Programa de Retorno ao Esporte para Pacientes com Tendinopatia de Aquiles na Porção Média - Comentário Clínico

CLINICAL COMMENTARY KARIN GRÄVARE SILBERNAGEL PT ATC PhD KAY M CROSSLEY BAppSc Physio PhD A Proposed ReturntoSport Program for Patients With Midportion Achilles Tendinopathy Rationale and Implementation Despite being the largest tendon in the body the Achilles tendon is one of the most commonly injured tendons especially in athletes involved in running and jumping sportsactivities14 The incidence rate of injury is reported to be 235 per 1000 in the adult population20 and it is not unusual for patients to have pain intermittently for many years56 Achilles tendinopathy is a painful overuse injury that affects an athletes ability to be physically active4 During the early stages of the injury the patient might be able to continue with regular activities and sports but as the injury progresses the patients ability to be physically active is progressively impaired44 Repetitive overloading of the Achilles tendon and training errors such as rapidly increasing training intensity or duration are reported to be contributing factors in 60 to 80 of those who develop Achilles tendinopathy2839 Greater number of running years and mileage were evident in injured runners compared to uninjured runners26 Recurrence of Achilles tendinopathy symptoms was common and reinjury risk high in elite soccer players with short recovery periods23 Because return to sport is the goal of rehabilitation this clinical commentary aims to describe a rationale for and the implementation of a returntosport program for athletes with midportion Achilles tendinopathy that incorporates clinical decision making This returntosport program was developed based on knowledge gained from a randomized clinical trial that investigated the effect of running and jumping during the rehabilitation process45 This program has also been used successfully in a clinic for recreational and elite athletes with which the first author KGS has been affiliated for 10 years Successful returntosport planning also requires an understanding of the injury and knowledge of how to effectively manage the injury in the earlier stages of treatment This clinical commentary will also include a brief description of the injury and the evidence and recommendations for the treatment preceding the initiation of the returntosport program Achilles Tendinopathy Achilles tendinopathy is an overuse injury characterized by a combination of pain swelling diffuse or localized and impaired performance3844 The diagnosis is based on the patients history and the findings of the physical examination Achilles tendinopathy can be divided into midpor SYNOPSIS Achilles tendinopathy is a common overuse injury in athletes involved in running and jumping activities and sports The intervention with the highest level of evidence is exercise therapy and it is recommended that all patients initially be treated with exercise for at least 3 months prior to considering other treatment options Recovery from Achilles tendinopathy can take up to a year and there is a high propensity for recurrence especially during the returntosport phase The extent of the tendon injury the age and sex of the athlete the magnitude of painsymptoms the extent of impairments and the demands of the sport all need to be considered when planning for return to sport This clinical commentary describes an approach to return to sport for patients with midportion Achilles tendinopathy The aim of the returntosport program is to facilitate the decisionmaking process in returning an athlete with midportion Achilles tendinopathy back to full sport participation and to minimize the chances for recurrence of the injury J Orthop Sports Phys Ther 20154511876886 Epub 21 Sep 2015 doi102519jospt20155885 KEY WORDS Achilles tendon eccentric exercise jumping running tendinosis Department of Physical Therapy University of Delaware Newark DE School of Allied Health College of Science Health and Engineering La Trobe University Melbourne Australia The authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article Address correspondence to Dr Karin Grävare Silbernagel Department of Physical Therapy University of Delaware 540 South College Avenue Newark DE 19713 Email kgsiudeledu Copyright 2015 Journal of Orthopaedic Sports Physical Therapy 876 NOVEMBER 2015 VOLUME 45 NUMBER 11 JOURNAL OF ORTHOPAEDIC SPORTS PHYSICAL THERAPY