Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis

Abstract

We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.

Tendinopathy—from basic science to treatment

“…Exercise is important in both prevention and treatment of tendinopathy. Eccentric exercise therapy has been reported to have some effect in prospective, randomized trials in athletic patients; 54,55 however, a review of 20 published trials found that there was little evidence of a positive effect on clinical outcomes, such as reduction of pain, return to function and patient satisfaction. 56 Shock-wave therapy, which is thought to function on the tenocytes to stimulate repair, might be effective in a carefully selected group of patients, 57 although other studies have reported no significant effect.…”

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

“…One study reports that 89% of the runners with Achilles tendinopathy were men (Kvist, 1991). In a review of several treatment studies, the percentage of men was between 45-86%, with the lower percentages seen in the more recent studies (Nelen et al, 1989, Schepsis et al, 1994, Alfredson et al, 1998b, Alfredson et al, 1998c, Angermann and Hovgaard, 1999, Paavola et al, 2000a, Paavola et al, 2000b, Mafi et al, 2001, Öhberg and Alfredson, 2002, Paavola et al, 2002b, Alfredson and Öhberg, 2005d.…”

“…Studies of the effect of strengthening exercise on tendon are almost non-existent, apart from a study by Simonsen and coworkers (1995), who found no effect from strength training on tendon in rats. Strength training has, however, been shown to have positive effect on injuries to the Achilles tendon (Niesen-Vertommen et al, 1992, Alfredson et al, 1998b, Mafi et al, 2001, Silbernagel et al, 2001, Alfredson et al, 2001a, Roos et al, 2004. Endurance type exercise might, however, not have the same effect as strengthening exercise on tendon.…”

“…When studying Achilles tendon injuries in athletes, Kvist (1991) found that the mean age of subjects with Achilles tendon disorders was 28±9 years, while it was 20±8 years in those without these disorders. Treatment studies (both surgical and non-surgical), that not only include athletes, report that the average age of patients with Achilles tendinopathy ranges between 30 and 55 years, with a total range from 17-80 years of age (Nelen et al, 1989, Leach et al, 1992, NiesenVertommen et al, 1992, Schepsis et al, 1994, Alfredson et al, 1998b, Alfredson et al, 1998c, Angermann and Hovgaard, 1999, Paavola et al, 2000a, Paavola et al, 2000b, Mafi et al, 2001, Öhberg and Alfredson, 2002, Paavola et al, 2002b, Neeter et al, 2003, Alfredson and Öhberg, 2005d. In a prospective study, Johansson (1986) reported that the annual incidence of Achilles tendon overuse injury in elite orienteers was 7%.…”

Effect of eccentric exercise on the healing process of injured patellar tendon in rats

“…20 Eccentric exercise is benefi cial in evoking gains in muscle power and muscle spring stiffness, 21,22 increasing stiffness in the tendon, preventing injury to the muscletendon unit and the tendon itself, 21 and reducing pain associated with tendon disorders. 21,23,24 The advantages of eccentric exercise compared to concentric exercise are reduction of metabolic costs and O 2 consumption, 3,25 production of much greater force (i.e., two-to threefold) than that of concentric exercise, 26 and a better remodeling response. Ischemia and local hypoxia are thought to be major stimuli for VEGF-induced angiogenesis.…”