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.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

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