Acupuncture for chronic achilles tendonpathy

NewsBot · Jan 4, 2013

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Acupuncture for chronic achilles tendnopathy: A randomized controlled study
Zhang BM, Zhong LW, Xu SW, Jiang HR, Shen J.
Chin J Integr Med. 2012 Dec 21.

OBJECTIVE:
To examine whether acupuncture treatment would improve outcome in chronic Achilles tendinopathy.

METHODS:
A randomized, controlled trial at two centers of 64 randomized patients aged 18 to 70 years with chronic Achilles tendinopathy was conducted from July 2007 to April 2010, with follow-up until October, 2010. These patients were randomly allocated into an acupuncture treatment group (acupuncture group) and an eccentric exercises group (control group). The validated Victorian Institute of Sports Assessment- Achilles (VISA-A) questionnaire was completed at baseline and 8, 16, and 24 weeks. The pain at rest and after activity was accessed at baseline and 8 weeks with Visual Analogue Scale (VAS).

RESULTS:
After randomization into the acupuncture group or control group, one patient was loss of follow-up. The mean VISA-A score improved significantly after 8 weeks in the acupuncture group to 67.1 points [95% confidence interval (CI), 64.1-70.2] and in the control group to 48.5 points (95% CI, 45.5-51.6) with an additional 18.6 points increase in acupuncture treatment patients (P =0.0000). Acupuncture treatment resulted in a significant increase from baseline in VISA-A of 25.8 after 16 weeks and 28.4 after 24 weeks. Whereas, in the control group the increase from baseline in VISA-A were 10.0 and 16.6 after 16 and 24 weeks, respectively (P =0.0000). The VAS diminished by 2.0 cm after activity, and by 1.5 cm at rest after 8 weeks in the control group. In the acupuncture group, the pain scores diminished significantly more than in the control group, with pain reduction of 3.7 cm after activity (P =0.0000) and 3.2 cm at rest (P =0.0000).

CONCLUSION:
Acupuncture intervention could improve pain and activity in patients with chronic Achilles tendinopathy compared with eccentric exercises.
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Admin2 · Jan 4, 2013

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Acupuncture for Plantar Fasciitis

NewsBot · May 15, 2013

Comparison of the acute inflammatory response and proliferation of dry needling and electrolysis percutaneous intratissue (epi) in healthy rat achilles tendons.
Valera-Garrido F, Minaya-Muñoz F, Sánchez-Ibáñez JM, García-Palencia P, Valderrama-Canales F, Medina-Mirapeix F, Polidori F.
Br J Sports Med. 2013 Jun;47(9):

INTRODUCTION:
Electrolysis Percutaneous Intratissue (EPI) is a new technique that involves the application of a galvanic current with an acupuncture needle that causes a theoretical local inflammatory process and subsequent tissue repair in the soft tissue. Electrolysis Percutaneous Intratissue (EPI) could promote wound healing. The purpose of this study was to examine the cellular response to Dry Needling versus Electrolysis Percutaneous Intratissue (EPI) after intratendinous treatment in an animal model.

METHODS:
Design: Controlled laboratory study. SETTING.: Department of Veterinary. University Complutense of Madrid-Spain. INTERVENTION.: Twenty-four male Sprague Dawley adult rats were included in this experiment, weighing 190-240 g. In all cases, healthy Achilles tendons were treated. In the intervention group (n=18), one Achilles tendon was treated with dry needling, and the other was treated with electrolysis percutaneous intratissue. In the control animals (n=6) no intervention was carried out. Twenty four total tendons were treated with dry needling, and 24 tendons with electrolysis percutaneous intratissue, and 12 tendons were the control animals. In the experimental animals, one Achilles tendon was treated with dry needling (two impacts), and the other was treated with EPI 4 mA, 4 segs. and 2 impacts. Animals were euthanized after 0, 1, 3, 8, 14 and 21days after intervention by CO2 asphyxiation. Muscle-Achilles tendon-bone units were harvested by transection of the middle part of the gastrocnemius muscle and of the calcaneus. Tendons were harvested and stained using E&H and scored semi-quantitatively for total white blood cells (WBCs), mononuclear cells (macrophages and lymphocytes), polymorphonuclear cells (PMNs), vascularity, fiber structure, and fibrosis.

RESULTS:
After intervention the macroscopic findings (0 days) inflammatory response and haemorrhage were higher in EPI group versus dry needling. There is no significant difference in the cellularity regardless of the intervention types (dry needling vs EPI) at 0 days after intratendinous intervention. Compared with Dry Needling, Electrolysis Percutaneous Intratissue causes a significantly greater acute inflammatory response at 1 and 3 days after intervention and focal areas of scar tissue. Compared with findings in control specimens, histological analysis of EPI showed a marked inflammatory infiltrate. Histological examination of the repair tendon tissue showed that by 14 days delivery of EPI led to the formation of well-organised, tendinous tissue with large collagen fibres.

DISCUSSION:
Electrolysis Percutaneous Intratissue can stimulate the tendon biology, initiate an inflammatory response and promote wound healing in normal tendon in rats. LIMITATIONS OF THE STUDY.: A limitation of the present study is the use of rat Achilles tendon, which does not accurately reflect human Achilles tendon. Future investigations are necessary to apply these findings to the clinical setting.
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NewsBot · Apr 26, 2017

Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review.
Chaudhry FA
Eur J Orthop Surg Traumatol. 2017 Apr 19. doi: 10.1007/s00590-017-1957-1.

Achilles tendinopathy is a common overuse condition affecting the adult population. The incidence is on the rise because of greater participation of people in recreational or competitive sporting activities. There are several treatment options available both non-operative and operative. Ultrasound-guided dry needling and high-volume image-guided injection is relatively a new procedure. The aim of this study was to find out the effectiveness of dry needling and HVIGI in the management of mid-portion chronic Achilles tendinopathy by performing a literature review. Search strategy was devised to find the suitable articles for critical appraisal using the electronic databases. Four articles were selected for critical appraisal, and these papers showed good short- to long-term results of image-guided high-volume injection in the management of Achilles tendinopathy. We conclude that high-volume image-guided injection is effective in the management of Achilles tendinopathy. It provides good short- and medium-term relief of symptoms. It should be considered as one of the many options available for this condition.
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NewsBot · Oct 9, 2018

A randomised feasibility study using an acupuncture protocol to the Achilles tendon in Achilles tendinopathy.
Kishmishian, Berj, Richards, James and Selfe, James
Physiotherapy Practice and Research . ISSN 2213-0683

Background: The prevalence of Achilles tendinopathy is greatest in activities including middle and long distance running, tennis, badminton, volleyball, and its incidence is increasing. However, currently no gold standard treatment for Achilles tendinopathy exists, although eccentric exercises are commonly recommended.
Purpose: This study aimed to investigate the changes in clinical scores when administering a) acupuncture and b) sham acupuncture to the Achilles tendon in patients diagnosed with Achilles tendinopathy who did not respond to modified eccentric exercises.
Methods: Twenty-two patients were randomised and received either acupuncture or the control sham acupuncture treatment. VISA-A, NPRS, EQ-5D and GRC were recorded before treatment at week 0, then at week 2, week 4 with a final follow-up review at week 12.
Main Results: Acupuncture resulted in significant differences between groups and time points in VISA-A, NPRS, EQ-5D and GRC. The Acupuncture group reached the minimum clinically important difference (MCID) threshold for important difference, when compared to sham acupuncture. The difference between treatments would suggest a beneficial response following the use of acupuncture to the Achilles tendon in Achilles tendinopathy.
Principal Conclusions: The overall findings suggest the use of a standardised acupuncture protocol to the Achilles tendon is a viable treatment alternative, which could be used as a second line treatment in patients diagnosed with Achilles tendinopathy who did not respond to eccentric exercises. However, in view of the small sample size, the results if this feasibility study should be viewed with caution
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