles tendon injuries according to the following [1]. protocol 1. Reduce pain and swelling /edema (mucoid degeneration) (a) ice (b) magnetic field therapy, laser, HVGS (c) grade I transverse mobilization (d) medication 2. Reduce load on tendon (a) rest from aggravating activities until able to tolerate eccentric exercise program (b) heel raise (c) massage therapy (i) gastrocnemius (ii) soleus (d) joint mobilization (i) subtalar joint (ii) talocrural joint (iii) midtarsal joint 3. Regain extensibility (a) massage therapy (b) stretching 4. Improve strength of calf and tendon (a) eccentric strengthening program beginning as soon as patient can tolerate the exercise program. 5. Biomechanical assessment and correction of abnormalities. Return to activity gradually according to clinical features while maintaining a program of stretching / strengthening / icing. 1 ® The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy 1 [email protected] 09/02/2010 Product Features AchilloTrain® Pro ® AchilloTrain Pro is an ankle support featuring a specially designed viscoelastic anatomical silicon insert. The main features of the insert are: the wing shape, designed to cover the paraAchilean area from the retro-malleolar to the calf muscle tendon-transition levels; the longitudinal groove - aimed to center the insert on the Achilles’ tendon-, allows for the application of pressure on the target areas; and the nubs, with a distribution and a profile allowing for permanent superficial friction during movement. The pressure on the insert is exerted by the three-dimensional fold-free flat knitting fabric. • • • A stretch zone in the tibial area, Compression-reduced borders, Seamless (but elastic) welding -of the inserts- and • Breathable / moisture dissipating knitting, ® make wearing and removing AchilloTrain Pro extremely easy and comfortable. Maximal wearing comfort is necessary to avoid interferences with nociceptors. Edema and hematoma reabsorption is improved, by the elastic massage of the insert, during flexionextension. AchilloTrain® ® AchilloTrain is an ankle support featuring a specially designed viscoelastic anatomical silicon insert and a removable heel wedge. The last raises the heel (approx. 6mm) in order to comply with the requirements of point 2 (b) of the rehabilitation protocol described at Pag.1. The integrated -anatomically contouredviscoelastic insert exerts intermittent compression during movement generated by the bielastic three-dimensional fold-free flat knitting fabric of the support. Comfort is achieved by: • • • • A particularly stretchy new knitting concept, compression-reduced borders, seamless (but elastic) welding -of the inserts- and breathable / moisture dissipating knitting Indications 2 ® The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy 2 [email protected] 09/02/2010 Achillodynia (Tendinosis, paratendinitis, bursitis subachillea, [Haglund’s deformity], Post-op treatment after Achilles tendon ruptures). ® ® AchilloTrain and AchilloTrain Pro have been designed to support the management of Achilles tendinopathy. The classification of tendinopathy encompasses a variety of histopathologic changes classified by Puddu et al. as follows: (1)- acute tendonitis alone; (2)- chronic tendinosus with acute tendonitis; (3)- chronic tendinosus alone. (A classification of Achilles tendon disease. Puddu G; Ippolito E; Postacchini F;- Am J Sport Med 1976;4:145150.) Massage therapy - with and /or without heel raise – is “the approach” common to most rehabilitation protocols. The goal of this treatment is to reduce pain and swelling /edema as well as the load on tendon. Once pain has subsided, strengthening and stretching exercises are necessary to promote the formation of new collagen. The time to full recovery of Achilles tendinopathy is normally two to three months. During this period tendon swelling and paratenonitis are treated with massages techniques including sliding the paratenon over the tendon longitudinally and in a rotatory movement in [2]. the transverse plane ® ® AchilloTrain and AchilloTrain Pro support and continue the soft tissue massage maintaining this action –during movementlong after the rehabilitation session. ® ® Further AchilloTrain and AchilloTrain Pro contribute to pain reduction by two possible coexisting mechanisms related to their ability to generate intermittent compression. The first involves the interaction with the (neuro) inflammation process. By reducing edema, at superficial and interfascias tissue levels, compression reduces the onset of the inflammation cycle (eritema, edema, tenderness )and pain. ® The second is the result of friction massage of the affected region when the tissue is under tension (sustained myofascial tension treatment of calf muscle thickening) . (CLINICAL SPORT MEDICINE Peter Brukner; Karim Khan -III Edition- Ch.28 - Pain in the Achilles Region by Håkan Alfredson) Consistent with the “gate control theory” the skin contact with the support generates tactile stimulations interfering (with) and reducing pain perception. (Pain Mechanism: A New Theory –Melzack R.; Wall P.; Science: 150, 171-9, 1965 AchilloTrain® Pro ® AchilloTrain Pro is indicated when pain is located (mainly) at mid–tendon level. Treatment of focal tendon nodules can be best ® treated with AchilloTrain Pro. Tendon nodules are lesions of the tendinosis causing pain and tenderness without much swelling. The nodules move as the tendon is moved trough full range in contrast to the lesion of the paratendon, which remains fixed as tendon slides. The action of tissue massage produced ® by the insert of AchilloTrain Pro is focused on the whole length of the tendon. AchilloTrain® ® AchilloTrain is indicated when pain is located (mainly) at tendon insertion level. The effect of the viscoelastic heel pad -inserted in the calcaneal area of the support- is important through all three phases of tendininopathy evolution. The magnitude of unloading - heel height- necessary to achieve pain relive remains a very subjective matter. When tendinopathy treatment has to be started with a more gradual progression (as for partial tendon tears) the heel pad insert justify the use ® of AchilloTrain . The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy 3 [email protected] 09/02/2010 3 Conclusion ® ® AchilloTrain and AchilloTrain Pro have a synergistic effect in the rehabilitation of Achilles tendinopathy. Massage and unloading effects, during and after rehabilitation, are valuable adjuncts to the therapeutic effect of eccentric training. Though few data support definitive conclusions regarding their effectiveness, elastic supports are safe and helpful in the management of most musculoskeletal disorders. Beside reducing pain –“gate control mechanism”-, the compression effect of AchilloTrain ® and AchilloTrain Pro produce friction massage having a beneficial effect on all three phases of both tendinopathy –as classified by Puddu et al.- and repair: • Friction stimulates phagocytosis (mobilization of tissue fluids). • Friction stimulates fibre orientation in regenerating connective tissue. • Friction prevents adhesion formation and ruptures unwanted adhesions. • Friction induces a traumatic hyperemia (vasodilatation increased blodflow). ® References 1. A TREATMENT ALGORITHM FOR MANAGING ACHILLES TENDINOPATHY: NEW TREATMENT OPTIONS. Håkan Alfredson, J Cook - Br J Sports Med 2007;41:211–216. doi: 10.1136/bjsm.2007.035543 2. CLINICAL SPORT MEDICINE Peter Brukner; Karim Khan -III EditionCh.28 - Pain in the Achilles Region by Håkan Alfredson. 3. PRINCIPLE OF REHABILITATION AFTER CHRONIC TENDON INJURIES. - Kibler W.B.; Chandler T.J.; Pace B.K.;- Clin. Sports Med 11, pp.661-671; 1992-. ® The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy 4 [email protected] 09/02/2010 4