Treatment of tendon injuries is a subject of frequent debate in sports medicine and physiotherapy. Multiple techniques have been described for their treatment and although some of them [22
To date, there is no consensus on the optimal treatment of tendinopathies. It has been suggested that the incomplete understanding of the underlying mechanisms (etiology of the condition), limits the ability to develop effective treatment strategies [23
]. Are emerging as the most accepted treatment option, more RCT's are still needed to clearly establish what the therapeutic protocol therapeutic to follow should be.
Doubts have mainly centered on the fact that there are few controlled prospective studies that analyze all aspects of tendinosis, and few studies that investigate the early stages of these processes and their healing mechanisms. The exact mechanism by which tendinopathy develops in humans remains the target of numerous investigations. A variety of degenerative characteristics associated tendinopathies, including accumulation glycosaminoglycan (GAG), calcification and lipid accumulation nerve damage and hyperinnervation, is one of the theories whose publications are scarce, despite its special interest in explaining the possible pathophysiological mechanisms of pain in tendinopathy [24
In several studies it has been shown that there is a correlation between tendinopathy and hyperinnervation, citing that the production of nerve growth factor (NGF) and the corresponding hyperinnervation could be induced by repetitive ischemic crisis in osteotendinous union [25
]. This growth of nerve fibers, which causes chronic pain, could be part of a process of abnormal tissue repair, preceded by repetitive microtrauma [27
Despite its prevalence, the precise pathogenic mechanisms of tendinopathy are not clear and, as a result, current treatments of tendinopathies are largely empirical and not always efficient [28
Despite over 15 years of experience in the use of the EPI®
technique and its widespread deployment in sporting clubs around the world, this technique has grown in relative to scientific dissemination in recent years [19
An experimental study showed that after application of the degenerated tendon EPI®
technique, an increase in anti -inflammatory proteins, like PPAR-γ has been observed after treatment with the EPI®
technique. These proteins play a key role in the inhibition of expression of proinflammatory molecules secreted by macrophages, such as TNF-α, IL-6 and IL-1β [29
] thus producing in the treated tissue a highly beneficial molecular response during tendinopathy. This, in turn, results in an increase of the expression of VEGF and VEGFR-2, mediators responsible for angiogenesis anti-inflammatory response [30
In another recent study by Sanchez-Ibanez and co-workers [19
] it has been illustrated that when treatment with the US-guided EPI®
technique and eccentric exercises in patellar tendinopathy it resulted in extensive improvement in the knee function and a rapid return to the previous level of activity after few sessions. The limitation of this study is the absence of a control group of subjects.
References to the use of the EPI®
technique in combination with eccentric exercise can be found in the literature. In those cases the EPI Technique®
focuses on biological tissue recovery, leaving the functional recovery of tissue biomechanics to eccentric exercise.
technique is contraindicated mainly in patients with tumors, articular or systemic infection and bleeding disorders [31