Eccentric exercise in treatment of Achilles tendinopathy

Eccentric exercise in treatment of Achilles tendinopathy. Nørregaard J, Larsen CC, Bieler T, Langberg H. Scand J Med Sci Sports. 2007 Apr;17(2):133-8.

AIM: Prognosis and treatment of Achilles tendon pain (achillodynia) has been insufficiently studied. The purpose of the present study was to examine the long-term effect of eccentric exercises compared with stretching exercises on patients with achillodynia.
METHODS: Patients with achillodynia for at least 3 months were randomly allocated to one of two exercise regimens. Exercise was performed daily for a 3-month period. Symptom severity was evaluated by tendon tenderness, ultrasonography, a questionnaire on pain and other symptoms, and a global assessment of improvement. Follow-up was performed at time points 3, 6, 9, 12 weeks and 1 year.
RESULTS: Of 53 patients with achillodynia 45 patients were randomized to either eccentric exercises or stretching exercises. Symptoms gradually improved during the 1-year follow-up period and were significantly better assessed by pain and symptoms after 3 weeks and all later visits. However, no significant differences could be observed between the two groups. Women and patients with symptoms from the distal part of the tendon had significantly less improvement.
CONCLUSIONS: Marked improvement in symptoms and findings could be gradually observed in both groups during the 1-year follow-up period. To that extent this is due to effect of both regimens or the spontaneous improvement is unsettled.

Diagnosis: Achilles tendinitis, both mid portion and insertional.

Outcome: Reported minimal improvement at 12 weeks in both groups, however at 1 year 21/23 tendons in eccentric group had “very significant improvement” or “completely cured” while only 12/19 were as improved in the stretching group.

When Assessed: 3, 6, 9, and 12 weeks and 1 year

Subjects: 45 patients, ~half men and women, average age ~42.

Protocol: Eccentric Protocol: 1 increasing to 2 & 3 sets of 15 reps of body weight eccentric calf raises with knees straight and with knee bent. 5kg added at a time to backpack pain decreased. Performed twice daily for 12 weeks. Stretching group did 5x 30 seconds with straight knee and bent knee performed twice per day. No other details as to how stretches were performed.

Other Activity: “They were allowed to continue ongoing pain free sporting activities, but were told not to take up new activities or increase the amount of training.”

Chad’s Comments:  The authors noted their results were not as good or as fast as Alfredson 1998 and Fahlstom 2003, but used the same training protocol, however they noted their groups activity may be lower, they included insertional tendinitis. They also reported supervision of subjects was not as good and subjects were not encouraged to work through pain as with Alfredson and Fahlstom. They also suspect their subjects less athletic to start. They also noted women had a poorer prognosis then men.

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Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.


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