RESUMO
BACKGROUND: There remains a lack of consensus regarding the treatment of Achilles insertional tendinopathy. The condition is typically treated with eccentric exercises despite the absence of satisfactory and sustained results. Shockwave therapy was presented as an alternative, but there is a paucity of literature, with good outcomes, supporting its use. The purpose of the present single-center, double-blinded, placebo-controlled, randomized trial was to determine if the use of shockwave therapy in combination with eccentric exercises improves pain and function in patients with Achilles insertional tendinopathy. METHODS: A total of 119 patients with Achilles insertional tendinopathy were evaluated and enrolled in the study from February 2017 to February 2019. Patients were allocated to 1 of 2 treatment groups, eccentric exercises with extracorporeal shockwave therapy (SWT group) and eccentric exercises with sham shockwave therapy (control group). Three sessions of radial shockwaves (or sham treatment) were performed every 2 weeks and eccentric exercises were undertaken for 3 months. The primary outcome was the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) at 24 weeks. Secondary outcomes included the visual analogue scale, algometry, the Foot and Ankle Outcome Score, and the 12-Item Short Form Health Survey. RESULTS: Both groups showed significant improvement during the study period; however, there were no between-group differences in any of the outcomes (all p >0.05). At the 24-week evaluation, the SWT group exhibited a mean VISA-A of 63.2 (95% confidence interval, 8.0) compared with 62.3 (95% confidence interval, 6.9) in the control group (p = 0.876). There was a higher rate of failure (38.3%) but a lower rate of recurrence (17.0%) in the SWT group compared with the control group (11.5% and 34.6%, respectively; p = 0.002 and p = 0.047). There were no complications reported for either group. CONCLUSIONS: Extracorporeal shockwave therapy does not potentiate the effects of eccentric strengthening in the management of Achilles insertional tendinopathy. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Tendão do Calcâneo/patologia , Terapia por Exercício , Tratamento por Ondas de Choque Extracorpóreas/métodos , Dor Musculoesquelética/terapia , Tendinopatia/terapia , Tendão do Calcâneo/fisiopatologia , Método Duplo-Cego , Feminino , Ondas de Choque de Alta Energia/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/fisiopatologia , Medição da Dor/estatística & dados numéricos , Recidiva , Tendinopatia/complicações , Tendinopatia/patologia , Tendinopatia/fisiopatologia , Resultado do TratamentoRESUMO
The essential oils of Brazilian Piper lepturum var. lepturum and Piper lepturum var. angustifolium (Piperaceae) were obtained by hydrodistillation and analyzed by flame-detector gas chromatography (GC) and gas chromatography coupled to mass spectrometry (GC/MS). According to GC and GC/MS analysis, the essential oils are mostly composed by sesquiterpenes hydrocarbons. beta-Guaiene (29.96 percent) was the principal component in the essential oil of P. lepturum var. lepturum and beta-Bisabolene (17.72 percent) was the principal components in the essential oil of P. lepturum var. angustifolium.
Los aceites esenciales de las especies brasileñas Piper lepturum var. lepturum y Piper lepturum var. angustifolium fueron obtenidos por hidrodestilación y analizados utilizando cromatografía gas líquido con detector de ionización de llama (CG) y cromatografía gas líquido acoplada a un detector de masas (CG/EM). De acuerdo con los análisis de CG y CG/EM, los aceites esenciales muestran como componente principal beta-Guaieno (29,96 por ciento) en el aceite esencial de P. lepturum var. lepturum y beta-Bisaboleno (17,71 por ciento) en el aceite esencial de P. lepturum var. angustifolium.