Achilles Tendinopathy, Symptom Recovery Does Not Ensure Functional Recovery

Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy. Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Br J Sports Med. 2007 Apr;41(4):276-80; discussion 280. Epub 2007 Jan 29.

Abstract
OBJECTIVE: To assess the relationship between muscle-tendon function and symptoms in patients with Achilles tendinopathy using a validated test battery.
DESIGN: A prospective non-randomised trial.
SETTING: Orthopaedic Department, Sahlgrenska University Hospital, Sweden.
PATIENTS: 37 patients with a clinical diagnosis of Achilles tendinopathy in the midportion of the tendon, with symptoms for >2 months, were evaluated at the initiation of the study and after 1 year.
INTERVENTION: The patients were treated using a rehabilitation programme, under the supervision of a physical therapist, for 6 months.
MAIN OUTCOME MEASUREMENTS: The patients were evaluated using the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S) for symptoms, and a test battery for evaluation of the lower leg muscle-tendon function.
RESULTS: There were significant improvements in the VISA-A-S score (p<0.00, n = 37) and the test battery (p<0.02, n = 19) at the 1-year follow-up. The VISA-A-S questionnaire had an effect size of 2.1 and the test battery had an effect size of 0.73. A low correlation (r = 0.178, p>0.05) was found between the VISA-A-S score and the test battery. A high correlation (r = 0.611, p<0.05) was found between the drop counter movement jump and the VISA-A-S score. All other tests in the test battery had low correlations (r = -0.305 to 0.155, p>0.05) with the VISA-A-S score. Only 25% (4/16) of the patients who had full symptomatic recovery had achieved full recovery of muscle-tendon function as measured by the test battery.
CONCLUSION: Full symptomatic recovery in patients with Achilles tendinopathy does not ensure full recovery of muscle-tendon function. The VISA-A-S questionnaire and the test battery are sensitive to clinically relevant changes with treatment and can be recommended for use in both the clinic and research.

Diagnosis: Achilles Tendinitis

Outcome: VISA-A and various functional tests. At one year follow up 67% were classified as fully recovered, average VISA-A increased from 56 to 89. Of those fully recovered (VISA-A at or above 90) only 25% had functional tests 90% or greater than their contralateral side.

When Assessed: 12 months

Subjects: 37 people, 17 women & 20 men, 30-58 years, ave age 46

Protocol: Progressive battery of exercises including both eccentric and concentric calf raises slow and fast, progressed over 6 months.

Other Activity: unclear, but these researches in other studies advocated continuing with recreational activities so long as pain (VAS) does not rise over 5/10. “In a recent study, we found that continued physical activity with use of a pain-monitorying model des not seem to hinder recovery (unpublished data).

Chad’s Comments:  Study used both concentric and eccentric exercises successfully, but found functional status often continues to lag even if patients are asymptomatic.  As such performance tests should be done to ensure full functional status has been restored.

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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Hello! Thanks for checking out Spinal Flow Yoga®!

This is one of my older “legacy” blogs from my prior physical therapy site. If the information you find here seems only moderately related, or a bit technical for yoga, it’s because I wrote it with a different, but still overlapping, audience in mind. However, I think each blog does showcase my thought processes and research base, both of which very much influenced what evolved into Spinal Flow Yoga®.

Further, given that spine pain has long been a favorite topic of mine, much of the content within these older blogs will be directly relevant to Spinal Flow® even if at times I criticized yoga. In fact, that’s why I created Spinal Flow Yoga®, to correct what were, and still are, many physical problems in modern yoga sequences. Time permitting, I may revisit some of my favorites blogs add some content relating them to newer Spinal Flow® concepts that aim to cure neck and back pain as well as improve overall health and fitness from the comfort of your own home without the need for equipment. Hopefully that will make more sense out of why this blog is here. And if you have neck or back pain, you're in luck. Before you needed a gym to utilize my methods, but I've been working hard, gearing it towards home training, and efficiency and effectiveness have been remarkable. Hit the button to learn more about SC5 and SF5, my 5-minute flows, both of which I'm very proud of.