The Effect of Eccentric Versus Concentric Exercise in the Management of Achilles Tendonitis

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

“…Khan and co-workers (2003b) The literature describes various types of treatment including rest, modalities, orthotics, anti-inflammatory medication, exercise and surgery (Józsa and Kannus, 1997, Kader et al, 2002, Paavola et al, 2002a, Alfredson, 2003c. Despite the high incidence of Achilles tendon disorders and the various recommended treatments only nine randomized treatment trials can be found in the literature (Lowdon et al, 1984, Niesen-Vertommen et al, 1992, Mafi et al, 2001, Silbernagel et al, 2001, Neeter et al, 2003, Peers, 2003a, Paoloni et al, 2004, Roos et al, 2004, Alfredson and Öhberg, 2005d. The type of treatment that is most effective for patients with Achilles tendinopathy and the criteria that should be used when choosing treatment are also unclear (Józsa and Kannus, 1997, Kader et al, 2002, Paavola et al, 2002a, Alfredson, 2003c.…”

“…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.…”

“…Instead, many studies use patient-reported pain (on a Visual Analog Scale) with tendon loading activity as a main outcome measure to determine the success of treatment. Sometimes, it is the investigator that grades the success of treatment based on patient-reported improvements (Clement et al, 1984, Lowdon et al, 1984, Nelen et al, 1989, Leach et al, 1992, Niesen-Vertommen et al, 1992, Schepsis et al, 1994, Alfredson et al, 1998b, Angermann and Hovgaard, 1999, Paavola et al, 2000b, Mafi et al, 2001, Testa et al, 2002, Öhberg and Alfredson, 2002, Alfredson and Lorentzon, 2003a, Gill et al, 2004, Koenig et al, 2004, Paoloni et al, 2004, Öhberg et al, 2004b, Costa et al, 2005, Alfredson and Öhberg, 2005d.…”

“…Strength measurements with dynamometry have been performed in patients with Achilles tendinopathy, in both etiological and prospective treatment studies (Niesen-Vertommen et al, 1992, Haglund-Åkerlind and Eriksson, 1993, Alfredson et al, 1998b, Alfredson et al, 1998c, Paavola et al, 2000a, Testa et al, 2002, Mahieu et al, 2005 , Haglund-Åkerlind and Eriksson, 1993, Alfredson et al, 1998b, Alfredson et al, 1998c, Mahieu et al, 2005. Paavola and coworkers (2000a), on the other hand, measured the isometric strength of the lower limb in an isometric leg press dynamometer.…”

“…The various body positions described in the literature and used to measure plantarflexion and dorsiflexion strength are supine with the knee and hip extended, sitting with the hip in 100-110 degrees of flexion and the knee in either 40 degrees or 90 degrees of flexion and a closed-chain position in which the measurement pad was placed on the knee (Niesen-Vertommen et al, 1992, Haglund-Åkerlind and Eriksson, 1993, Alfredson et al, 1998b, Alfredson et al, 1998c, Mahieu et al, 2005, Möller et al, 2005. The reliability of isokinetic and isometric dynamometry is generally high and the various testing positions for plantarflexion and dorsiflexion have shown good test-retest reliability (Alfredson et al, 1998c, Möller et al, 2005.…”