Tratamiento de la tendinopatia rotuliana a traves del ejercicio: Una revision sistematica
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2018-04-05
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Jaén: Universidad de Jaén
Resumen
[ES] Introducción: La tendinopatía rotuliana es una lesión crónicas de carácter degenerativo, que presenta una alta prevalencia en sujetos deportistas, alto porcentaje de recidivas y llega incluso a forzar el abandono deportivo. Existe una amplia gama de tratamientos, destacando entre ellos el ejercicio físico por ser económico y de fácil aplicación, pero la evidencia científica es limitada y no hay consenso en cuanto a cual es el tratamiento mas efectivo.
Objetivo: Conocer la efectividad de los distintos tratamiento de la tendinopatía rotuliana a través de ejercicio físico y compararlo con otros tratamientos más complicados de llevar a cabo, con mayor coste, mayores riesgos y de discutida efectividad.
Material y Método: Se realizaron búsquedas en las bases de datos Medline, Scopus, PEDro y Scielo utilizando las palabras clave: “Patellar tendinopathy exercise” y “Jumper´s knee exercise”. Los artículos seleccionados fueron ECAs en inglés o español, cuya intervención se realizara sobre sujetos con tendinopatía rotuliana.
Resultados: Se seleccionaron 9 artículos, con una calidad metodológica PEDro entre 3 y 8. De los 9 artículos, 5 evaluaban el dolor (EVA) y 6 analizaban la función (VISA-P) entre otras variables. De los 9 estudios, 1 comparaba la efectividad de la cirugía Vs el ejercicio terapéutico, 3 compararon distintos tipos de protocolos de ejercicios, 3 compararon distintos tratamientos conservadores con el ejercicio, y 2 compararon ejercicio con un grupo control. Se encontraron mejoras significativas en cuanto al manejo del dolor y mejora de la funcionalidad a través de los ejercicios excéntricos (EEs) aislados, EEs combinados con estiramientos antes y después, EEs sobre plano inclinado, y entrenamiento de resistencia de alta carga (HSR).
Conclusión: Debido a la heterogeneidad de los resultados, estudios y protocolos parece que hay una evidencia moderada a favor del uso del ejercicio físico terapéutico (concretamente el ejercicio excéntrico), para disminuir el dolor y mejorar la función en la tendinopatía rotuliana. No hay consenso en cuanto al protocolo más adecuado, por lo que es necesario realizar más estudios y mejor diseñados donde se puedan analizar las distintas variables y diseñar un protocolo universal óptimo para esta patología.
[EN] Background: Chronic patellar tendinopathy is a degenerative injury, which has a high prevalence in athletes, high rate of recurrence and even force subjects to drop out their sports. There is a wide range of treatments, stand out physical exercise for inexpensive and easy to apply, but the scientific evidence is limited and there is no consensus about what is the most effective treatment. Objective: To determine the effectiveness of different treatment of patellar tendinopathy through exercise, and compare it to other treatments more complicated to carry out, with higher costs, greater risks and a controversial effectiveness. Methods: A search was achieved in Medline, Scopus, PEDro and Scielo database using the keywords: "Patellar tendinopathy exercise" and "Jumper's knee exercise". The articles selected were RCTs written either in English or Spanish, whose procedures took place on subjects with patellar tendinopathy. Results: 9 articles were selected, with a PEDro methodological quality between 3 and 8. 5 of them analyced pain (EVA) and 6 assessed the function (VISA-P) among other variables. From these 9 studies, one compared the effectiveness of surgery Vs therapeutic exercise, 3 compared different types of exercise protocols, 3 compared different conservative treatments against the exercise, and the last 2 studies compared exercise with a control group. Significant improvements were found in the pain management and function through eccentric exercises (EEs) isolated, EEs combined with stretching before and after, EEs on inclined plane, and heavy slow resistance training. Conclusion: Due to the heterogeneity of results, studies and protocols, there seems to be a moderate evidence that the use of therapeutic exercise (particularly eccentric exercise) reduces pain and improves function in patellar tendinopathy. There is no consensus about the most appropriate protocol, for that reason more and better designed studies are required, where they can analyze the different variables and design an optimal universal protocol for this injury.
[EN] Background: Chronic patellar tendinopathy is a degenerative injury, which has a high prevalence in athletes, high rate of recurrence and even force subjects to drop out their sports. There is a wide range of treatments, stand out physical exercise for inexpensive and easy to apply, but the scientific evidence is limited and there is no consensus about what is the most effective treatment. Objective: To determine the effectiveness of different treatment of patellar tendinopathy through exercise, and compare it to other treatments more complicated to carry out, with higher costs, greater risks and a controversial effectiveness. Methods: A search was achieved in Medline, Scopus, PEDro and Scielo database using the keywords: "Patellar tendinopathy exercise" and "Jumper's knee exercise". The articles selected were RCTs written either in English or Spanish, whose procedures took place on subjects with patellar tendinopathy. Results: 9 articles were selected, with a PEDro methodological quality between 3 and 8. 5 of them analyced pain (EVA) and 6 assessed the function (VISA-P) among other variables. From these 9 studies, one compared the effectiveness of surgery Vs therapeutic exercise, 3 compared different types of exercise protocols, 3 compared different conservative treatments against the exercise, and the last 2 studies compared exercise with a control group. Significant improvements were found in the pain management and function through eccentric exercises (EEs) isolated, EEs combined with stretching before and after, EEs on inclined plane, and heavy slow resistance training. Conclusion: Due to the heterogeneity of results, studies and protocols, there seems to be a moderate evidence that the use of therapeutic exercise (particularly eccentric exercise) reduces pain and improves function in patellar tendinopathy. There is no consensus about the most appropriate protocol, for that reason more and better designed studies are required, where they can analyze the different variables and design an optimal universal protocol for this injury.