Chronic Achilles tendon pain treated with eccentric calf-muscle training. Fahlström M, Jonsson P, Lorentzon R, Alfredson H. Knee Surg Sports Traumatol Arthrosc. 2003 Sep;11(5):327-33. Epub 2003 Aug 26.
Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful mid-portion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients, and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain. Seventy-eight consecutive patients, having chronic painful Achilles tendinosis at the mid-portion (2-6 cm level) in a total of 101 tendons (55 unilateral and 23 bilateral), and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons (29 unilateral and one bilateral) were treated with eccentric calf-muscle training for 12 weeks. Most patients were recreational athletes. Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale (VAS), before and after treatment. In 90 of the 101 Achilles tendons (89%) with chronic painful mid-portion Achilles tendinosis, treatment was satisfactory and the patients were back on their pre-injury activity level after the 12-week training regimen. In these patients, the amount of pain during activity, registered on the VAS-scale (mean+/-SD), decreased significantly from 66.8+/-19.4 to 10.2+/-13.7. On the contrary, in only ten of the tendons (32%) with chronic insertional Achilles tendon pain was treatment satisfactory, with a significant decrease on the VAS-scale (mean+/-SD), from 68.3+/-7.0 to 13.3+/-13.2. Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis, but not in patients with chronic insertional Achilles tendon pain.
Diagnosis: Mid portion Achilles tendinitis (2-6 cm above insertion) & patients with insertional tendinitis.
Outcome: VAS during activity. 90/101 good vs. poor result for mid-portion tendinitis, while 10/31 of insertional tendinitis had good vs. poor result. Good groups were able to return to preinjury activity level and had VAS drop from ~66 to 13 while poor groups only dropped 5-10/100 points on VAS.
When Assessed: 0 and 12 weeks
Subjects: 101 mid portion tendons, 31 tendons with insertional pain. Average age in 40s.
Protocol: 2 exercises (one with knee straight and one with knee bent) 3×15 each, 2 x per day, 7 days per week for 12 weeks, starting with full body weight on one leg, train with pain unless “disabling”, no indication of varied speed
Other Activity: “During the 12-week training regimen, walking and bicycling was allowed if it could be performed with only mild discomfort or pain. Light jogging on flat ground and a slow pace was allowed after four to six weeks, if it could be done without pain. Thereafter their activities could be gradually increased if not severe pain in the tendon was felt.”
Chad’s Comments: They found significantly more women and those with high BMI in the poor result group. In the poor result insertion group all were treated surgically and there were signs of retrocalcaneal and subcutaneous bursitis in all subjects and signs of impingement between the postero-superior part of the calcaneus and the Achilles tendon.
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Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.