Eccentric Training Decreases Paratendon Capillary Blood Flow and Preserves Paratendon Oxygen Saturation in Chronic Achilles Tendinopathy

Abstract

a chilles tendinopathy is associated with a certain degree of neovascularisation 15 and pain, which may be demonstrated by either color Doppler or Power Doppler ultrasound. The introduction of Laser Doppler supports imaging in soft tissue inflammation and is believed to be more sensitive than Power Doppler. 5The baseline Achilles tendon as well as paratendon microcirculation in healthy athletes differs from patients with either insertional or midportion tendinopathy, where capillary blood flow at the point of pain is increased as determined by laser Doppler flowmetry. 13 Combining laser Doppler flowmetry to assess capillary blood flow, with spectrophotometry to determine local oxygen saturation and t study design: A controlled, randomized, prospective study.t obJectiVe: To assess the changes in paratendon microcirculation after 12 weeks of daily painful eccentric training in individuals with chronic Achilles tendinopathy.t bacKground: Changes in tendon and paratendon microcirculation are evident in insertional and midportion Achilles tendinopathy. Whether the paratendon is involved in eccentric training response is not known.t Methods: Twenty patients with chronic Achilles tendinopathy were recruited for a prospective, controlled trial using eccentric exercise. A laser Doppler system assessed capillary blood flow (flow), tissue oxygen saturation (SO 2 ), and postcapillary venous filling pressure (rHb) at 8 paratendon locations at depths of 2 and 8 mm.t results: Pain in the eccentric-training group was reduced by 48% (from a mean of 4.1 6 2.9 to 2.1 6 2.2, P,.05). Deep paratendon blood flow decreased at the midportion paratendon location (P,.05). Superficial blood flow at the medial distal midportion position (by 31%, P = .008) and the lateral proximal midportion location (by 45%, P = .016) were significantly decreased postintervention. No significant change of superficial or deep paratendon oxygenation was found after intervention as compared to baseline. Deep paratendon postcapillary venous filling pressures were significantly reduced following eccentric training (P,.05).t conclusion: An eccentric-training program performed daily over 12 weeks reduced the increased paratendinous capillary blood flow in Achilles tendinopathy by as much as 45% and decreased pain level based on a visual analog scale. Local paratendon oxygenation was preserved while paratendinous postcapillary venous filling pressures were reduced after 12 weeks of eccentric training, which appears to be beneficial from the perspective of microcirculation.

Untitled

“…It has been reported that nerves appear to travel in close association to tendon neovessels [5]. This finding suggests that angiogenesis plays an important role in pain-experienced in tendinopathy condition [6,7]. These data are in accordance with clinical studies showing that strategies to destroy neovessels (i.e local injection of a sclerosing agent, polidocanol) lead to pain improvement [7].…”

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

“…There are 3 studies with level I evidence 108,110,120 and 11 studies with level II evidence. 5,25,31,56,75,77,97,111,114,117,121 Although these studies generally note good outcomes with athletic individuals who have midportion Achilles tendinopathy, it is reported that nonathletic individuals 75,114 and those with insertional Achilles tendinopathy 31 do not seem to respond as favorably. Curwin and Stanish 22 developed the eccentric program in the early 1980s.…”

“…The eccentric program was found to be superior to low-energy shock wave treatment 110 ; however, extracorporeal shockwave therapy (ESWT) combined with the eccentric program was better than eccentric exercises alone. 108 Additional studies have also noted an eccentric training program for those with midportion Achilles tendinopathy to decrease pain, 5,31,56,77,111,117 improve function, 111 improve VISA-A scores, 25,75,120 and increase strength. 5 Concentric exercises do not seem to have the same effect as an eccentric program.…”

“…If a greater amount of external resistance is necessary, subjects are to use a weight machine. 5 This eccentric training may be beneficial because of its effect on improving microcirculation 56 and peritendinous type I collagen synthesis. 55 There is considerable variability in the way eccentric exercise are performed, and it is not currently known which protocol is most effective.…”

Ultrasound-Guided EPI® Technique and Eccentric Exercise, New Treatment for Achilles and Patellar Tendinopathy Focused on the Region-Specific of the Tendon

“…It is considered that hypoxia could be responsible for neovascularization in tendinopathies, capillary flow and post-capillary pressure decreased following 12 weeks of eccentric loading [57].…”