Achilles Tendon Rehabilitation

Strom, Adam C.; Casillas, Mark M.

doi:10.1016/j.fcl.2009.08.003

Cited by 30 publications

(23 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The sustained increase in expression and deposition of COL3A1 , LUM , and MMP13 in the regions adjacent to the lesion, combined with a regional decrease in DCN expression seen throughout the study period, demonstrates ongoing disturbances in tissue metabolism and structure for up to 16 weeks following surgical partial transection of the superficial flexor tendons in this model of tendinopathy. In horses and humans with clinical tendon injury or tendinopathy, rehabilitation programs following tendon injury often recommend a graded increase in or a return to normal activity within 16 weeks after tendon injury depending on clinical progress and/or the results of ultrasonographic examination [88, 89]. However, ultrasound has been shown to underestimate the degree of pathology occurring at the molecular and structural levels in an equine model of tendinopathy [22].…”

Section: Discussionmentioning

confidence: 99%

Spatiotemporal variations in gene expression, histology and biomechanics in an ovine model of tendinopathy

et al. 2017

View full text Add to dashboard Cite

Flexor tendinopathy is a common problem affecting humans and animals. Tendon healing is poorly understood and the outcomes of conservative and surgical management are often suboptimal. While often considered a localized injury, recent evidence indicates that in the short term, tendinopathic changes are distributed widely throughout the tendon, remote from the lesion itself. Whether these changes persist throughout healing is unknown. The aim of this study was to document gene expression, histopathological and biomechanical changes that occur throughout the superficial digital flexor tendon (SDFT) up to 16 weeks post-injury, using an ovine surgical model of tendinopathy. Partial tendon transection was associated with decreased gene expression for aggrecan, decorin, fibromodulin, tissue inhibitors of metalloproteinases (TIMPS 1, 2 and 3), collagen I and collagen II. Gene expression for collagen III, lumican and matrix metalloproteinase 13 (MMP13) increased locally around the lesion site. Expression of collagen III and MMP13 decreased with time, but compared to controls, collagen III, MMP13 and lumican expression remained regionally high throughout the study. An increase in TIMP3 was observed over time. Histologically, operated tendons had higher pathology scores than controls, especially around the injured region. A chondroid phenotype was observed with increased cellular rounding and marked proteoglycan accumulation which only partially improved with time. Biomechanically, partial tendon transection resulted in a localized decrease in elastic modulus (in compression) but only at 8 weeks postoperatively. This study improves our understanding of tendon healing, demonstrating an early ‘peak’ in pathology characterized by altered gene expression and notable histopathological changes. Many of these pathological changes become more localized to the region of injury during healing. Collagen III and MMP13 expression levels remained high close to the lesion throughout the study and may reflect the production of tendon tissue with suboptimal biomechanical properties. Further studies evaluating the long-term response of tendon to injury (6–12 months) are warranted to provide additional information on tendon healing and provide further understanding of the mechanisms underlying the pathology observed in this study.

show abstract

Section: Discussionmentioning

confidence: 99%

Spatiotemporal variations in gene expression, histology and biomechanics in an ovine model of tendinopathy

et al. 2017

View full text Add to dashboard Cite

show abstract

“…2 Postoperative rehabilitation for AT injuries postrupture is designed to reduce pain and swelling by using a specific exercise progression that promotes the gradual recovery of ankle range of motion (ROM), strength, and power. 3 Early weight bearing and ankle ROM exercises can result in a more rapid return to normal activity than keeping the area largely immobilized. 4 Full weight bearing and heel-raising and -lowering strengthening exercises are typically implemented about 6 to 8 weeks postoperatively to strengthen the Achilles tendon.…”

mentioning

confidence: 99%

“…4 Full weight bearing and heel-raising and -lowering strengthening exercises are typically implemented about 6 to 8 weeks postoperatively to strengthen the Achilles tendon. 3,5 These exercises are thought to improve the mechanical and structural properties of the tendon. 6 Some protocols have suggested initiating these exercises either earlier or later based on the nature of the injury and tendon healing.…”

mentioning

confidence: 99%

Achilles Tendon Loading During Heel-Raising and -Lowering Exercises

Revak

Diers

Kernozek

et al. 2017

Journal of Athletic Training

View full text Add to dashboard Cite

Context: Achilles tendinopathies are common injuries during sport participation, although men are more prone to Achilles tendon injuries than women. Heel-raising and -lowering exercises are typically suggested for Achilles tendon rehabilitation.Objective: To compare the estimated Achilles tendon loading variables and the ankle range of motion (ROM) using a musculoskeletal model during commonly performed heelraising and -lowering exercises.Design: Controlled laboratory study. Setting: University biomechanics laboratory.Patients or Other Participants: Twenty-one healthy men (age ¼ 21.59 6 1.92 years, height ¼ 178.22 6 8.02 cm, mass ¼ 75.81 6 11.24 kg).Intervention(s): Each participant completed 4 exercises: seated heel raising and lowering, bilateral standing heel raising and lowering, bilateral heel raising and unilateral lowering, and unilateral heel raising and lowering.Main Outcome Measure(s): A repeated-measures multivariate analysis of variance (a ¼ .05) was used to compare Achilles tendon stress, force, and strain and ankle ROM for each exercise. Kinematic data were recorded at 180 Hz with 15 motion-analysis cameras synchronized with kinetic data collected from a force platform sampled at 1800 Hz. These data were then entered in a musculoskeletal model to estimate force in the triceps surae. For each participant, we determined Achilles tendon stress by measuring cross-sectional images using ultrasound.Results: Peak Achilles tendon loading was lowest when performing the seated heel-raising and -lowering exercise and highest when performing the unilateral heel-raising and -lowering exercise. Loading was greater for the unilateral exercise or portions of the exercise that were performed unilaterally.Conclusions: Bilateral and seated exercises with less weight-bearing force resulted in less Achilles tendon loading. These exercises may serve as progressions during the rehabilitation process before full-body weight-bearing, unilateral exercises are allowed. Ankle ROM did not follow the same order as loading and may need additional monitoring or instruction during rehabilitation.Key Words: kinematics, kinetics, strain, therapeutic exercise, rehabilitation Key PointsBilateral and seated heel-raising and -lowering exercises resulted in less Achilles tendon loading. Unilateral exercises and the unilateral phase of the bilateral heel-raising and unilateral heel-lowering exercise resulted in more Achilles tendon loading.

show abstract

“…All subjects provided written informed consent, and the rights of the subjects were protected. Six orthopedic surgeons from 4 surgical groups that primarily use the Kessler suturing technique to repair ruptured Achilles tendons and that recommend a 16‐week rehabilitation protocol [9,10] after such repairs were invited to join the study for subject recruitment.…”

Section: Methodsmentioning

confidence: 99%