The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis

Gärdin, Anna; Movin, Tomas; Svensson, Leif; Shalabi, Adel

doi:10.1007/s00256-009-0798-3

Cited by 48 publications

(63 citation statements)

References 30 publications

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“…Similarly, long-term follow-up (mean of 4.2 years) of the same cohort reported no significant difference in tendon volume compared to baseline measures, despite improvements in pain and function. 36 Furthermore, previous research has found that Achilles tendon structure on UTC is no different after a 16-week eccentric loading program, despite improvements in the VISA-A score. 23 The findings of these studies suggest that improvements in the tendon are not necessary to facilitate clinical improvement after an eccentric exercise program.…”

Section: Monitoring Of Tendon Structure: What Can We Expect From the mentioning

confidence: 95%

Tendinopathy: Is Imaging Telling Us the Entire Story?

Docking¹,

Ooi²,

Connell³

2015

J Orthop Sports Phys Ther

137

132

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Section: Monitoring Of Tendon Structure: What Can We Expect From the mentioning

confidence: 95%

Tendinopathy: Is Imaging Telling Us the Entire Story?

Docking¹,

Ooi²,

Connell³

2015

J Orthop Sports Phys Ther

137

132

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“…Eccentric exercise is commonly prescribed to patients with tendinopathy, based on the high success rate (82%-100%) of the intervention for athletes with midportion Achilles tendinopathy. 1,11,13,22,27 However, eccentric exercise has been less effective (60% success rate) for sedentary individuals with Achilles tendinopathy, 30 and for individuals with IAT (32% or less success rate). 11,29 While these studies focus on return to the previous level of selfreported function, few studies focus on the mechanical function of the tendon.…”

Section: T T Conclusionmentioning

confidence: 99%

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Chimenti¹,

Flemister²,

Tome³

et al. 2014

J Orthop Sports Phys Ther

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A cross-sectional image was obtained 2 cm proximal to the tendon insertion. Echogenicity was quantified as the mean grayscale value for the central 1 cm of the entire depth of the tendon cross-section (FIGURES 1C and 1D). The grayscale value for a pixel could range from 0 (black) to 255 (white). The mean grayscale value for all pixels in the region of interest was quantified using ImageJ, with a lower value indicating greater pathology. All ultrasound images had the same gain setting of 56 and were collected at a 3-cm depth, so that differences in ultrasound settings would not influence the mean grayscale values between participants. Tendon Mechanical PropertiesThe combination of ultrasound imaging and dynamometry was used to measure tendon mechanical properties (strain, stiffness). Each participant's ankle was positioned and secured in a Biodex System 4 (Biodex Medical Systems, Inc, Shirley, NY) in sitting, with the seatback reclined to 45°, the chair height adjusted so that the tibia was parallel to the floor, and the hip in neutral adduction/abduction (FIGURE 2A). The participant's ankle was moved in the sagittal plane from 10° of plantar flexion to 10° of dorsiflexion at a rate of 5°/s, and the passive plantar flexion torque was recorded at a rate of 1000 Hz. Similar to previous studies, 5,8,18 ultrasound imaging was used to track the linear displacement of the gastrocnemius muscle-Achilles tendon junction (MTJ), with the probe at a fixed point on the calf (FIGURES 2B and 2C). A first set of 6 rotations was used for preconditioning, followed by a second set of 6 rotations, from which images were used to calculate tendon mechanical properties. B-mode ultrasound images were collected when the ankle was in (1) 10° of plantar flexion at the start and end of the second set and (2) 10° of dorsiflexion during the third, fourth, and fifth repetitions. The location of the MTJ in each ankle position was averaged, so that distance between the MTJ locations in 10° of plantar flexion and 10° of dorsiflexion could be calculated. A video was taken on the second repetition to confirm that the images captured the full range of MTJ displacement. Passive torque values from the third, fourth, and fifth repetitions of the second set were used for analysis. Participants were instructed to relax as the foot plate moved the ankle. To ensure that the condition was passive, the activity of the medial gastrocnemius and the anterior tibialis muscles was monitored by a 2-channel Bagnoli desktop electromyography system (Delsys Inc, Natick, MA). Single-differential surface electrodes (input impedance greater than 1015 Ω // 0.2 pF; common-mode rejection ratio, -92 dB; noise, 1.2 μV; preamplifier gain, 10 V/V  1%) were used. The contact material was 99.9% Ag, in the shape of 2 bars with contact dimensions of 10 × 1 mm and spaced 1 cm apart. The electrodes were placed over the motor point of the medial gastrocnemius and the anterior tibialis muscles. The raw electromyography signal was viewed using a 2-channel digitizing oscilloscope (Tektr...

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“…31 Several studies have demonstrated that eccentric exercises can improve patientreported outcomes with favorable changes in strength, clinical imaging, and biochemical and histological markers of ECM remodeling. 32,33 While the mechanisms are not completely understood at the molecular level, eccentric exercises result in the production of new type I collagen and increase the density of collagen fibrils. 34 Furthermore, mechanical loading induces the expression of genes such as scleraxis and tenomodulin that are associated with the accumulation of new tenocytes and the production of healthy ECM.…”

Section: Eccentric Exercisesmentioning

confidence: 99%

“…Non-operative Eccentric exercises Promotion of tissue reorganization with improved changes in tendon structure and mechanical properties 31,34 Positive outcomes including reduced pain, improved strength, and decreased time to return to sport 32,33 NSAIDs Reduced pain and inflammation during tendon healing 37 Positive short-term outcomes for analgesia 35,36 ; no significant long-term benefits 29,37 ; some evidence to support that NSAIDs have potential to inhibit normal tendon healing 39,40 Corticosteroids…”

Section: Treatment Proposed Mechanism Outcomementioning

confidence: 99%

Pathogenesis and management of tendinopathies in sports medicine

et al. 2018

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Tendinopathy is a major clinical problem in sports medicine and is often difficult to treat. Traditional therapeutic approaches have focused on reducing inflammation, yet research suggests that little to no inflammation is present in the tendons that fail to heal. The purpose of this review was to evaluate the effectiveness of the available treatment options for tendinopathy and to inform best clinical practices. A comprehensive search of electronic databases (PubMed, Google Scholar, and Web of Science) was conducted to identify relevant studies through June 2016. Studies were deemed relevant if they were published in English and contained original research on the management of tendinopathy in humans. Studies varied in methodological quality and were often limited by small sample size and lack of sufficient control groups. Critical evaluation of the literature suggests that physical therapy with or without eccentric exercise should be considered a first-line treatment. Corticosteroids and non-steroidal anti-inflammatory drugs provide short-term symptomatic relief, but long-term efficacy has not been demonstrated. Inconsistent results do not support the routine use of prolotherapy, platelet-rich plasma injections, and topical nitric oxide patches. Operative intervention should be reserved until conservative measures fail or an obvious operative lesion is present. While numerous therapeutic modalities exist for tendinopathy in the athlete, the ideal treatment protocol has not been clearly defined. The development of new targeted therapies for tendinopathy is likely to follow a greater understanding of the cellular and molecular mechanisms that underlie its pathogenesis.

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The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis

Cited by 48 publications

References 30 publications

Tendinopathy: Is Imaging Telling Us the Entire Story?

Tendinopathy: Is Imaging Telling Us the Entire Story?

Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy

Pathogenesis and management of tendinopathies in sports medicine

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