Eccentric Exercise and Heel Brace for Achilles Tendinopathy

Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without the AirHeel Brace. A randomized controlled trial. A: effects on pain and microcirculation. Knobloch K, Schreibmueller L, Longo UG, Vogt PM. Disabil Rehabil. 2008;30(20-22):1685-91.

PURPOSE: To compare eccentric training and the combination of eccentric training with the AirHeel Brace for the management of tendinopathy of the main body of the Achilles tendon.
METHODS: We recruited 116 subjects with unilateral tendinopathy of the main body of the Achilles tendon, who were randomized in two groups. Group A performed a regimen of daily eccentric training associated with the AirHeel Brace (Donjoy Orthopedics, Vista, CA, USA). Group B performed the same eccentric training without the AirHeel Brace. Tendon microcirculatory mapping was performed using combined Laser-Doppler and spectrophotometry. Pre- and post-operative FAOS score and VAS score were used to evaluate the patients.
RESULTS: The FAOS score and the VAS score showed significant improvements from pre-operative to post-operative values in both groups (A 5.1 +/- 2 vs. 2.9 +/- 2.4, 43% reduction and B: 5.4 +/- 2.1 vs. 3.6 +/- 2.4, 33% reduction, both p = 0.0001). There were no statistically significant differences in FAOS score and VAS score when comparing the two groups after the end of the intervention. In Group A, tendon oxygen saturation in the main body of the Achilles tendon showed significant increase from pre- to post-management values (68 +/- 12 vs.74 +/- 8%, p = 0.003). Post-capillary venous filling pressures showed significant reduction from pre- to post-intervention values.
CONCLUSION: Eccentric training, associated or not with the AirHeel Brace, produces the same effect in patients with tendinopathy of the main body of the Achilles tendon. The combination of eccentric training with the AirHeel Brace can optimize tendon microcirculation, but these micro-circulator advantages do not translate into superior clinical performance when compared with eccentric training alone.

Diagnosis: Achilles Tendinitis

Outcome: FAOS improved significantly in both groups that did eccentric exercise but did not differ with use of the brace. VAS decreased from 5.1 to 2.9 in one group and 5.4 to 3.6 both eccentric groups (a 43.1% and 34.6% improvement respectively) while use of heel brace did not have a significant effect on pain or function.

When Assessed: 12 weeks

Subjects: 63 males and 34 females average age 47

Protocol: Eccentric training 3 sets of 15 reps twice daily.

Other Activity: “All groups performed their regular sport activity throughout the study period for at least 12 weeks.”

Chad’s Comments:  Physical therapy study showing beneficial changes in pain, function, and quality of life with eccentric exercise WHILE ALLOWING SUBJECTS TO CONTINUE WITH REGULAR SPORTS ACTIVITY.  The ankle brace had no effect on outcomes and I expect much the same to be true with the use of elbow straps with medial or lateral epicondylitis.

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember Spinal Flow Yoga for you or someone you know in the future.

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.

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