Background and rationale {6a}
tendinopathies, tendinopathy, pain
ACHILLES TENDINOPATHY, HAND SWELLING
The Achilles tendon is the largest and strongest tendon in the human body. Achilles tendinopathy (AT) is a common clinical problem with Achilles overuse; it is a clinical condition characterised by a combination of pain and swelling in the posterior leg and heel region. AT results from an altered tendon structure and mechanical properties. It impairs lower extremity function during activities of daily living and athletic capability [The number of Achilles tendon problems has risen in industrialised countries over the past decades [AT is treated by various interventions, including exercises, orthotics, laser therapy, manual soft-tissue mobilisation, extracorporeal shockwave therapy, injection therapies, surgical debridement, and tendon reconstruction. The treatment with the highest level of evidence is exercise rehabilitation. The exercise aims to provide a mechanical load to the tendon to promote remodelling, decrease pain, and improve calf muscle strength and lower leg function. The loading programmes have consisted of eccentric exercise, isolated concentric, or a combination of concentric and eccentric exercises. They have good reported results in controlled settings, but the effects are limited by poor compliance [Denaro et al. investigated the effects of pulsed electromagnetic fields on human tenocyte cultures. They assessed whether pulsed electromagnetic field therapy (PEMF) could represent a viable therapeutic option in tendon pathologies. A controlled laboratory study evaluated the effects of PEMF on an in vitro tenocyte ‘‘wound’’ closure model. Primary human tenocytes were isolated from healthy supraspinatus and quadriceps tendons. An in vitro cut was mechanically produced in tenocyte culture to mimic the failed healing response in tendinopathy. Compared with the control group, a significant decrease in the ‘‘wound’’ width was found after 12 and 24 h of PEMF exposure. Exposure to PEMF significantly accelerated cut closure 12 and 24 h after the injury. The results supported that PEMF could be a healing-promoting agent in tendon injury. This kind of exogenous stimuli could accelerate the intrinsic tendon healing process by acting directly on tenocytes, the basic cellular component of the tendon tissue, and synthesise collagen and all components of the extracellular matrix. These results provide the preliminary in vitro work and the basis to support the study of the in vivo effects of PEMF on tendinopathies [In addition, a parallel prospective study showed PEMF to reduce pain in patients with AT. Visual analogue scores for pain measurement decreased from 6.9 ± 1.3 at baseline to 3.6 ± 2.0 within 12 weeks [