Shock wave therapy associated with eccentric strengthening versus isolated eccentric strengthening for Achilles insertional tendinopathy treatment: a double-blinded randomised clinical trial protocol.

BACKGROUND: There is no consensus regarding the treatment of Achilles insertional tendinopathies. Eccentric training remains the main choice in the conservative treatment of this illness; however, the good results in the management of non-insertional Achilles tendinopathy were not replicated in the insertional condition. Low energy shock wave therapy has been described as an alternative to these patients, but has yet to be empirically tested. HYPOTHESIS: Shock wave therapy, adjunctive to the eccentric strengthening protocol, will improve measures of pain and function. DESIGN: Double blind, placebo-controlled, parallel groups, randomised clinical trial. MATERIALS AND METHODS: 93 patients with a diagnosis of chronic insertional tendinopathy, referred from primary or secondary healthcare services, will be assessed and enrolled in this study. They will be divided into two groups (randomised by sequentially numbered identical envelopes, which will be administered serially to participants), one containing the combination of low energy shock wave and eccentric exercises, as treatment and the other comprehending the exercises and the placebo treatment (an apparatus placed in the therapeutic head). The assessments will occur in 2, 4, 6, 12 and 24 weeks. Patients will be evaluated primarily by the Victorian Institute of Sport Assessment-Achilles questionnaire and secondarily by the visual analogue scale, Algometry, the American Orthopedic Foot and Ankle Society scale, the Foot and Ankle Outcome Score and the 12-item Short Form Health Survey. We will use comparison of two proportions via relative frequency analysis, the Pearson Correlation the χ2 test and the analysis of variance for statistical analyses. DISCUSSION: This study intends to demonstrate if the association of the eccentric exercise programme with the shock wave therapy can produce good results regarding the treatment of the Achilles insertional tendinopathy. In an attempt to prevent the high costs and complications associated with the surgical intervention, we will try to prove this combination as a viable therapeutic option in the conservative management of this prevalent condition. The strengths of the study are the design and the novelty of the combination of methods. The main limitation is the short follow-up course. ETHICS AND DISSEMINATION: The study is registered in the Clinical Trials database (protocol number: 8094833648737701) and was approved by the University Ethics Committee (number: 1373481). TRIAL REGISTRATION NUMBER: 8094833648737701 (NCT02757664); Pre-results.

Terapia extracorpórea por ondas de choque no tratamento da lesão muscular crônica / Extracorporeal shockwave terapy to treat chronic muscle injury

Objetivo: Avaliar o tratamento com terapia por ondas de choqueextracorpórea (TOCE) de baixa energia associada à fisioterapia notratamento das lesões musculares crônicas graus 2 e 3 nos membrosinferiores de atletas amadores. Métodos: Oito atletas com lesãomuscular do membro inferior há mais de três semanas foram tratadoscom fisioterapia e TOCE. Foram avaliados os seguintes parâmetrosdurante o tratamento: presença de gap palpável, força muscular,dor, e escala de Tegner, bem como as características de imagemultrassonográfica e a capacidade de retorno ao esporte. Resultados:O tempo médio de lesão na primeira avaliação foi de 8,75 semanas.Todos os pacientes evoluíram com força muscular grau V após oitosemanas. A dor passou de 5,75 para 0,5 pontos da escala visualanalógica de dor (EVA) ao final do tratamento. O questionário de Tegnerapós o tratamento atingiu em média seis pontos em sua escala.Os pacientes retornaram ao esporte em média após 8,14 semanas.Conclusão: TOCE associada à fisioterapia mostrou ser eficaz notratamento da lesão muscular de longa data, com boa evolução ecapacidade de retorno ao esporte de todos os pacientes avaliados.Nível de Evidência IV, Estudo Prospectivo de Série de Casos.

Objective: To evaluate the low energy extracorporeal shock wavestherapy (ESWT) associated with physical therapy in the treatmentof chronic muscle injuries classified as grades 2 and 3 in thelower limbs of amateur athletes. Methods: Eight athletes presentingwith lower limb muscle injury for more than three weeks weretreated with physiotherapy and ESWT. We evaluated the followingparameters during treatment: palpable gap, muscle strength,pain, and Tegner score, as well as ultrasound image features andthe ability to return to sports practice. Results: The average timeof the first evaluation of the injury was 8.75 weeks. All patientspresented muscle strength grade V after eight weeks. The painscore evolved from 5.75 to 0.5 points of the visual analoguescale (VAS), at the end of the treatment. The Tegner score aftertreatment was six points on average. Patients returned to sportspractice after 8.14 weeks. Conclusion: ESWT associated withphysical therapy proved to be effective to treat long-term muscleinjury, with good performance and the ability to return to sportpractice for all patients. Level of Evidence IV, Case Series,Prospective Study.

Consenso brasileiro de osteoporose 2002 / Brazilian consensus on osteoporosis 2002

Objetivo: estabelecer diretrizes para o diagnóstico precoce, prevenção e tratamento da osteoporose. Métodos: representantes das diferentes especialidades que estudam e trabalham com os diferentes aspectos da osteoporose participaram deste consenso, no qual estabeleceram estas diretrizes baseados em uma revisão sistemática da literatura buscando evidências científicas consistentes. Os trabalhos foram selecionados pela sua metodologia, desenho, medidas adequadas e validade dos resultados contemplando procedimentos diagnósticos, preventivos e terapêuticos. Resultados: Após extensa discussão os participantes produziram um texto básico sujeito a correções posteriores, e revisões até a aprovação final