Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful mid-portion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients, and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain. Seventy-eight consecutive patients, having chronic painful Achilles tendinosis at the mid-portion (2-6 cm level) in a total of 101 tendons (55 unilateral and 23 bilateral), and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons (29 unilateral and one bilateral) were treated with eccentric calf-muscle training for 12 weeks. Most patients were recreational athletes. Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale (VAS), before and after treatment. In 90 of the 101 Achilles tendons (89%) with chronic painful mid-portion Achilles tendinosis, treatment was satisfactory and the patients were back on their pre-injury activity level after the 12-week training regimen. In these patients, the amount of pain during activity, registered on the VAS-scale (mean+/-SD), decreased significantly from 66.8+/-19.4 to 10.2+/-13.7. On the contrary, in only ten of the tendons (32%) with chronic insertional Achilles tendon pain was treatment satisfactory, with a significant decrease on the VAS-scale (mean+/-SD), from 68.3+/-7.0 to 13.3+/-13.2. Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis, but not in patients with chronic insertional Achilles tendon pain.

In this short-term pilot study this new model of painful eccentric calf-muscle training showed promising clinical results in 67% of the patients.

With a strict method for how to measure tendon thickness and set criteria for evaluating structural changes and amount and distribution of neovascularisation, US and colour Doppler is a reliable method for evaluating Achilles and patellar tendons. The modified, 4-graded, Öhberg score was found to be a reproducible instrument for assessment of tendon structure and neovascularisation.

Objective: To investigate the degree of kinesiophobia in patients with chronic pain, to examine differences in kinesiophobia and other pain-related characteristics between men and women, and to examine differences in pain-related characteristics between patients with high and low levels of kinesiophobia. Design: Postal survey. Subjects/patients: Eighty-eight men and 173 women with chronic musculoskeletal pain. Methods: Patients completed questionnaires covering background data, pain variables, disability and psychological characteristics. The Swedish version of Tampa Scale for Kinesiophobia (TSK-SV) was used to measure kinesiophobia. Results: Kinesiophobia (TSK-SV score > 37) was found in 56% of patients, with men having a higher frequency (72%) than women (48%). Pain intensity was correlated with TSK-SV score in both men and women. No correlations were found between kinesiophobia and age, pain duration or probable depression/anxiety. Women with high kinesiophobia tended to be younger, had more pain and showed more tiredness, disability, stress, interference and life dissatisfaction compared with women with low kinesiophobia. These differences were not seen in men. Conclusion:The results indicate differences between men and women with chronic pain. The use of the TSK-SV questionnaire might assist therapists to identify patients whose fear of movement may negatively impact their rehabilitation. There is some evidence to suggest that optimal cut-off scores may differ between male and female patients.

Background Proximal patellar tendinopathy/jumper's knee (PT/JK) is well known to be diffi cult to treat. Recent studies using an ultrasound and colour Dopplerbased treatment approach on the dorsal side of the tendon, sclerosing polidocanol injections and ultrasoundguided arthroscopic shaving, have shown promising clinical results. Objectives To compare the clinical effects after treatment with sclerosing polidocanol injections and arthroscopic shaving. Material and methods 52 patellar tendons (43 men and two women) with ultrasound and colour Dopplerverifi ed diagnosis of PT/JK were randomly assigned to treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections (group A) or ultrasound and colour Doppler-guided arthroscopic shaving (group B). All patients were involved in patellar tendon loading sports or recreational activities, and had had a long duration of pain symptoms from the proximal patellar tendon. Pain during patellar tendon loading activity, and at rest, before and after treatment (visual analogue scale; VAS), and patient satisfaction with the result of the treatment, was registered. Results After treatment, the patients treated with arthroscopic shaving had a signifi cantly lower VAS score at rest and during activity, and were signifi cantly more satisfi ed compared with the patients in the sclerosing injection group. Conclusions Both treatment with ultrasound and colour Doppler-guided sclerosing polidocanol injections and arthroscopic shaving showed good clinical results, but patients treated with arthroscopic shaving had less pain and were more satisfi ed with the treatment result. Because surgical treatment is a one-stage treatment return to sports was faster in this group.