Effectiveness of isokinetic training with biofeedback in comprehensive rehabilitation of patients with post-thrombotic syndrome: a quasi-experimental study

Vollständiger Abstract

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INTRODUCTION. Dysfunction of the lower leg muscle-venous pump (MVP) in post-thrombotic syndrome (PTS) can be considered a therapeutic target in the treatment of chronic venous insufficiency. Correction of muscle dysfunction and reduction of functional deficit (arthritic muscle inhibition / AMI) can be achieved by improving neuromuscular control and proprioception during robotic isokinetic MVP training, which will improve the effectiveness of comprehensive rehabilitation for PTS. AIM. To study the effectiveness of a comprehensive rehabilitation program using robotic isokinetic lower limb muscle training with biofeedback (BFB) on lower leg MVP performance and ankle range of motion in patients with PTS. MATERIALS AND METHODS. The study included 30 patients with lower extremity PTS (C3–C5 according to the CEAP classification), with an average age of 57.24 ± 10.17 years, a disease duration of 8.67 ± 1.14 years, and a BMI of 32.61 ± 5.81 kg/m2. All patients had a documented history of DVT of varying duration. The dynamics of the ankle joint range of motion (AROM) (dorsiflexion, plantar flexion) indicators were studied in degrees according to goniometry data. The performance indicators of the lower leg MVP were investigated according to isokinetic dynamometry of the lower limb muscles, including peak torque, work of the extensor and flexor muscles of the foot and the fatigue coefficient characterizing proprioception. Each patient underwent measurements before and after a rehabilitation course, including intermittent pneumatic compression of the legs No. 12, intravenous laser irradiation of blood using Low-level laser radiation in the infrared range (wavelength 890 nm) No. 12, as well as 12 isokinetic training sessions on a robotic Isokinetic Extremity System "Leg press" with biofeedback. The study was conducted at the National Medical Research Center for Rehabilitation and Balneology from February 2024 to August 2025. RESULTS. At baseline, patients with PTS showed a significant decrease in muscle strength in both limbs (affected and intact). In the affected limb with edema, the extensor strength deficit reached 55–64% of the lower limit of normal, and an even more pronounced deficit of 75–83 % was recorded for the flexors. Moreover, the muscles of the back of the leg (m. gastrocnemius, m. soleus) were weakened to a greater extent than the anterior tibialis and other dorsiflexors. After the rehabilitation course, an increase in AROM (dorsiflexion) goniometry values was noted from 9.88 ± 2.92° to 12.44 ± 4.35° (p 0.001); AROM (plantar flexion) from 26.90 ± 10.06° to 31.27 ± 9.08° (p 0.001). After the rehabilitation course, a significantly more pronounced improvement in the maximum extension torque on the affected limb was noted by 36 % (p = 0.019), compared with an increase of 16.1 % (p = 0.04) in the intact limb; an improvement in the relative extension torque on the intact limb was 45.5% (p = 0.006), compared with the affected limb, where the increase was 16.7 % (p = 0.028), indicating the effectiveness of MVP training in an isokinetic mode and with biofeedback, due to the correction of proprioceptive sensitivity, muscle strength, and, possibly, due to improved coordination abilities. A decrease in the malleolar circumference by 10.4 % (p 0.05) was also noted after treatment. DISCUSSION. In previous studies it has been proven that supravenous Low-level laser therapy provides an anti-inflammatory effect, reducing the severity of perivascular venous inflammation, while pressotherapy promotes lymphatic drainage in PTS. Isokinetic training is an effective method for increasing the hemodynamic efficiency of the muscle pump, overcoming the mechanisms of AMI by activating proprioceptors, as well as muscle strength, as evidenced by an increase in AROM, peak torque, overall work of the extensor and flexor muscles of the foot, and the fatigue coefficient. CONCLUSION. Incorporating isokinetic training of the lower extremity muscles into a rehabilitation program (with intermittent pneumatic compression and Low-level laser therapy) improves the function of the muscles involved in the MVP by reducing the identified functional deficit (AMI).