Alfredson's "prescription" for achilles tendinopathy

NewsBot · Jan 23, 2023

Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading: Implications for Achilles tendinopathy
Lauren Pringels, Luc Vanden Bossche, Evi Wezenbeek, Arne Burssens, Hannes Vermue, Jan Victor, Amelie Chevalier
14 December 2022

Mechanical overload is considered the main cause of Achilles tendinopathy. In addition to tensile loads, it is believed that the Achilles tendon may also be exposed to compressive loads. However, data on intratendinous pressures are lacking, and consequently, their role in the pathophysiology of tendinopathy is still under debate. Therefore, we aimed to evaluate the intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading. Twelve pairs of human cadaveric legs were mounted in a testing rig, and a miniature pressure catheter was placed through ultrasound-guided insertion in four different regions of the Achilles tendon: the insertion (superficial and deep layers), mid-portion, and proximal portion. Intratendinous pressure was measured during three simulated loading conditions: a bent-knee calf stretch, a straight-knee calf stretch, and an eccentric heel-drop. It was found that the intratendinous pressure increased exponentially in both the insertion and mid-portion regions of the Achilles tendon during each loading condition (p < 0.001). The highest pressures were consistently found in the deep insertion region (p < 0.001) and during the eccentric heel-drop (p < 0.001). Pressures in the mid-portion were also significantly higher than in the proximal portion (p < 0.001). These observations offer novel insights and support a role for compression in the pathophysiology of Achilles tendinopathy by demonstrating high intratendinous pressures at regions where Achilles tendinopathy typically occurs. To what extent managing intratendinous pressure might be successful in patients with Achilles tendinopathy by, for example, avoiding excessive stretching, modifying exercise therapy, and offering heel lifts requires further investigation.
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NewsBot · Jan 30, 2023

Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis
Diego Ailton Prudêncio, Nicola Maffulli, Filippo Migliorini, Thiago Teixeira Serafim, Luis Felipe Nunes, Luciana Sayuri Sanada & Rodrigo Okubo
BMC Sports Science, Medicine and Rehabilitation volume 15, Article number: 9 (2023)

Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented “some concerns”, and 37.5% (five and three articles, respectively) presenting “high risk” of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was − 1.21 (− 2.72 to − 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT
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NewsBot · Apr 12, 2023

"I've got a spring in my step" participants experience of action observation therapy and eccentric exercises, a telehealth study for mid-portion Achilles Tendinopathy: a qualitative study
Deirdre Ryan et al
J Foot Ankle Res. 2023 Apr 11;16(1):19

Background: Quantitative research has dominated the field of Achilles Tendinopathy. The use of qualitative research allows in-depth exploration of participants' perspectives, offering great insight in the evaluation of a trial's processes, particularly when exploring a novel intervention such as Action Observation Therapy combined with eccentric exercises which has not been previously researched. This study aimed to qualitatively explore participants' experiences of partaking in a telehealth study including the acceptability of the intervention, motivators for participation, and perspectives on the trial processes.

Method: A thematic analysis as guided by Braun and Clarke was used to analyse the semi-structured interviews conducted on a purposive sample of participants with mid-portion Achilles Tendinopathy who recently completed a pilot feasibility study. The study adhered to the criteria for reporting qualitative research guidelines (COREQ).

Results/discussion: Sixteen participants were interviewed. The five themes identified were: (i) The impact of Achilles Tendinopathy is commonly not prioritised with 'The acceptance and minimisation of pain' as a sub-theme (ii) Therapeutic alliance has the greatest impact on support (iii) Factors which influenced adherence (iv) Action Observation Therapy is valued and recommended (v) Recommendations for future interventions.

Conclusion: This study provides insightful recommendations around; exploring the use of Action Observation Therapy in Achilles Tendinopathy, the relative importance of therapeutic alliance rather than mode of therapy delivery, and that sufferers of Achilles Tendinopathy may not prioritise health seeking for this condition.
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NewsBot · Jul 27, 2024

A Comparative Study of the Graston Technique and Alfredson Protocol in the Management of Achilles Tendinopathy
Aliyah Usman Qureshi et al
Cureus. 2024 Jun 12;16(6)

Background and objectives: The Achilles tendon, the largest and strongest tendon in the human body, is frequently injured by overuse; this condition is known as Achilles tendinopathy (AT). It serves as a link between the heel bone and the calf muscles and is necessary for motions, such as walking, sprinting, and jumping. Evidence is presented to support the efficacy of the Graston technique and Alfredson protocol for pain reduction and improvement of function and calf muscle strength. The objective of this study is to compare the efficacy of the Graston technique versus the Alfredson protocol in patients with AT. Methods and data collection: After obtaining approval from the ethical review board of the Rawalpindi Medical University, all patients fulfilling the inclusion criteria are divided into two groups, A and B, by generating random identity numbers using Microsoft Excel for allocation. Group A comprises patients who undergo treatment with the Graston technique as conventional therapy with Alfredson protocol (12-week calf muscle eccentric exercises), while those in group B follow a Graston technique with sole heel lift. Individuals in the eccentric exercises group follow an Alfredson method-based 12-week eccentric exercise plan for their leg muscles. The workouts need to be done twice a day, seven days a week for 12 weeks. The plan includes two exercises: the first done with the knee straightened to work the gastrocnemius and the second done with the knee bent to work the soleus. Three sets of 15 repetitions with no rest interval for each exercise are completed twice a day on the affected limb to yield functional improvement.

Results: The results showed that both the Alfredson protocol and the Graston technique were effective in managing AT symptoms. The study involved dividing 32 participants into two groups who received either treatment for four weeks. The main way to measure improvement was a score called the Villalta-Scanlon Achilles Tendonitis Index score. In both groups, these scores showed significant improvement (with a p-value less than 0.001, which means that the results are very statistically significant). For Group A (who received the Alfredson protocol), the average Villalta-Scanlon Achilles Tendonitis Index score before treatment was 29.25. This score increased to 31.25 at mid-treatment and 34.38 after the full four weeks of treatment. Group B (who received the Graston technique) started with an average Villalta-Scanlon Achilles Tendonitis Index score of 22.94. Their scores also increased throughout the treatment, reaching 34.94 at mid-treatment and 42.88 after four weeks. These findings provide evidence that both treatments can improve AT symptoms, with some suggestions that the Graston technique might be even more effective based on the higher average Villalta-Scanlon Achilles Tendonitis Index scores after treatment.

Conclusions: The Graston technique shows promising results, particularly in the mid- and post-treatment phases, indicating its potential efficacy in comparison to the Alfredson protocol in the treatment of AT.
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NewsBot · Jan 10, 2025

Loading Speed and Intensity in Eccentric Calf Training Impact Acute Changes in Achilles Tendon Thickness and Stiffness: A Randomized Crossover Trial
Lauren Pringels, Dries Pieters et al
Med Sci Sports Exerc. 2024 Dec 30.

Purpose: Eccentric calf training for Achilles tendinopathy shows variable success in athletes. Recent insights suggest a role for tendon fluid flow (exudation or redistribution) during exercise, which explains post-exercise reductions in thickness and increases in stiffness of the tendon. This fluid flow is thought to be beneficial as it may promote tendon remodeling, reduce intratendinous pressure, and alleviate pain. In this perspective, slow, high-load exercises are promoted as they theoretically facilitate tendon fluid flow. However, evidence supporting this assumption is lacking. Therefore, this study aimed to investigate whether loading speed and intensity during eccentric calf training impact acute changes in midportion Achilles tendon thickness and stiffness, reflecting alterations in local tendon fluid content.

Methods: A randomized, assessor-blinded, crossover trial was conducted with 34 healthy athletes (17 men, 17 women, age: 23.7 ± 6 years). Participants underwent 3 single-leg eccentric heel-drop interventions with 20% additional bodyweight, varying in loading speed (fast: 1 s, slow: 3 s) and loading intensity (low: to plantigrade, high: to maximal dorsiflexion). Achilles tendon anteroposterior diameter (APD), cross-sectional area (CSA), and shear-wave velocity (SWV) were assessed in the midportion region using ultrasonography and shear-wave elastography pre-and immediately post-intervention.

Results: The slow, high-load intervention produced greater immediate reductions in tendon APD and CSA (8.7% and 10.1%), compared to the slow, low-load (4.0% and 4.7%) and fast, high-load (2.9% and 3.4%) interventions (p < 0.001). Moreover, only the slow, high-load intervention increased tendon SWV (52.4%, p < 0.001).

Conclusions: These findings provide the first evidence that both loading speed and intensity during eccentric calf training impact acute changes in Achilles tendon thickness and stiffness, likely mediated by changes in fluid flow, which could be relevant for tendinopathy rehabilitation.
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Alfredson's "prescription" for achilles tendinopathy

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Alfredson's "prescription" for achilles tendinopathy

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

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Share This Page

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