Evaluation of SASTM in the Treatment of Lower Body Tendinopathy

1. Evaluation of SASTM in the Treatment of Lower Body Tendinopathy Rachel Kloentrup ATTR 540 Research Methods in Human Performance

2. Introduction • Chronic injury • Achilles and patellar tendonitis • Conservative treatment methods • Eccentric exercise program • Most effective in treatment of achilles (Mafi, N., Lorentzon, R., Alfredson, H. Superior, 2001) and patellar tendinopathy (Jonsson, P., Alfredson, H., 2005) • Deep tissue massage • Sound Assisted Soft Tissue Mobilization (SASTM) • Lack of conclusive research

3. Purpose • To determine the effectiveness of SASTM in the treatment of lower body tendinopathy.

4. Hypothesis • SASTM combined with an eccentric exercise program will be effective in the treatment of lower body tendinopathy.

5. Methods • Procedures • Approval from the Manchester University IRB • Subject Selection • 9 student athletes • Manchester University • Achilles or patellar tendinopathy • Informed consent • Demographics • Age, gender, sport, tendinopathy • Informational eccentric exercise session • VISA questionnaire

6. Methods • Delimitations • Achilles tendinopathy • Excluded if they have a history of ankle injury within the past 6 months • Patellar tendinopathy • Excluded if they have a history of knee injuries within the past 6 months • Out of season athletes • Limitations • Small sample size

7. Methods • Instrumentation • Eccentric Exercise Program • Education session • Achilles tendinopathy • Calf raises using a stair (Achilles eccentric exercises) • Patellar tendinopathy • 25° decline board (Patellar eccentric exercises) • Decline causes the calf muscles to relax in order to increase the stress on the knee extensor muscles (quadriceps)

8. Methods • Measurement Techniques • Victorian Institute of Sport Assessment-Achilles tendinopathy (VISA-A) (Robinson, J.M., Cook, J.L., Purdam C., et. al., 2001) • VISA-A • Victorian Institute of Sport Assessment-patellar tendinopathy (VISA-P) (Zwerver, J., Kramer, T., Akker-Scheek, I., 2009) • VISA-P

9. Methods • Sound Assisted Soft Tissue Mobilization • Assist the clinician’s hands • Polymer coated tools transmit sound waves through the tissue • Controlled microtrauma to soft tissue in order to promote the healing process • Clinician must be specially trained

10. Methods • Eccentric exercise program performed daily • VISA questionnaire prior to treatment • SASTM • 2 treatments per week (2 days rest between) for 3 weeks • 5 minute SASTM treatment time

11. Statistical Analysis • VISA-A and VISA-P questionnaires • Value of 0 to 100 (VISA-A and VISA-P) • Friedman • Wilcoxon Signed Ranks test

12. Results

13. Conclusion • Results • Accept hypothesis: • SASTM combined with an eccentric exercise program will be effective in the treatment of lower body tendinopathy.

14. References • Mafi, N., Lorentzon, R., Alfredson, H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surgery Sports Traumatology Arthroscopy. 2001; 9: 42 -47. • Jonsson, P., Alfredson, H. Superior results with eccentric compared to concentric quadriceps training in patients with jumper’s knee: a prospective randomized study. British Journal of Sports Medicine. 2005; 847 – 850. • Robinson, J.M., Cook, J.L., Purdam C., et. al. The VISA-A questionnaire: A valid and reliable index of the clinical severity of Achilles tendinopathy. British Journal of Sports Medicine. 2001; 35: 335 – 341. • Zwerver, J., Kramer, T., Akker-Scheek, I. Validity and reliability of the Dutch translation of the VISA-P questionnaire for patellar tendinopathy. BioMed Central Musculoskeletal Disorders. 2009; 10: 102 – 106.

15. Questions/Comments?