Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy

Beyer, R.; Kongsgaard, M.; Kjær, Birgitte Hougs; Øhlenschlæger, Tommy Frisgaard; Kjær, Michael; Magnusson, Peter

doi:10.1177/0363546515584760

Cited by 302 publications

(358 citation statements)

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“…We selected the eccentric heel drop as it remains an integral part of Achilles tendon rehabilitation (Beyer et al, 2015;Habets and van Cingel, 2015;Kjaer and Heinemeier, 2014), induces high tendon strains (∼8.5%; Jeong et al, 2014) and has been shown to affect immediate changes in mechanical (Obst et al, 2015) and 2D morphological (Grigg et al, 2009) properties of the Achilles free tendon in healthy adults. We expected that transverse morphology and strain (CSA, AP diameter and ML diameter) of the Achilles free tendon would be altered immediately following exercise and correlated to the corresponding change in longitudinal strain.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional morphology and strain of the Achilles free tendon immediately following eccentric heel drop exercise

Obst

Newsham-West

Barrett

2015

Journal of Experimental Biology

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Our understanding of the immediate effects of exercise on Achilles free tendon transverse morphology is limited to single site measurements acquired at rest using 2D ultrasound. The purpose of this study was to provide a detailed 3D description of changes in Achilles free tendon morphology immediately following a single clinical bout of exercise. Freehand 3D ultrasound was used to measure Achilles free tendon length, and regional cross-sectional area (CSA), medio-lateral (ML) diameter and antero-posterior (AP) diameter in healthy young adults (N=14) at rest and during isometric muscle contraction, immediately before and after 3×15 eccentric heel drops. Post-exercise reductions in transverse strain were limited to CSA and AP diameter in the midproximal region of the Achilles free tendon during muscle contraction. The change in CSA strain during muscle contraction was significantly correlated to the change in longitudinal strain (r=−0.72) and the change in AP diameter strain (r=0.64). Overall findings suggest the Achilles free tendon experiences a complex change in 3D morphology following eccentric heel drop exercise that manifests under contractile but not rest conditions, is most pronounced in the mid-proximal tendon and is primarily driven by changes in AP diameter strain and not ML diameter strain.

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Section: Introductionmentioning

confidence: 99%

Three-dimensional morphology and strain of the Achilles free tendon immediately following eccentric heel drop exercise

Obst

Newsham-West

Barrett

2015

Journal of Experimental Biology

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“…The symptoms may become severe without adequate rest and treatment. Systemic nonsteroidal anti-inflammatory drugs, 12 transcutaneous electrical nerve stimulation, eccentric training, 4,5 heavy slow resistance training, 13 laser, ultrasound, 12 and massage have been described as potentially useful methods. As mentioned for interventional choice, radiofrequency therapies, plateletrich plasma injections, local glucocorticosteroid injections, or surgery 12 are chosen for chronic cases.…”

Section: Discussionmentioning

confidence: 99%

Healing of Achilles Tendon Partial Tear Following Focused Shockwave: A Case Report and Literature Review

Hsu

2017

Ultrasound in Medicine & Biology

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“…Malliaras and his colleagues [16] concluded that clinicians should consider eccentric -concentric loading alongside or instead of eccentric loading in Achilles and patellar tendinopathy. A Heavy Slow Resistance (HSR) program is recommended in the management of lower limb tendinopathy [26,27]. The HSR program was produced equivalent pain and function improvement (VISA) than the Alfredson eccentric program, but significantly better patient satisfaction at six month follow -up.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of Eccentric - Concentric Training of Wrist Extensors and Eccentric - Concentric Training Combined With Supinator Strengthening in Healthy Population

Stasinopoulos¹

2017

ORP

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IntroductionLateral Elbow Tendinopathy (LET) seems to be the most appropriate term to use in clinical practice because all the other terms such as lateral epicondylitis, lateral epicondylalgia, lateral epicondylosis and tennis elbow make reference to inappropriate aetiological, anatomical and Pathophysiological terms [1]. LET is one of the most common lesions of the arm work-related or sport-related pain disorder. The condition is usually defined as a syndrome of pain in the area of the lateral epicondyle [2] that may be degenerative or failed healing tendon response rather than inflammatory [3]. Hence, the increased presence of fibroblasts, vascular hyperplasia, Proteoglycans and Glycosaminoglycans together with disorganized and immature collagen may all take place in the absence of inflammatory cells [4]. The most commonly affected structure is the origin of the Extensor Carpi Radialis Brevis (ECRB) [4]. The dominant arm is commonly affected, the peak prevalence.The main complaint of patients with LET are pain and decreased function [2,3] both of which may affect daily activities. Diagnosis is simple, and a therapist should be able to reproduce this pain in at least one of three ways: (1) Digital palpation on the facet of the lateral epicondyle, (2) Resisted wrist extension and resisted middle-finger extension with the elbow in extension and (3) by getting the patient to grip an object [2,3,5].Although the signs and symptoms of LET are clear and its diagnosis is easy, to date, no ideal treatment has emerged. Many clinicians advocate a conservative approach as the treatment of choice for LET [2,3,[6][7][8]. Physiotherapy is a conservative treatment that is usually recommended for LET patients [2][3][4][5][6][7][8][9]. A wide array of physiotherapy treatments have been recommended for the management of LET [10][11][12][13][14]. These treatments have different theoretical mechanisms of action, but all have the same aim, to reduce pain and improve function. Such a variety of treatment options suggests that the optimal treatment strategy is not known and more research is needed to discover the most effective treatment in patients with LET.One of the most common physiotherapy treatments for LET is an exercise programme [2][3][4][5][6][7][8][9][10][11][12][13][14]. One consisting of eccentric exercises has shown good clinical results in LET [15] as well as in conditions similar to LET in clinical behavior and histopathological appearance, such as Patellar and Achilles tendinopathy [16]. Such an exercise programme is used as the first treatment option for our patients with LET [9,17]. Malliaras and his colleagues concluded that clinicians should Demosthenous M, et al., J Orthop Res Physiother 2017, 3: 036 DOI: 10.24966/ORP-2052 HSOA Journal of Orthopedic Research and Physiotherapy Review Article Abstract ObjectivesTo compare the effectiveness of eccentric-concentric training of wrist extensors and eccentric-concentric training combined with supinator strengthening in healthy subjects. MethodsA randomized clinical t...

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Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy

Abstract: The results of this study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.

Cited by 302 publications

References 46 publications

Three-dimensional morphology and strain of the Achilles free tendon immediately following eccentric heel drop exercise

Three-dimensional morphology and strain of the Achilles free tendon immediately following eccentric heel drop exercise

Healing of Achilles Tendon Partial Tear Following Focused Shockwave: A Case Report and Literature Review

Comparison of the Effectiveness of Eccentric - Concentric Training of Wrist Extensors and Eccentric - Concentric Training Combined With Supinator Strengthening in Healthy Population

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