ORIGINAL ARTICLE   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2017 June;176(6):330-7

DOI: 10.23736/S0393-3660.16.03339-8

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Effect of rehabilitation and prolotherapy on pain and functional performance in patients with chronic patellar tendinopathy

Seung-Ik CHO ^{1, 2}, Yun-A SHIN ^{1, 2} ✉

¹ Department of Prescription and Rehabilitation of Exercise College of Physical Exercise, Dankook University, Cheonan, South Korea; ² Department of Kinesiologic Medical Science, Graduate School, Dankook University, Cheonan, South Korea

BACKGROUND: Prolotherapy, which has been commonly used to manage pain associated with chronic musculoskeletal diseases. However, previous studies evaluating its effects on patients with chronic patellar tendinopathy are lacking and reports about the effects of injection therapy in combination with exercise therapy are scarce. In this regard, this study aimed to evaluate the efficacy of rehabilitation program and injection therapy including prolotherapy on reducing pain and improving function after a 12-week rehabilitation exercise program plus prolotherapy in patients who were diagnosed with chronic patellar tendinitis.
METHODS: The 30 patients (16 men, 14 women) whose condition had been diagnosed with chronic patellar tendinopathy for at least 3 months were enrolled. The participants were divided into three groups: combined rehabilitation exercise program and prolotherapy (EPG; N.=10); rehabilitation exercise program alone (EG; N.=10); and prolotherapy alone (PG; N.=10). For the clinical assessment, we used the Visual Analog Scale (VAS) and the Victorian Institute of Sport Assessment-Patella (VISA-P) questionnaire to give an index of pain and severity of symptoms in patients with patellar tendinopathy, respectively. For the assessment of function, we assessed isokinetic muscle strength of the knee by measuring peak torque at 60°/sec using a dynamometer and functional performance by taking the VAS after 10 repeats of a single-legged decline squat on a 25°decline board and one leg hop test. The results for all these assessments were taken at the following time-points; pre, 6 weeks, and 12 weeks of treatment.
RESULTS: VAS score showed significant changes duration of treatment (P<0.001), group (P<0.01), and an interaction effect between group and duration of treatment (P<0.05). A lower VAS score in EPG and EG, compared to PG (P<0.05). VISA-P score showed significant changes duration of treatment (P<0.001) and group (P<0.01). A higher VISA-P score in EPG and EG, compared to PG (P<0.05). The maximum muscular strength for the knee extensor at 60°/s showed an interaction effect between group and duration of treatment (P<0.01). EPG and EG showed a significant increase following 12 week treatment, but PG showed a significant decrease following 12 week treatment. The maximum muscular strength for the knee flexor at 60°/s showed significant changes duration of treatment (P<0.01). One leg hop meter showed significant changes duration of treatment (P<0.01). VAS during 25° decline board squat showed a significant changes duration of treatment (P<0.001) and group (P<0.01). A lower VISA-P score in EPG and EG, compared to PG (P<0.05).
CONCLUSIONS: Our results show that a 12-week rehabilitation exercise program including eccentric muscle contraction exercise combined with prolotherapy for alleviating pain and recovering knee function is more effective than injection therapy alone.

KEY WORDS: Tendinopathy - Patellar tendon - Exercise therapy - Rehabilitation