Abstract
M.Tech.
This unblinded, controlled pilot study was conducted in order to compare the effectiveness of soft tissue therapy and ultrasound therapy, versus chiropractic manipulation and mobilization therapy, or a combination of the aforementioned therapeutic
protocols in the treatment of acute Achilles tendinitis. In executing the comparison, it was hypothesized that both treatment protocols would be effective, but the combined therapy
would be the most effective for the treatment of acute Achilles tendinitis, as this treatment protocol focused not only on the symptomatic pathological area entailing the Achilles tendon in this case, but also focused on the entire kinetic chain which perhaps was contributing to the pathomec.hanics in turn causing Achilles tendinitis. It is hoped that this combined therapy will be more effective in terms of a more speedy recovery and long term
effect. This will not only benefit the patient from the point of view of health and quality of life, but financially as well, as less consultation fees will have to be paid. Patients were recruited for the study by the use of advertisements in newspapers and posters, or from patients entering the Technikon Witwatersrand Chiropractic Day Clinic complaining of
Achilles pain. Only those forty-five patients who conformed to the specified delimitations and diagnostic criteria were accepted. These patients were randomly placed into three groups of fifteen patients each. Group one received chiropractic manipulative and
mobilisation therapy and group two received soft tissue therapy and ultrasound therapy. Group three received a combination of the aforementioned therapies. Each patient received eight treatments over a three week period, ie. three treatments in weeks
one and two, and two treatments in week three. After the treatment period there was a month break from the treatment and a follow-up consultation at the end of this month. This follow-up period was used to determine the lasting effects of the treatment
protocol. The subjective data was collected with the use of the McGill Pain
Questionnaire. The objective data was obtained from readings on
the digital inclinometer, showing the extent of the ankle range of
motion in dorsiflexion and plantarflexion, as well as from muscle
activity levels in the triceps surae complex, recorded with the
use of electromyography. Depending on normality being reached,
both parametric testing and non-parametric tests were used to
analyse the data. These tests were conducted on a 95%
confidence level.
The results indicated that all three treatments were in treating
acute Achilles tendinitis. Treatment received by group one
caused a generalized increase in EMG muscle activity levels
specifically in the triceps surae, where as group two and group
threes' treatment protocols caused an overall decrease in EMG
muscle activity levels in the triceps surae. Group one showed the greatest improvement achieved in ankle
range of motion in both dorsiflexion and plantarflexion
throughout the study. And group one and group three showed the
most significant response to treatment in terms of 100%
reduction of pain and return to activity.
Overall it was deduced that chiropractic manipulative and
mobilization therapy were very effective in creating an increase
in range of motion of the ankle joint as well as causing a
significant improvement in reduction of pain in the Achilles
tendon. It was noted that soft tissue therapy was beneficial in
certain cases in terms of causing a relaxation in the triceps surae,
as well as clearing any scar (fibrin) tissue found in the Achilles
tendon. In summary group three showed the best response to treatment
carried out in the study. The therapy used in group three not only
directly treats the pathological injured-,Achilles tendon and
associated triceps surae, but also the kinetic chain, thereby
correcting any biomechanical dysfunction that could potentially
be the cause of tension overload in the Achilles tendon.