Ejercicios isométricos como tratamiento de la tendinopatía rotuliana: una revisión sistemática de ensayos clínicos controlados y aleatorizados

Resumen

La tendinopatía rotuliana afecta al 53 % de los atletas con el dolor como síntoma predominante. El tratamiento fisioterapéutico sigue siendo un tema debatido debido al conocimiento limitado sobre el proceso patológico subyacente. Se llevó a cabo una revisión sistemática de seis estudios publicados entre 2013 y 2020. Estos se centraron en la eficacia de los métodos de tratamiento empleados para la tendinopatía rotuliana. La mayoría de los participantes (84 %) eran hombres de entre 18 y 40 años. Todos los sujetos reportaron dolor localizado en el polo inferior de la rótula, específicamente en el tendón rotuliano. Tanto los ejercicios isométricos como los isotónicos demostraron una reducción significativa del dolor. No se encontró evidencia concluyente de que los ejercicios isométricos sean más efectivos que los isotónicos para el alivio del dolor a corto plazo. La respuesta al ejercicio isométrico varía entre los individuos.

Palabras clave

Tendinopatía, tendón, fisioterapia.

Citas

Aguayo-Albasini, J. L., Flores-Pastor, B. y Soria-Aledo, V. (2014). GRADE System: Classification of Quality of Evidence and Strength of Recommendation. Cirugía Espa-ñola, 92(2), 82-88. https://doi.org/10.1016/j.cireng.2013.08.002Alexander, R. M. (1991). Energy-saving mechanisms in walking and running. Jour-nal of Experimental Biology, 160(1), 55-69. https://doi.org/10.1242/jeb.160.1.55Alway, S. E., MacDougall, J. D. y Sale, D. G. (1989). Contractile adaptations in the human triceps surae after isometric exercise. Jour-nal of Applied Physiology, 66(6), 2725-2732. https://doi.org/10.1152/jappl.1989.66.6.2725Chandler, J., Cumpston, M., Li, T., Page, M. J. y Welch, V. J. H. W. (2019). Cochrane handbook for systematic reviews of inter-ventions. Wiley. https://dariososafoula.wor-dpress.com/wp-content/uploads/2017/01/cochrane-handbook-for-systematic-re-views-of-interventions-2019-1.pdfCook, J. L. y Purdam, C. R. (2014). The cha-llenge of managing tendinopathy in compe-ting athletes. British Journal of Sports Medi-cine, 48(7), 506-509. https://doi.org/10.1136/bjsports-2012-092078Del Balso, C. y Cafarelli, E. (2007). Adap-tations in the activation of human skele-tal muscle induced by short-term isome-tric resistance training. Journal of Applied Physiology, 103(1), 402-411. https://doi.org/10.1152/japplphysiol.00477.2006Ding, H., Hu, G. L., Zheng, X. Y., Chen, Q., Threapleton, D. E. y Zhou, Z. H. (2015). The method quality of cross-over studies involved in Cochrane Systematic Reviews. PLoS ONE, 10(4), e0120519. https://doi.org/10.1371/journal.pone.0120519Escriche-Escuder, A., Casaña, J. y Cues-ta-Vargas, A. I. (2020). Load progression criteria in exercise programmes in lower limb tendinopathy: A systematic review. BMJ Open, 10(11), e041433. https://doi.org/10.1136/bmjopen-2020-041433Goodwill, A. M., Pearce, A. J. y Kidgell, D. J. (2012). Corticomotor plasticity following uni-lateral strength training. Muscle and Nerve, 46(3), 384-393. https://doi.org/10.1002/mus.23316Higgins, J. P. T., Thompson, S. G., Deeks, J. J. y Altman, D. G. (2003). Measuring incon-sistency in meta-analyses. British Medical Journal, 327(7414), 557-560. https://doi.org/10.1136/bmj.327.7414.557Holden, S., Lyng, K., Graven-Nielsen, T., Riel, H., Olesen, J. L., Larsen, L. H. y Rathleff, M. S. (2020). Isometric exercise and pain in patellar tendinopathy: A randomi-zed crossover trial. Journal of Science and Medicine in Sport, 23(3), 208-214. https://doi.org/10.1016/j.jsams.2019.09.015Kettunen, J. A., Kvist, M., Alanen, E. y Kujala, U. M. (2002). Long-term prognosis for jum-per’s knee in male athletes: A prospective follow-up study. American Journal of Sports Medicine, 30(5), 689-692. https://doi.org/10.1177/03635465020300051001Kongsgaard, M., Kovanen, V., Aagaard, P., Doessing, S., Hansen, P., Laursen, A. H., Kaldau, N. C., Kjaer, M. y Magnusson, S. P. (2009). Corticosteroid injections, eccen-tric decline squat training and heavy slow resistance training in patellar tendinopa-thy. Scandinavian Journal of Medicine and Science in Sports, 19(6), 790-802. https://doi.org/10.1111/j.1600-0838.2009.00949.x Kongsgaard, Mads, Qvortrup, K., Larsen, J., Aagaard, P., Doessing, S., Hansen, P., Kjaer, M. y Magnusson, S. P. (2010). Fibril morphology and tendon mechanical pro-perties in patellar tendinopathy: Effects of heavy slow resistance training. American Journal of Sports Medicine, 38(4), 749-756. https://doi.org/10.1177/0363546509350915Kosek, E. y Ekholm, J. (1995). Modula-tion of pressure pain thresholds during and following isometric contraction. Pain, 61(3), 481-486. https://doi.org/10.1016/0304-3959(94)00217-3Moher, D., Cook, D. J., Eastwood, S., Olkin, I., Rennie, D. y Stroup, D. F. (1999). Impro-ving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM statement. The Lancet, 354(9193), 1896-1900. https://doi.org/10.1159/000055014Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. y Prisma Group. (2010). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA state-ment. International Journal of Surgery, 8(5), 336-341. https://doi.org/10.1016/j.ijsu.2010.02.007Pearson, S. J., Stadler, S., Menz, H., Morris-sey, D., Scott, I., Munteanu, S. y Malliaras, P. (2020). Immediate and short-term effects of short-and long-duration isometric contrac-tions in patellar tendinopathy. Clinical Journal of Sport Medicine, 30(4), 335-340. https://doi.org/10.1097/JSM.0000000000000625Pitman, B. M. y Semmler, J. G. (2012). Reduced short-interval intracortical inhi-bition after eccentric muscle damage in human elbow flexor muscles. Journal of Applied Physiology, 113(6), 929-936. https://doi.org/10.1152/japplphysiol.00361.2012Rio, E., Kidgell, D., Moseley, L., Pearce, A., Gaida, J. y Cook, J. (2013). Exercise to reduce tendon pain: A comparison of iso-metric and isotonic muscle contractions and effects on pain, cortical inhibition and muscle strength. Journal of Science and Medicine in Sport, 16, e28. https://doi.org/10.1016/j.jsams.2013.10.067Rio, E., Kidgell, D., Purdam, C., Gaida, J., Moseley, G. L., Pearce, A. J. y Cook, J. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendino-pathy. British Journal of Sports Medicine, 49(19), 1277-1283. https://doi.org/10.1136/bjsports-2014-094386Rio, E., Moseley, L., Purdam, C., Sami-ric, T., Kidgell, D., Pearce, A. J. ... y Cook, J. (2014). The pain of tendinopathy: Phy-siological or pathophysiological? Sports Medicine, 44, 9-23. https://doi.org/10.1007/s40279-013-0096-zRio, E., Van Ark, M., Docking, S., Moseley, G. L., Kidgell, D., Gaida, J. E. ... y Cook, J. (2017). Isometric contractions are more analgesic than isotonic contractions for pate-llar tendon pain: An in-season randomized clinical trial. Clinical Journal of Sport Medi-cine, 27(3), 253-259. https://doi.org/10.1097/JSM.0000000000000364Van Ark, M., Cook, J. L., Docking, S. I., Zwer-ver, J., Gaida, J. E., Van Den Akker-Scheek, I. y Rio, E. (2016). Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A ran-domised clinical trial. Journal of Science and Medicine in Sport, 19(9), 702-706. https://doi.org/10.1016/j.jsams.2015.11.006Van Ark, M., Rio, E., Cook, J., Van Den Akker-Scheek, I., Gaida, J. E., Zwerver, J. y Docking, S. (2018). Clinical improve-ments are not explained by changes in tendon structure on ultrasound tissue cha-racterization after an exercise program for patellar tendinopathy. American Journal of Physical Medicine and Rehabilitation, 97(10), 708-714. https://doi.org/10.1097/PHM.0000000000000951Vang, C. y Niznik, A. (2021). The effecti-veness of isometric contractions compa-red with isotonic contractions in reducing pain for in-season athletes with patellar tendinopathy. Journal of Sport Rehabilita-tion, 30(3), 512-515. https://doi.org/10.1123/JSR.2019-0376