Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy

NewsBot · Mar 10, 2019

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Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy: The role of soleus
SethO'Neill SimonBarry PaulWatson
Physical Therapy in Sport

Highlights
•There are large statistically and clinically meaningful differences in plantar flexor strength and endurance between subjects with and without Achilles tendinopathy.
•Rehabilitation should take into account the specific strength and endurance deficits associated with Achilles tendinopathy.
•Our data shows healthy runners generate eccentric torque of twice bodyweight, In order to rehabilitate subjects with Achilles tendinopathy to this level substantial external loads will be required.
•Researchers and clinicians cannot use the non-symptomatic limb as a comparator when assessing strength and endurance, instead normative values need to be considered.
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Objectives
Determine how the strength and endurance of the plantar flexors are affected by Achilles tendinopathy and whether one muscle is more affected than another.

Design
Case control study.

Setting
University Laboratory.

Participants
39 Runners with mid-portion Achilles tendinopathy and 38 healthy runners participated in this study.

Main outcome measures
Isokinetic dynamometry was completed bilaterally in two knee positions on all subjects to assess the torque and endurance capacity of the plantar flexors.

Results
Subjects with Achilles tendinopathy were statistically weaker (by 26.1Nm Concentric 90°/sec, 14,8Nm Concentric 225°/sec and 55.5Nm Eccentric 90°/sec for knee extended testing and 17.3Nm, 10.1Nm and 52.3Nm for the flexed knee respectively) than healthy controls at all isokinetic test speeds and contraction modes irrespective of knee position (p value = <0.001). The endurance capacity of the plantar flexors was significantly reduced (Total work done 613.5Nm less) in subjects with Achilles tendinopathy when compared to the healthy controls (p value = <0.001).

Conclusions
Achilles tendinopathy is associated with large deficits in plantar flexor torque and endurance. The deficits are bilateral in nature and appear to be explained by a greater loss of the soleus force generating capacity rather than the gastrocnemius.
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NewsBot · Aug 10, 2019

Altered Strength Profile in Achilles Tendinopathy: A
Systematic Review and Meta-Analysis
Sea´n McAuliffe et al
Journal of Athletic Training 2019;54(8):000–000

Background: Persistent strength deficits secondary to
Achilles tendinopathy (AT) have been postulated to account
for difficulty engaging in tendon-loading movements, such as
running and jumping, and may contribute to the increased risk of
recurrence. To date, little consensus exists on the presence of
strength deficits in AT. Consequently, researchers are uncertain
about the appropriate methods of assessment that may inform
rehabilitation in clinical practice.
Objective: To evaluate and synthesize the literature investigating plantar-flexion (PF) strength in individuals with AT.
Study Selection: Two independent reviewers searched 9
electronic databases using an agreed-upon set of key words.
Data Extraction: Data were extracted from studies comparing strength measures (maximal, reactive, and explosive
strength) between individuals with AT and healthy control
participants or between the injured and uninjured sides of
people with AT. The Critical Appraisal Skills Programme CaseControl Study Checklist was used to assess the risk of bias for
the included studies.
Data Synthesis: A total of 19 studies were eligible. Pooled
meta-analyses for isokinetic dynamometry demonstrated reductions in maximal strength (concentric PF peak torque [PT] slow
[Hedges g ¼ 0.52, 44% deficit], concentric PF PT fast [Hedges g
¼0.61, 38% deficit], and eccentric PF PT slow [Hedges g¼0.26,
18% deficit]). Reactive strength, particularly during hopping, was
also reduced (Hedges g range ¼ 0.32–2.61, 16%–35% deficit).
For explosive strength, reductions in the rate of force development (Hedges g range ¼ 0.31–1.73, 10%–21% deficit) were
observed, whereas the findings for ground reaction force varied
but were not consistently altered.
Conclusions: Individuals with AT demonstrated strength
deficits compared with the uninjured side or with asymptomatic
control participants. Deficits were reported across the strength
spectrum for maximal, reactive, and explosive strength. Clinicians and researchers may need to adapt their assessment of
Achilles tendon function, which may ultimately help to optimize
rehabilitation outcomes.
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