RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DESERTATION
1 / NAME OF THE CANDIDATE / SREENATH.SS/O SIVARJI.A
PEDDAELASAGRI
HOSUR
2 / NAME OF THE INSTITUTE / K.T.GCOLLEGE OF PHYSIOTHERAPHY
3 / COURSE OF STUDY AND SUBJECT / MASTERS OF
PHYSIOTHERAPHY (MUSCULOSKELETAL
DISORDERS AND SPORTS PHYSIOTHERAPHY)
4 / DATE OF ADMISSION TO COURSE / 9-06-2010
5 / TITLE OF THE TOPIC
“EFFECT OF SUBMAXIMAL ECCENTRIC TRAINING FOR THE TREATMENT OF ACHILLES TENDINOSIS”.
BRIFE RESUME OF INTENDED WORK:
5.1 NEED OF THE STUDY:
Achilles tendinosis is defined as the degeneration of Achilles tendon due to repetitive micro trauma without associated inflammation .
Achilles tendon is the largest tendon in the human body and is very vulnerable to injury . Achilles tendon maladies may account for 5-10 % of all the athletic injuries and theyare the major problem in almost every sport activities like running , tennis and basketball.
The majority of Achilles tendon overuse injuries occur in middle aged , athletic males, Runners with overly pronated feet may be at greater risk for developing Achilles
tendinosis . The increased pronation may put additional stress on the tendon , therefore , placing it at greater risk for injury .
Electronic muscle work is a lengthening muscle action . and eccentric training is particularly effective in treating the tendenopathies it helps to promote the formation of new collagen , and proved beneficial in Achilles tendinosis .
The project ect.aims to find the effect of submaximal eccentric training exercises for treatment of Achilles tendinosis .
HYPOTHESIS:
NULL HYPOTHESIS:
There will be no significant difference between submaximal eccentric training for the Achilles tendinosis reducing pain improving ankle joint range of motion for patients
ALTERNATE HYPOTHESIS:
There will be significant difference between submaximal eccentric training for the Achilles tendinosis reducing pain improving ankle joint range of motion for patients
5.2 REVIEW OF LITERATURE
- Alfredson. H, Lorentzon. R (1988) conducted a study in 15 patients
training for 12 weeks showed very promising results and may
possible reduce the needs for surgical treatment.
- Sean Hulvaney M.D., Conducted study on 30 patients. 15 patients
conservative therapy for 12 weeks. The result supported. Heavy-load
eccentric calf muscle training appears to be effective safe, and
reasonable treatment of chronic condition.
- S Hakabi, Adel, et al. Conducted study on 22 patients. With eccentric
tendon examined with MRI. The result shows immediate response of
eccentric loading and increase in tendon volume both eccentric and
concentric training of Achilles tendon result in increased total tendon
volume.
- Mafi, Loreentzon et al. Conducted study on 44 patients. The 22
22 patients (12 men and 10 women) were treated with the concentric
training. The result showed that after eccentric training regimen 82%
resume previous activity level. Compared to 30% who were treated
with concentric training.
- Alfredson. H. Nordstrom. P, et al. Conducted study 14 patients [12
Eccentric calf results were excellent, all the 14 patients were at their
Pre injury level.
- Astrom, Rausing. A (1995). Conducted study in 22 patients 25%
training. Surgical treatment took long time to recover but eccentric
training showed promising result and minimized the need for surgery.
- Alfredson. H, et al. (1998) Conducted study on so recreational
treated conventionally. Conventional treatment was not successful. The
patients treated with 12 weeks eccentric training has very good short-
term effects.
- Oberg. L, Lorentzon, R, et al. Conducted study in 26 patients with
for 12 weeks who had long duration of painful symptom. The
ultrasound shows the normalized tendon structure after eccentric
training.
- Alfredson. H, Pietila. T, Et Al. conducted a study on 12 patients treated
measurement were donepre operatively and at 16, 26,32 weeks post
operatively the concentric and eccentric peak torque show a slow
increase after surgery.
- Mouraux A1. D, B. Stallenburg et al. designed a study the effects of six
peak torque and cross sectional area of calf muscle in 10 patients sectional
area of calf muscle in 10 patients following training the peak torque is
increased.
5.3 OBJECTIVES OF THE STUDY:
The objectives of the study are:
To evaluate the calf muscle strength and amount of pain
after eccentric training.
To evaluate the range of motion of ankle after the
Eccentric training.
6.1 METHOD OF COLLECTION OF DATA:
STUDY DESIGN:
Type of Study
An experimental study.
Population of the study
Population chosen were the patients with Achilles tendunosis,
referred by orthopedic surgeon of K.T.G Hospitals Bangalore,
patients were informed for the proposed research study with their
consent 30 patients were selected for the study who has fulfilling
the following criteria.
MATERIALS USED:
a)Ice pack
b)Ultra sound
c)IFT (Vectrostiom)
d)Conducting Gel
e)Weighs
f)Towel
g)Cotton
h)Sand bag
i)Pillow
Inclusion Criteria
a) Irrespective gender
b)Age between 40 to 45
c)Recreational athlete
d)Patients muscle power 3.
Exclusive Criteria
Age below 35
Osteoporosis
III degree strain
Measurement Tools
Goniometer
Visual Analog Scale
Out come measures
The pain during and after the training was measured using the
Visual Analog Scale
The Range of motion was measured by the goniometer
The strength of the calf muscle was measured using the manual
muscle testing.
7.1 METHEDOLOGY
Individually informed consent will be taken from all the 30 subjects selected for the study on the basis of inclusion & exclusion criteria.
INTERVENTION TO BE CARRIED ON PARTICIPANTS:
Treatment Procedure:
ECCENTRIC MUSCLE ACTION – A RESPONSE TO TRAINING
Eccentric muscle action is lengthening muscle contraction. The
muscle fiber (sarcomere) cross bridges are at their maximal overlap at
the beginning of the contraction, therefore, the eccentric contraction
Generates more tension that both concentric and isometric contractions.
It has been proposed that possible explanations for the positive
affects of eccentric training on tendinitis might be either an effect of
stretching, with a lengthening of muscle tendon unit and consequently
less strain during ankle joint motion or hypertrophy and increase strength
in the tendon (Albertson, pletila, josson). It is the concept that may
Explain the possible remodeling effect of tendon due to eccentric exercise.
The Eccentric Exercise Program
The eccentric exercise program starts after 7 – 10 Days when patient pain subsides
3 steps of 10 repetitions eccentric exercise 1 set of 10 times
CRYOTHERAPY
Duration: 10 minutes
Begin and end the eccentric program with ice
Ice through a wet towel over the tendon for 10 minutes period are most effective.
WARM UP:
Duration: 5-15 minutes
Began each training session with a walk to warm up. Followed
by Exercises
Walking 4 min
Jogging 2 Min
Repeat 4 Times
Gradual Return to fitness:
Thera – Band Exercise
Position:Long sitting
Technique:start with toes pointed, giving resistance
Trough the thera-band slowly allow your
foot into dorsiflexion.
Duration:3 sets of 10 repetitions and progressed
later 1 Sets of 10 Times
Heel Drop – Both Legs
Position:Standing
Technique:Stand on the edge of step or ankle boardsid lower the heels
down, both at same time. You can adjust theassuredon injured leg by taking most of your weight in good leg.speat this exercise as many times as it is comfortable. Do not over
doespecially in the early stages.
Repeat the exercise twice daily progress to do two and ten threeSets at a time.
Increase the speed number of sets and the amount of weight as
Tolerated.
- Wight is supported on both feet during toe exercise.
- Weights the shift of weight to the involved.
- Weights in supported on the involved side only
- Increase the speed of dropping.
- Add weight to shoulders.
Duration: 3X30 sec calf stretches
Stretching is the term used to describe any therapeutic Maneuver
designed to lengthen (elongate) pathologically shorted soft tissue
structures and thereby to increase range of motion.
Passive stretching :
Position of Patient: supine lying
Position of therapist: Standing beside the Patient.
Procedure:
The therapist holds the lower thigh region with his left hand and flexing the knee.
The therapist’s right hand holds the heel in neutral position.
Slowly extending the knee with the left hand and dorsiflexes the heel with the right hand
Self-Stretching:
Standing on slopping surface and falling forwards
Standing on the steps with the ball of the toes.
Apply “cold therapy” to after stretching exercises.
Electrotheraphymodalities
The Electrotherapy modalities include
1. Ultra sound
Duration: 10 minutes
Position: prone lying
Intensity: 1W/cm2
Mode : Pulsed mode
Frequency:1 MHz
Technique: Around the Achilles tendinosis.
Subject will be positioned in prone lying in couch the ultra sound along with the coupling medium over the transducer is given on the tendon
2. INTER FERENTIAL THERAPHY(IFT)
Duration: 15 Minutes
Position:Prone lying
Frequency: 80.-100 Htz
Pulse width: 150 us
Intensity: 30 mA
Technique:
IFT being applied to the lateral and medial aspect of the ankle joint. The electrode are secuted in position with adhesive pads and pulsar unit is shown to given indication of patients.
STATISTICAL ANALYSIS:
Clinical Features.
Symptoms usually are described as diffuse pain in or around back
Of the ankle (from calf to heel.)
The pain is aggravated by activity especially uphill running or stair
Climbing and by wearing higher – heeled shoes.
Palpation well reveal tender thickening of the peri tendon.
Diagnosis
- MRI
- Ultra sound – hypo echoic areas
a) Stair Climbing Test
Ask the patient to put the forefoot of the normal leg on the edge of a
step, and lift himself up on that leg as in stair climbing. Repeat the
test with injured leg the patient will be unable to lift himself up on
that leg due to discontinuity of Achilles tendon.
b) Thompson’s Grip Test
in the normal leg with the knee in flexion when the calf muscle is
compressed by gripping, the foot moves into plantar flexion when
the Achilles tendon is lost by rupture the grip compression does not
cause plantar flexion on the foot.
7.2 ETHICAL CLEARANCE:
As the study includes human subjects ethical clearance will be obtained from research and ethical committee of institution. Also a written consent will be taken from each subject who participates in the study.
8.1 LIST OF REFERENCE:
- DAVID J. MAGEE ; “Orthopedic physical Assessment” – (2002)
- DAVID. REID, B.P.T, M.D. “Sports injury Assessment and
- KOLT SYNDER - ,ACKLER, “physical therapies in sports and
- JOSEPH J. CIPRIANO – “Regional orthopeadic and neurological
- TORTORA GRABOWSKI – “Principles of anatomy and physiology”-
- B.D. CHAURASIA’S “HUMAN ANATOMY” – (2000)
- BRENT BROTZMAN – “The essential orthopedics” – (1998)
- SMART GW, TAUTON JE, CLEMENT DB, “Medicine and science in
- GROSS MT ‘ “Orthopedic and sports physical therapy” –(1992)
- JOHN EBNEZER - “Essentials of orthopedics for
JOURNALS
- Alfredson. H, Pietila. T, et al. Heavy – load eccentric calf muscle
journal of sports medicine-1998, May – Jun. 360-6.
- Ohberg. L, Lorenzon, et al. eccentric training in patient with
decreased normalized tendon structure and decreased thickness at
follow up. Britaian journal of sports medicine – 2004.
- Mafi. N, Lorentzon et al. Superior short term results with
randomized prospective multicenter study in patients eith chronic
Achilles tendinosis knee surg, sports traumatol aarthrose – 2001.
- Niesen – Vertommen. SI et al. the effect of eccentric versus
journal sports medicine – 1992.
9 / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF THE GUIDE
11 / NAME AND DESIGNATION (IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
12 / 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
1