Rat tendon morphologic and functional changes resulting from soft tissue mobilization

Achilles tendinopathy: some aspects of basic science and clinical management

Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.

Neutrophils and macrophages accumulate sequentially following Achilles tendon injury

Structural damage and inflammation occur following tendon injury. The purpose of this study was to determine the time course of inflammatory cell accumulation in two animal models of acute tendinopathy. In the first model, rat Achilles tendons were exposed by blunt dissection, injected with collagenase and sacrificed at 1, 3, 7, 14 and 28 days. In the second model, collagenase was injected percutaneously and rats were sacrificed after 1 and 3 days. Sham animals were sacrificed at 1 and 3 days in both models. Neutrophil and ED1 macrophage populations increased by 46- and 18-fold, respectively, after 1 day in surgically exposed Achilles tendons (EAT) injected with collagenase. Neutrophils dropped by 70% while the concentration of ED1 macrophages remained constant at day 3 post-injury. Neutrophils and ED1+ macrophages returned to control values after 7 and 14 days, respectively. ED2+ macrophages showed a tendency to increase at day 28 although no significant difference was observed relative to ambulatory controls. Collagenase injected percutaneously reduced the extent of inflammation compared with operated animals. Thus, injured tendons exhibited a specific sequence of inflammatory cell accumulation which varied in intensity according to the modality used for collagenase injection.

Comparison of Rehabilitation Methods in the Treatment of Patellar Tendinitis

Objective:

To compare outcomes of 2 rehabilitation protocols on patellar tendinitis subjects.

Design:

Prospective, randomized, blinded, controlled clinical trial.

Setting:

Outpatient rehabilitation clinic.

Subjects:

Randomized into 2 rehabilitation groups—traditional (n= 10) and ASTM AdvantEDGE (n= 10).

Main Outcome Measures:

Clinical data and self-reported questionnaires collected at 0, 6, and 12 weeks.

Results:

On completion of the 6th week, 100% of the ASTM AdvantEDGE group and 60% of the traditional group had resolved. The unresolved subjects were crossed over to the ASTM AdvantEDGE for additional therapy. At the end of the additional therapy, 50% of the crossover subjects had resolved. The ASTM AdvantEDGE group's clinical outcomes and weekly journals indicated a statistically significant (P= .04) improvement in subjective pain and functional-impairment ratings.

Conclusions:

Findings suggest that ASTM AdvantEDGE resulted in improved clinical outcomes in treating patellar tendinitis.

Fibroblast responses to variation in soft tissue mobilization pressure

Augmented soft tissue mobilization therapy (ASTM), a newly developed massage therapy, has been successfully used in the treatment of chronic tendinitis patients. We theorized that the ASTM technique promotes healing through a controlled application of microtrauma.

PURPOSE

The purpose of this study was to determine morphologic changes in the rat Achilles tendon after enzyme-induced injury with collagenase and subsequent pressure variations in ASTM therapy.

METHODS

Thirty male white rats were randomly assigned to one of five groups with six animals per group: tendinitis (A), tendinitis plus light ASTM (B), tendinitis plus medium ASTM (C), tendinitis plus extreme ASTM (D), and control with surgery only (E). ASTM was performed for 3 min, for a total of six treatment sessions. The Achilles tendons of each group were harvested 1 wk after the last ASTM treatment. Fibroblast numbers were assessed by light microscopy. An electron microscope was used to observe enlargement of fibroblasts.

RESULTS

Statistical analysis of the number of fibroblasts present indicated a significant difference (P<0.00) between group D and all other groups.

CONCLUSION

The morphological evidence indicated that the application of heavy pressure promoted the healing process to a greater degree than light or moderate pressure.

Chronic ankle pain and fibrosis successfully treated with a new noninvasive augmented soft tissue mobilization technique (ASTM): a case report

This clinical case report demonstrates the clinical effectiveness of a new form of soft tissue mobilization in the treatment of excessive connective tissue fibrosis (scar tissue) around an athlete's injured ankle. The scar tissue was causing the athlete to have pain with activity, pain on palpation of the ankle, decreased range of motion, and loss of function. Surgery and several months of conventional physical therapy failed to alleviate the athlete's symptoms. As a final resort, augmented soft tissue mobilization (ASTM) was administered. ASTM is an alternative nonsurgical treatment modality that is being researched at Performance Dynamics (Muncip, IN). ASTM is a process that uses ergonomically designed instruments that assist therapists in the rapid localization and effective treatment of areas exhibiting excessive soft tissue fibrosis. This is followed by a stretching and strengthening program. Upon the completion of 6 wk of ASTM therapy, the athlete had no pain and had regained full range of motion and function. This case report is an example of how a noninvasive augmented form of soft tissue mobilization (ASTM) demonstrated impressive clinical results in treating a condition caused by connective tissue fibrosis.