Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy

NewsBot · May 28, 2015

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Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy
A Randomized Controlled Trial
Rikke Beyer , PT, MSc, Mads Kongsgaard , PhD, Birgitte Hougs Kjær , PT, MSc, Tommy Øhlenschlæger , MD, Michael Kjær , MD, DMSci and S. Peter Magnusson , PT, DMSci
Am J Sports Med May 27, 2015

Background: Previous studies have shown that eccentric training has a positive effect on Achilles tendinopathy, but few randomized controlled trials have compared it with other loading-based treatment regimens.
Purpose: To evaluate the effectiveness of eccentric training (ECC) and heavy slow resistance training (HSR) among patients with midportion Achilles tendinopathy.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: A total of 58 patients with chronic (>3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms (Victorian Institute of Sports Assessment–Achilles), tendon pain during activity (visual analog scale), tendon swelling, tendon neovascularization, and treatment satisfaction were assessed at 0 and 12 weeks and at the 52-week follow-up. Analyses were performed on an intention-to-treat basis.
Results: Both groups showed significant (P < .0001) improvements in Victorian Institute of Sports Assessment–Achilles and visual analog scale from 0 to 12 weeks, and these improvements were maintained at the 52-week follow-up. Concomitant with the clinical improvement, there was a significant reduction in tendon thickness and neovascularization. None of these robust clinical and structural improvements differed between the ECC and HSR groups. However, patient satisfaction tended to be greater after 12 weeks with HSR (100%) than with ECC (80%; P = .052) but not after 52 weeks (HSR, 96%; ECC, 76%; P = .10), and the mean training session compliance rate was 78% in the ECC group and 92% in the HSR group, with a significant difference between groups (P < .005).
Conclusion: The results of this study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.
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Admin2 · May 28, 2015

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NewsBot · Jun 30, 2015

Cyclic mechanical stimulation rescues Achilles tendon from degeneration in a bioreactor system
Tao Wing et al
Journal of Orthopaedic Research; Accepted Article

Physiotherapy is one of the effective treatments for tendinopathy, whereby symptoms are relieved by changing the biomechanical environment of the pathological tendon. However, the underlying mechanism remains unclear. In this study, we first established a model of progressive tendinopathy-like degeneration in the rabbit Achilles. Following ex vivo loading deprivation culture in a bioreactor system for 6 and 12 days, tendons exhibited progressive degenerative changes, abnormal collagen type III production, increased cell apoptosis and weakened mechanical properties. When intervention was applied at day 7 for another 6 days by using cyclic tensile mechanical stimulation (6% strain, 0.25Hz, 8h/day) in a bioreactor the pathological changes and mechanical properties were almost restored to levels seen in healthy tendon. Our results indicated that a proper biomechanical environment was able to rescue early-stage pathological changes by increased collagen type I production, decreased collagen degradation and cell apoptosis. The ex-vivo model developed in this study allows systematic study on the effect of mechanical stimulation on tendon biology.
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NewsBot · Oct 22, 2016

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