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Tendon structure's lack of relation to clinical outcome after eccentric exercises

Discussion in 'General Issues and Discussion Forum' started by Mart, Dec 5, 2012.

  1. Mart

    Mart Well-Known Member

    Members do not see these Ads. Sign Up.
    I am unable to find a copy of this paper via my library anyone able to help out?

    J Sport Rehabil. 2012 Feb;21(1):34-43. Epub 2011 Nov 15.

    Tendon structure's lack of relation to clinical outcome after eccentric exercises in chronic midportion Achilles tendinopathy.

    de Vos RJ, Heijboer MP, Weinans H, Verhaar J AN, van Schie J TM.


    Department of Orthopedics, Erasmus Medical Center, Rotterdam, The Netherlands.



    Chronic midportion Achilles tendinopathy is a common and hard-to-treat disorder characterized by degenerative changes of the tendon matrix. Ultrasonographic tissue characterization (UTC) was successfully used to quantify structural human Achilles tendon changes. This novel and reliable technique could be used in follow-up studies to relate tendon structure to symptoms.


    To quantify structural tendon changes and assess clinical change in patients with tendinopathy.


    Prospective observational study.


    Orthopedic department in a university medical center.


    23 patients with chronic midportion Achilles tendinopathy.


    The patients performed a 16-wk home-based eccentric exercise program. An experienced researcher performed the ultrasonographic data collection with the UTC procedure. These data were assessed by a blinded observer. The severity of symptoms was established with the validated Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire.


    UTC was performed to quantify tendon structure through measuring the proportion of 4 echo types. Echo types I and II represent more or less organized tendon bundles, and echo types III and IV represent disintegrated tendon structure. On the VISA-A, the total possible score is divided by 100 for a percentage score, with a perfect score of 100. Follow-up was at 2, 8, 16, and 24 wk.


    The mean percentage of echo types I and II changed by 0.3% after 24 wk (P = .92, 95% CI -5.8 to 5.3). The mean VISA-A score increased slightly but significantly by 11.3 points after 24 wk (P = .01, 95% CI 2.6-20.0). An increased VISA-A score was not correlated with an increased percentage of echo types I and II (P = .94, r = -.02), and the baseline percentage of echo types I and II did not correlate with an increased VISA-A score (P = .74, r = .07).


    There is no short-term increase in organized tendon structure after eccentric exercises. Tendon structure is not related to symptom severity and cannot be used as a predictor of clinical outcome.



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  2. RunDNC

    RunDNC Member

    Hi Martin,

    here is a copy of the article you were looking for...hope it helps out

    Cheers Daina

    Attached Files:

  3. RunDNC

    RunDNC Member

    Here is another along a similar line that pain was reduced but tendon structure did not change following eccentric exercises

    Effect of Eccentric Exercise Program for Early Tibialis Posterior Tendinopathy

    Morphology and vascularization of painful tibialis
    posterior (TP) tendons before and after an intervention
    targeting the degenerated tendon were examined. Functional
    status and pain level were also assessed.

    Materials and Methods:
    A10-week twice daily, progressive eccentric tendon loading, calf
    stretching program with orthoses was implemented with ten,
    early stage TP tendinopathy subjects. TP tendons were imaged
    by grayscale and Doppler ultrasound at INITIAL and POST
    evaluations to assess the tendon’s morphology and signs of
    neovascularization. The Foot Functional Index (FFI), Physical
    Activity Scale (PAS), 5-Minute Walk Test, and single heel raise
    (SHR) test were completed at INITIAL and POST evaluations.
    The Global Rating Scale (GRS) was completed at 6 months
    followup. One-way ANOVA was used to compare the FFI at
    INITIAL, POST, and 6-MONTH time points. Paired t-tests were
    used to compare means between the remaining variables. The
    level of significance was p = 0.05.

    There was a significant
    difference in FFI total, pain, and disability at the three
    time-points. Post-hoc paired t-tests revealed that the FFI scores
    were lower for the total score and pain and disability subcategories
    when comparing from INITIAL to POST and INITIAL to
    6-MONTH evaluations (p < 0.05 for all). The number of SHR
    increased significantly on the involved side from INITIAL to
    POST evaluation (p = 0.041). The GRS demonstrated minimum
    clinically important differences for improvements in symptoms
    at 6-MONTH. Tendon morphology and vascularization
    remained abnormal following the intervention.

    A 10-week tendon specific eccentric program resulted in improvements
    in symptoms and function without changes in tendon
    morphology or neovascularization.

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