Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function

Radovanović, Goran; Kunz, Jona; Böhm, Sebastian; Arampatzis, Adamantios; Legerlotz, Kirsten

doi:10.1080/02640414.2021.1959981

Cited by 9 publications

(10 citation statements)

References 43 publications

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“…Structural adaptation also does not directly translate into an improvement in function or better performance, even though higher tendon stiffness is reported to contribute to improved jump performance [ 84 ]. While in healthy adults the home-based application of the same high-load protocol led to increased DJ height [ 41 ], in the tendinopathy patients of this study no change in DJ height was observed and the CMJ height even dropped post-intervention. Moreover, while Achilles tendinopathy is said to be accompanied by a decrease in functional capacity such as vertical jumping [ 85 ], a clinically effective exercise therapy that was associated with significant improvements in VISA-A score did similarly not result in improved CMJ performance [ 49 ].…”

Section: Discussionmentioning

confidence: 68%

“…High-load group : Patients in the High-load group obtained a feedback-fitted sling (displaying the applied force due to an integrated strain gauge) for home-based application [ 41 ] of the high-loading protocol reported by Arampatzis et al [ 26 ], which provides an efficient stimulus for tendon adaptation [ 27 , 28 , 46 , 47 ]. Patients were instructed to sit on the floor with extended knees.…”

Section: Methodsmentioning

confidence: 99%

“…Functional properties were assessed by estimating drop jump (DJ) and countermovement jump (CMJ) height as described previously [ 41 ]. Briefly, after a warm-up with up to 12 jumps of low to moderate intensity, five maximum effort CMJs and five DJs were performed (bare feet, hands akimbo, 1-min rest between repetitions).…”

Section: Methodsmentioning

confidence: 99%

“…Thus, we hypothesize that a mechanical loading protocol that induces adaptation in healthy Achilles tendons [ 28 ] yields similar responses in tendinopathic Achilles tendons, meaning that a high-loading exercise protocol that increases tendon stiffness, CSA [ 28 ] and DJ performance [ 41 ] in a healthy population should also induce beneficial structural adaptations in tendinopathic Achilles tendons in addition to improving pain and function, counteracting the pathological tissue deterioration. In addition, the high-loading protocol is highly time-saving as it requires approximately 20% of the time when compared to the Alfredson protocol (Table 1 ).…”

Section: Introductionmentioning

confidence: 99%

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Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial

et al. 2022

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Background Assuming that the mechanisms inducing adaptation in healthy tendons yield similar responses in tendinopathic tendons, we hypothesized that a high-loading exercise protocol that increases tendon stiffness and cross-sectional area in male healthy Achilles tendons may also induce comparable beneficial adaptations in male tendinopathic Achilles tendons in addition to improving pain and function. Objectives We investigated the effectiveness of high-loading exercise in Achilles tendinopathy in terms of inducing mechanical (tendon stiffness, maximum strain), material (Young’s modulus), morphological (tendon cross-sectional area (CSA)), maximum voluntary isometric plantar flexor strength (MVC) as well as clinical adaptations (Victorian Institute of Sports Assessment—Achilles (VISA-A) score and pain (numerical rating scale (NRS))) as the primary outcomes. As secondary outcomes, drop (DJ) and counter-movement jump (CMJ) height and intratendinous vascularity were assessed. Methods We conducted a controlled clinical trial with a 3-month intervention phase. Eligibility criteria were assessed by researchers and medical doctors. Inclusion criteria were male sex, aged between 20 and 55 years, chronic Achilles tendinopathy confirmed by a medical doctor via ultrasound-assisted assessment, and a severity level of less than 80 points on the VISA-A score. Thirty-nine patients were assigned by sequential allocation to one of three parallel arms: a high-loading intervention (training at ~ 90% of the MVC) (n = 15), eccentric exercise (according to the Alfredson protocol) as the standard therapy (n = 15) and passive therapy (n = 14). Parameters were assessed pre- and-post-intervention. Data analysis was blinded. Results Primary outcomes: Plantar flexor MVC, tendon stiffness, mean CSA and maximum tendon strain improved only in the high-loading intervention group by 7.2 ± 9.9% (p = 0.045), 20.1 ± 20.5% (p = 0.049), 8.98 ± 5.8% (p < 0.001) and −12.4 ± 10.3% (p = 0.001), respectively. Stiffness decreased in the passive therapy group (−7.7 ± 21.2%; p = 0.042). There was no change in Young’s modulus in either group (p > 0.05). The VISA-A score increased in all groups on average by 19.8 ± 15.3 points (p < 0.001), while pain (NRS) dropped by −0.55 ± 0.9 points (p < 0.001). Secondary outcomes: CMJ height decreased for all groups (−0.63 ± 4.07 cm; p = 0.005). There was no change in DJ height and vascularity (p > 0.05) in either group. Conclusion Despite an overall clinical improvement, it was exclusively the high-loading intervention that induced significant mechanical and morphological adaptations of the plantar flexor muscle–tendon unit. This might contribute to protecting the tendon from strain-induced injury. Thus, we recommend the high-loading intervention as an effective (alternative) therapeutic protocol in Achilles tendinopathy rehabilitation management in males. Clinical Trials Registration Number: NCT02732782.

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Section: Discussionmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial

et al. 2022

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“…Consequently, individuals who participate in an exercise activity with an aerial phase should slowly increase their training intensity level to allow the Achilles tendon sufficient time to adapt to the high impact loading. Further, when performing a sport with an aerial phase, it might be helpful to include specific strength training sessions, as proposed recently by Radovanović et al (2021) . Such strategies could help to improve Achilles tendon properties and to prevent overuse injuries.…”

Section: Discussionmentioning

confidence: 99%

An Identical Twin Study on Human Achilles Tendon Adaptation: Regular Recreational Exercise at Comparatively Low Intensities Can Increase Tendon Stiffness

2022

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Achilles tendon adaptation is a key aspect of exercise performance and injury risk prevention. However, much debate exists about the adaptation of the Achilles tendon in response to exercise activities. Most published research is currently limited to elite athletes and selected exercise activities. Also, existing studies on tendon adaptation do not control for genetic variation. Our explorative cross-sectional study investigated the effects of regular recreational exercise activities on Achilles tendon mechanical properties in 40 identical twin pairs. Using a handheld oscillation device to determine Achilles tendon mechanical properties, we found that the Achilles tendon appears to adapt to regular recreational exercise at comparatively low intensities by increasing its stiffness. Active twins showed a 28% greater Achilles tendon stiffness than their inactive twin (p < 0.05). Further, our research extends existing ideas on sport-specific adaptation by showing that tendon stiffness seemed to respond more to exercise activities that included an aerial phase such as running and jumping. Interestingly, the comparison of twin pairs revealed a high variation of Achilles tendon stiffness (305.4–889.8 N/m), and tendon adaptation was only revealed when we controlled for genetic variance. Those results offer new insights into the impact of genetic variation on individual Achilles tendon stiffness, which should be addressed more closely in future studies.

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Effect of the temporal coordination and volume of cyclic mechanical loading on human Achilles tendon adaptation in men

Tsai,

Domroes,

Pentidis

et al. 2024

Sci Rep

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Human tendons adapt to mechanical loading, yet there is little information on the effect of the temporal coordination of loading and recovery or the dose–response relationship. For this reason, we assigned adult men to either a control or intervention group. In the intervention group, the two legs were randomly assigned to one of five high-intensity Achilles tendon (AT) loading protocols (i.e., 90% maximum voluntary contraction and approximately 4.5 to 6.5% tendon strain) that were systematically modified in terms of loading frequency (i.e., sessions per week) and overall loading volume (i.e., total time under loading). Before, at mid-term (8 weeks) and after completion of the 16 weeks intervention, AT mechanical properties were determined using a combination of inverse dynamics and ultrasonography. The cross-sectional area (CSA) and length of the free AT were measured using magnetic resonance imaging pre- and post-intervention. The data analysis with a linear mixed model showed significant increases in muscle strength, rest length-normalized AT stiffness, and CSA of the free AT in the intervention group (p < 0.05), yet with no marked differences between protocols. No systematic effects were found considering the temporal coordination of loading and overall loading volume. In all protocols, the major changes in normalized AT stiffness occurred within the first 8 weeks and were mostly due to material rather than morphological changes. Our findings suggest that—in the range of 2.5–5 sessions per week and 180–300 s total high strain loading—the temporal coordination of loading and recovery and overall loading volume is rather secondary for tendon adaptation.

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Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function

Abstract: 2021): Reliable and effective novel home-based training set-up for application of an evidence-based high-loading stimulus to improve triceps surae function, Journal of Sports Sciences,

Cited by 9 publications

References 43 publications

Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial

Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial

An Identical Twin Study on Human Achilles Tendon Adaptation: Regular Recreational Exercise at Comparatively Low Intensities Can Increase Tendon Stiffness

Effect of the temporal coordination and volume of cyclic mechanical loading on human Achilles tendon adaptation in men

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