The Achilles tendon : an evaluation of the healing processes occuring with chronic pathology : using a prospective comparison study of conservative treatment regimes and micro-current application
Muscles enable the skeleton to move. Muscles are attached to bones via tendons. Inappropriate stress placed upon the muscular-skeletal system, for example sporting activities for which the subject Is untrained, can result in Injuries which may occur either in the muscle, muscle-tendinous junction or the tendon tissue itself. The resultant pathology can often result in loss of strength or pain in the area. The healing processes of tendon tissue are not well understood and the difficulty In the clinical management of pathology reflects this. Current treatment of this type of Injury Is dependent upon the severity of the injury, its site of occurrence and the practitioners preference of treatment modality. The purpose of the study was to evaluate, following the application of micro-current for therapeutic purposes, the functional outcome In patients presenting with chronic pathology in the Achilles tendon in comparison with the current conservative management. A prospective comparison study was undertaken utilising a blocked randomisation method. Subjects were allocated to either group A and were exposed to current clinical management or group B the experimental micro-current regime. Classification and subsequent evaluation of pathology was assessed employing clinical assessment and tests; subjective assessment by the subject and assessment by diagnostic ultrasound. Subjects were assessed at three, six and twelve month intervals post entry into the study. Forty eight subjects, twenty four in each group completed the study. A statistical analysis was performed, calculating the differences between the two groups and between each interval assessment. Categorical variables were compared between the two groups using the Chi-squared test. The Mann-Whitney test was performed to assess changes in ordinal variables. The Spearman rank correlation test was used to test for correlation between age and changes in the variables. Statistically significant differences were found In favour of group B, the experimental group, in four out of the five clinical markers used. No difference was found between age or sex and the changes recorded. It was concluded that the appropriate application of micro-current treatment to the Achilles tendon presenting with chronic pathology can make a significant contribution to the clinical management of the condition. This has the Implication that a degenerative cycle promotes chronic pathology occurring In the Achilles tendon. In order to narrow the gap between the clinical and experimental findings an examination of in-vitro applications was undertaken with laboratory work undertaken evaluating the effect of micro-current stimulation on 3T3 mouse and human tendon fibroblast proliferation. The results showed that the cells stimulated with 40pA proliferated at a greater rate than the non-stimulated control group. Stimulating the cells with 1pA suppressed activity with a suppression in proliferation.