Effect of a Common Exercise Programme with an Individualised Progression Criterion Based on the Measurement of Neuromuscular Capacity Versus Current Best Practice for Lower Limb Tendinopathies (MaLaGa Trial): a Protocol for a Randomised Clinical...

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Aug 18

PMID 34404699

Authors

Adrian Escriche-Escuder

Antonio I Cuesta-Vargas

Jose Casana

Affiliations

Soon will be listed here.

Abstract

Introduction: High-load resistance training has shown positive effects in pain and function in lower limb tendinopathies. However, some authors suggest that current exercise programmes produce an increase in tolerance to load and exercise in general but without fixing some existing issues in tendinopathy. This may indicate the need to include training aspects not currently taken into account in the current programmes. The main objective of this study will be to compare the effect of a common exercise protocol for the three predominant lower limb tendinopathies (Achilles, patellar and gluteal), based on an individualised control of the dose and training of specific aspects of the neuromuscular system versus the current best practice for each location.

Methods And Analysis: This study will be conducted among people with mid-portion Achilles, patellar or gluteal tendinopathy. The participants allocated to the experimental group will perform a 14-week innovative common therapeutic exercise programme. Participants allocated to the control group will carry out a 14-week exercise programme based on the best current practice for each of the studied locations. The Victorian Institute of Sports Assessment questionnaire will be considered the primary outcome. Pain, central sensitisation, fear avoidance behaviour, quality of life, treatment satisfaction, lower-limb strength and function, and high-density electromyography profile will be evaluated as secondary outcomes. Outcomes will be assessed at baseline, 7 weeks, after the intervention (week 14), 26 weeks and 52 weeks.

Ethics And Dissemination: The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía Ethics Committee (1221-N-19). All participants will be informed about the purpose and content of the study and written informed consent will be completed. The results of this study will be published in a peer-reviewed journal and will be disseminated electronically and in print.

Trial Registration Number: NCT03853122; Pre-results.

References

Habets B, van Cingel R, Backx F, Huisstede B . Alfredson versus Silbernagel exercise therapy in chronic midportion Achilles tendinopathy: study protocol for a randomized controlled trial. BMC Musculoskelet Disord. 2017; 18(1):296. PMC: 5504829. DOI: 10.1186/s12891-017-1656-4. View

Alfredson H, Pietila T, Jonsson P, Lorentzon R . Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998; 26(3):360-6. DOI: 10.1177/03635465980260030301. View

Pareja-Blanco F, Alcazar J, Sanchez-Valdepenas J, Cornejo-Daza P, Piqueras-Sanchiz F, Mora-Vela R . Velocity Loss as a Critical Variable Determining the Adaptations to Strength Training. Med Sci Sports Exerc. 2020; 52(8):1752-1762. DOI: 10.1249/MSS.0000000000002295. View

Crombie K, Brellenthin A, Hillard C, Koltyn K . Endocannabinoid and Opioid System Interactions in Exercise-Induced Hypoalgesia. Pain Med. 2017; 19(1):118-123. PMC: 6454785. DOI: 10.1093/pm/pnx058. View

Carlsson A . Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain. 1983; 16(1):87-101. DOI: 10.1016/0304-3959(83)90088-X. View

Beyer R, Kongsgaard M, Hougs Kjaer B, Ohlenschlaeger T, Kjaer M, Magnusson S . Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med. 2015; 43(7):1704-11. DOI: 10.1177/0363546515584760. View

Neblett R, Mayer T, Hartzell M, Williams M, Gatchel R . The Fear-avoidance Components Scale (FACS): Development and Psychometric Evaluation of a New Measure of Pain-related Fear Avoidance. Pain Pract. 2015; 16(4):435-50. DOI: 10.1111/papr.12333. View

Habets B, van Cingel R . Eccentric exercise training in chronic mid-portion Achilles tendinopathy: a systematic review on different protocols. Scand J Med Sci Sports. 2014; 25(1):3-15. DOI: 10.1111/sms.12208. View

Malliaras P, Barton C, Reeves N, Langberg H . Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med. 2013; 43(4):267-86. DOI: 10.1007/s40279-013-0019-z. View

10.

Scott A, Squier K, Alfredson H, Bahr R, Cook J, Coombes B . ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology. Br J Sports Med. 2019; 54(5):260-262. DOI: 10.1136/bjsports-2019-100885. View

11.

Hernandez-Sanchez S, Poveda-Pagan E, Alakhdar-Mohmara Y, Hidalgo M, Fernandez-de-Las-Penas C, Arias-Buria J . Cross-cultural Adaptation of the Victorian Institute of Sport Assessment-Achilles (VISA-A) Questionnaire for Spanish Athletes With Achilles Tendinopathy. J Orthop Sports Phys Ther. 2017; 48(2):111-120. DOI: 10.2519/jospt.2018.7402. View

12.

Van Wilgen P, van der Noord R, Zwerver J . Feasibility and reliability of pain pressure threshold measurements in patellar tendinopathy. J Sci Med Sport. 2011; 14(6):477-81. DOI: 10.1016/j.jsams.2011.05.004. View

13.

Kountouris A, Cook J . Rehabilitation of Achilles and patellar tendinopathies. Best Pract Res Clin Rheumatol. 2007; 21(2):295-316. DOI: 10.1016/j.berh.2006.12.003. View

14.

Corradi E, Lanza M, Lacerda L, Andrushko J, Martins-Costa H, Diniz R . Acute physiological responses with varying load or time under tension during a squat exercise: A randomized cross-over design. J Sci Med Sport. 2020; 24(2):171-176. DOI: 10.1016/j.jsams.2020.07.015. View

15.

Tompra N, van Dieen J, Coppieters M . Central pain processing is altered in people with Achilles tendinopathy. Br J Sports Med. 2015; 50(16):1004-7. DOI: 10.1136/bjsports-2015-095476. View

16.

Cuesta-Vargas A, Roldan-Jimenez C, Neblett R, Gatchel R . Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus. 2016; 5(1):1837. PMC: 5074937. DOI: 10.1186/s40064-016-3515-4. View

17.

Tran Q, Docherty D . Dynamic training volume: a construct of both time under tension and volume load. J Sports Sci Med. 2013; 5(4):707-13. PMC: 3861774. View

18.

Martinez-Valdes E, Laine C, Falla D, Mayer F, Farina D . High-density surface electromyography provides reliable estimates of motor unit behavior. Clin Neurophysiol. 2016; 127(6):2534-41. DOI: 10.1016/j.clinph.2015.10.065. View

19.

Sancho I, Morrissey D, Willy R, Barton C, Malliaras P . Education and exercise supplemented by a pain-guided hopping intervention for male recreational runners with midportion Achilles tendinopathy: A single cohort feasibility study. Phys Ther Sport. 2019; 40:107-116. DOI: 10.1016/j.ptsp.2019.08.007. View

20.

Muff G, Dufour S, Meyer A, Severac F, Favret F, Geny B . Comparative assessment of knee extensor and flexor muscle strength measured using a hand-held vs. isokinetic dynamometer. J Phys Ther Sci. 2016; 28(9):2445-2451. PMC: 5080149. DOI: 10.1589/jpts.28.2445. View