Clinical commentary of the evolution of the treatment for chronic painful mid-portion Achilles tendinopathy

Abstract

The chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.

A 3-Arm Randomized Trial for Achilles Tendinopathy: Eccentric Training, Eccentric Training Plus a Dietary Supplement Containing Mucopolysaccharides, or Passive Stretching Plus a Dietary Supplement Containing Mucopolysaccharides

“…Although the efficacy of the eccentric gastrocnemius muscle training has been widely described, 21 less data about the efficacy of a protocol of PS are available. It has been recently published that isometric exercises could induce pain reduction in patellar tendinopathy 22 .…”

Physiological Mechanisms of Eccentric Contraction and Its Applications: A Role for the Giant Titin Protein

“…A unique advantage of high-intensity eccentric training is shorter recovery times for some of the most common, long-lasting, and debilitating sports injuries (Ohberg and Alfredson, 2004 ; Ohberg et al, 2004 ; Frizziero et al, 2014 ). High-intensity eccentric training is an effective alternative to tendon remodeling surgery, with high success rates and shorter recovery times than conventional physical therapy (Alfredson et al, 1998 ; Ohberg et al, 2004 ; Alfredson, 2015 ).…”

“…Pain leads to reduced physical activity and muscle atrophy (Ohberg and Alfredson, 2004 ; Galloway, 2013 ; Galloway et al, 2013 ). Conventional nonsurgical treatments, including physical therapy and rest, often fail to provide relief (Galloway et al, 2013 ; Alfredson, 2015 ). Surgery to repair the tendon is often prescribed, and may incapacitate athletes for months.…”

Lesões do Aquiles – Parte 1: Tendinopatias

“…Ainda hoje, apresenta grau de recomendação A (boa evidência baseada em estudos nível I com resultados consistentes) para o tratamento inicial dessa condição. 24,25 Alguns artigos confrontaram o protocolo original com modificações (uma vez ao dia, três vezes na semana) , com o fortalecimento concêntrico e com o treinamento resistido.…”

“…This protocol still holds an a grade of recommendation “A” (good evidence based on level I studies with consistent results) for initial treatment of the condition. 24 25 …”