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The Achilles tendon exhibits high tensile strength and can withstand extremely high loads. However, it is susceptible to injuries such as tendinopathies and ruptures, which are associated with structural alterations and loss of function. Strategies have been investigated to enhance clinical rehabilitation. Nevertheless, the effects of neuromuscular electrical stimulation on pain and functional improvement, as well as the optimal dosing parameters for the rehabilitation of Achilles tendon injuries, remain inconclusive. The aim of this study is to compare the immediate effects of two electrical stimulation protocols on pain, functional performance, peripheral oxygen extraction, and maximal tendon displacement during a single leg heel rise functional task in patients with Achilles tendinopathy and/or a history of Achilles tendon rupture. In addition, this study aims to characterize Achilles tendon structural properties and ankle plantarflexor muscle strength in this population.
All groups will be composed of participants with a primary complaint of pain and/or a history of previous Achilles tendon rupture. Participants will perform the interventions in two blocks separated by a seven-day interval (wash-out). Block A: (1) control without active intervention and (2) electrical stimulation applied at the maximum tolerated intensity. Block B: (3) control with sham stimulation and (4) sensory-level electrical stimulation. Block A will always be performed first, followed by Block B. Interventions within each block will be conducted in three sets of 10 repetitions, totaling six sets per day.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control without active intervention | No Intervention | In this group, participants will perform three sets of 10 repetitions of the single leg heel rise functional task without the application of electrical stimulation. Immediately after each set, pain level, functional performance, peripheral oxygen extraction, and maximal Achilles tendon displacement will be assessed. | |
| Electrical stimulation applied at the maximum tolerated intensity | Experimental | Under this condition, participants will perform three sets of 10 repetitions of the single leg heel rise functional task with superimposed electrical stimulation applied at the maximum tolerated intensity, characterized by visible muscle contraction and associated with a self-reported discomfort level between 8 and 10 on the Numeric Rating Scale. Immediately after each set, pain level, functional performance, peripheral oxygen extraction, and maximal Achilles tendon displacement will be assessed. |
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| Control with sham stimulation | Placebo Comparator | For this condition, participants will perform three sets of 10 repetitions of the single leg heel rise functional task with superimposed sham electrical stimulation. Electrical stimulation parameters will initially be configured identically to those used in the active intervention. However, to ensure adequate blinding, stimulation will be applied for approximately 40 seconds and then gradually reduced until complete cessation. From this point onward, no additional current will be delivered, although the device will remain on and the electrodes will remain in place throughout the test. Immediately after each set, pain level, functional performance, peripheral oxygen extraction, and maximal Achilles tendon displacement will be assessed. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Neuromuscular Electrical Stimulation (NMES) | Device | Neuromuscular electrical stimulation-induced contractions will be delivered using an electrical stimulator connected to a pair of 5×5 cm self-adhesive surface electrodes. Stimulation will be applied in a superimposed manner during voluntary movement, at a frequency of 75 Hz and a phase duration of 400 µs. |
| Measure | Description | Time Frame |
|---|---|---|
| Pain level | Pain intensity during the single leg heel rise task will be assessed using the Visual Analog Scale, consisting of a numerical scale ranging from 0 to 10 points, in which 0 represents no pain and 10 corresponds to the worst pain ever experienced by the participant. | Immediately after the performance of the functional task |
| Measure | Description | Time Frame |
|---|---|---|
| Total time | The total time (s) during the single-leg heel rise task will be measured using the MuscleLab® system. | Immediately after the performance of the functional task. |
| Maximal displacement |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| João LQ Durigan, PhD | Contact | +55 61 3107-8450 | joaodurigan@gmail.com | |
| José RS Júnior, PhD | Contact | +55 61 3107-8450 | joserobertofisio@gmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Brasilia | Recruiting | Brasília | Federal District | 72220900 | Brazil |
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| ID | Term |
|---|---|
| D010146 | Pain |
| ID | Term |
|---|---|
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| Sensory-level electrical stimulation | Active Comparator | In this condition, participants will perform three sets of 10 repetitions of the single leg heel rise functional task with superimposed electrical stimulation applied at the sensory level, defined as the highest intensity that does not elicit visible muscle contraction. Immediately after each set, pain level, functional performance, peripheral oxygen extraction, and maximal Achilles tendon displacement will be assessed. |
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The maximal displacement (cm) during the single-leg heel rise task will be measured using the MuscleLab® system.
| Immediately after the performance of the functional task. |
| Total work | The total work (J) during the single-leg heel rise task will be measured using the MuscleLab® system. | Immediately after the performance of the functional task. |
| Total power | The total power (W) during the single-leg heel rise task will be measured using the MuscleLab® system. | Immediately after the performance of the functional task. |
| Number of repetitions | The number of repetitions completed during the single-leg heel rise task will be recorded using the MuscleLab® system. | Immediately after the performance of the functional task. |
| Peripheral oxygen extraction | Oxygen extraction of the periarticular ankle muscles will be assessed using near-infrared spectroscopy, with the sensor positioned on the skin over the lateral gastrocnemius muscle during the single leg heel rise task. Variations in oxy- and deoxy-hemo/myoglobin (O₂Hb and HHb, respectively) will be recorded in arbitrary units at a sampling frequency of 25 Hz. | Immediately after the performance of the functional task. |
| Maximal Achilles tendon displacement | Maximal Achilles tendon displacement (%) will be measured using a transducer positioned over the myotendinous junction of the gastrocnemius muscles, secured to a specific support, during the single leg heel rise task. Maximal displacement will be determined based on the change in Achilles tendon length relative to its resting length. | Immediately after the performance of the functional task. |
| Lenght of achilles tendon | The total and free length (cm) of the Achilles tendon will be measured using portable ultrasonography. | Baseline (prior to Block A only) |
| Thickness of achilles tendon | The thickness (mm) of the Achilles tendon will be measured using portable ultrasonography. | Baseline (prior to Block A only) |
| Cross-sectional area of achilles tendon | The cross-sectional area (cm²) of the Achilles tendon will be measured using portable ultrasonography. | Baseline (prior to Block A only) |
| Presence of neovascularization of the Achilles tendon | The presence of neovascularization of the Achilles tendon will be assessed using portable ultrasonography. | Baseline (prior to Block A only) |
| Elastic modulus | The median elastic modulus (kPa) of the Achilles tendon will be measured using shear wave elastography. | Baseline (prior to Block A only) |
| Shear wave velocity | The median shear wave velocity (m/s) of the Achilles tendon will be measured using shear wave elastography. | Baseline (prior to Block A only) |
| Depth | The measurement depth (cm) of the Achilles tendon during elastography assessment will be recorded using shear wave elastography. | Baseline (prior to Block A only) |
| Isometric strength | Isometric strength will be assessed using an isokinetic dynamometer, based on peak isometric torque (N/m) during plantar flexion at 0°. | Baseline (prior to Block A only) |