Eccentric Overload Training and Chronic Achilles Tendinitis

Eccentric overload training for patients with chronic Achilles tendon pain–a randomised controlled study with reliability testing of the evaluation methods. Silbernagel KG, Thomeé R, Thomeé P, Karlsson J. Scand J Med Sci Sports. 2001 Aug;11(4):197-206.


The purpose was to examine the reliability of measurement techniques and evaluate the effect of a treatment protocol including eccentric overload for patients with chronic pain from the Achilles tendon. Thirty-two patients with proximal achillodynia (44 involved Achilles tendons) participated in tests for reliability measures. No significant differences and strong (r=0.56-0.72) or very strong (r=0.90-0.93) correlations were found between pre-tests, except for the documentation of pain at rest (P<0.008, r=0.45). To evaluate the effect of a 12-week treatment protocol for patients with chronic proximal achillodynia (pain longer than three months) 40 patients (57 involved Achilles tendons) with a mean age of 45 years (range 19-77) were randomised into an experiment group (n=22) and a control group (n=18). Evaluations were performed after six weeks of treatment and after three and six months. The evaluations (including the pre-tests), performed by a physical therapist unaware of the group the patients belonged to, consisted of a questionnaire, a range of motion test, a jumping test, a toe-raise test, a pain on palpation test and pain evaluation during jumping, toe-raises and at rest. A follow-up was also performed after one year. There were no significant differences between groups at any of the evaluations, except that the experiment group jumped significantly lower than the control group at the six-week evaluation. There was, however, an overall better result for the experiment group with significant improvements in plantar flexion, and reduction in pain on palpation, number of patients having pain during walking, having periods when asymptomatic and having swollen Achilles tendon. The controls did not show such changes. Furthermore, at the one-year follow-up there were significantly more patients in the experiment group, compared with the control group, that were satisfied with their present physical activity level, considered themselves fully recovered, and had no pain during or after physical activity. The measurement techniques and the treatment protocol with eccentric overload used in the present study can be recommended for patients with chronic pain from the Achilles tendon.

Diagnosis:  Mid portion tendinitis (2-6 cm above insertion)

Outcome:  Tested ROM, functional tests, pain, yes or no follow up questions. Both groups improved over time but the experimental results were better. At one year 12/20 felt fully recovered while control group 4/17 were fully recovered.

When Assessed:  12 week exercise program, assessed at 6 weeks, 3 months, 6 months, and follow up questions at 1 year.

Subjects:  30 tendons in experimental group, 27 in control group, average age 47 and 41 respectively.

Protocol:  All groups included some stretch and body weight concentric and eccentric calf raises. Eccentric group was allowed to train though pain of up to 5/10, while control group avoided pain. Eccentric group ramped up repetitions as symptoms would allow but no additional resistance was added beyond body weight. Frequency varied from 3x per day to every other day, progressing to lesser frequency as time progressed. Control group did concentric and eccentric calf raises but only progressed to 3 sets of 5 reps.

Other Activity:  Largely active group, more than half were joggers, and several others were active in other sports.

Chad’s Comments:  Both groups improved, but neither did so in a stunning manner. The eccentric group did do better but exercise intensity and duration was also more so one can not determine if changes are due to the eccentric nature of the exercise, or the amount of exercise. Exercising with pain up to 5/10 was clearly not detrimental in comparison to pain free exercise. Even eccentric exercise group intensity was relatively light as they never added external resistance beyond body weight.

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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