The Role of the Vascular and Structural Response to Activity in the Development of Achilles Tendinopathy: A Prospective Study

Abstract

This prospective study identified both female sex and the diminished blood flow response after running as significant risk factors for the development of Achilles tendinopathy. UTC of tendon structure, Achilles tendon thickness, and foot posture did not significantly contribute to the prediction of Achilles tendinopathy. A general evaluation of tendon structure by UTC, measurement of tendon thickness, or determination of the foot posture index will not allow clinicians to identify patients at risk for developing Achilles tendinopathy. Furthermore, it may be possible to improve blood flow after activity by using noninvasive techniques (such as prostaglandins, compression stockings, heat, massage, and vibration techniques). These techniques may be useful in the prevention and management of Achilles tendinopathy, but further research is needed.

Clinical risk factors for Achilles tendinopathy: a systematic review

“…There is conflicting evidence that sex affects the risk for AT. One cohort study reported that being female is associated with AT 23. No association was demonstrated in two cohort studies 17 24…”

Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients

“…Unfortunately, the relatively low number of female participants does not allow for a gender-based inference. As women may be more prone to develop Achilles tendinopathy [35,36], future random-controlled trials (RCTs) should aim to include an equal number of men and women in both study arms.…”

“…As the collagen matrix of tendon is a highly mechanosensitive tissue, cytokine homeostasis and cell survival underlie an intimate balance between adequate biomechanical stimuli and disturbance through load deprivation and overload. This delicate balance between tendon blood flow and loading pattern was recently highlighted in a study by showing that the risk of developing Achilles tendinopathy increased if blood flow increase in the tendon after running was reduced [36]. Based on these new insights, future studies on novel therapeutic strategies for tendinopathy should preferably assess tendon blood flow response both at rest as well as following a standardized tendon-loading protocol.…”

Ankle Joint Position and the Reliability of Ultrasound Tissue Characterization of the Achilles Tendon: A Pilot Study

“…The MDC values using maximum dorsiflexion gave us a comparable threshold of error of measurement that has also been shown in previously published studies. [20,21,31,32]. Testing the tendon at 100% dorsiflexion at the ankle provides a smaller variation in the measurements, and provides a more reliable measure of acoustic impedance and, by association, structural integrity.…”

“…Given the differences in strain seen between healthy and pathological Achilles tendons [44], and the variation in fluid exchange that could affect matrix echogenicity, extrapolation of the data found in this study on positional reliability measures when investigating echotypes in unhealthy tendons, should be considered with some caution. The triceps surae, Achilles tendon, and the aponeurosis, exhibit variation in comparative stiffness properties, and when subjected to longitudinal stretch, are likely to have differential areas that are subject to more or less strain [32]. Also, shear occurs between the soleus and gastrocnemius on passive and active tasks [46,47].…”