Eccentric training in patients with chronic Achilles tendinosis

Pain in the Achilles

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First, I am not a medical person, just someone who has had Achilles problems for a number of years and have tried to find as much info on the problem as possible.

I am a 72 year old track runner and a retired T&F coach. I now coach age 30+ T&F athletes via the internet.

Make sure whether you have an Achilles problem or have Plantar Fasciitis. Take a look at the info on this web page: http://www.coachr.org/planfasc.htm 

 

If you have been told that you have tendonitis, please read this editorial from the British Journal of Sports Medicine: Time to abandon the "tendinitis" myth at: http://bmj.bmjjournals.com/cgi/content/full/324/7338/626

Last fall I had to quit running completely because on the pain in my Achilles Tendon. I had it x-rayed to see if it had a tear. It didn't. While searching the Sports/Medical Journals for info to put in my newsletter, I found this in December: 


Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up 

L Öhberg1, R Lorentzon2 and H Alfredson2
1 Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
2 Department of Surgical and Perioperative Science, Sports Medicine and National Institute for Working Life, University of Umeå

 

Correspondence to: 

Dr Öhberg 

Department of Radiology, University Hospital of Umeå, 901 85 Umeå, Sweden; lars.ohberg.us@vll.se  


Objective: To prospectively investigate tendon thickness and tendon structure by ultrasonography in patients treated with eccentric calf muscle training for painful chronic Achilles tendinosis located at the 2–6 cm level in the tendon. 


Methods: The patients were examined with grey scale ultrasonography before and 3.8 years (mean) after the 12 week eccentric training regimen. At follow up, a questionnaire assessed present activity level and satisfaction with treatment. 


Results: Twenty six tendons in twenty five patients (19 men and six women) with a mean age of 50 years were followed for a mean of 3.8 years (range 1.6–7.75). All patients had a long duration of painful symptoms (mean 17.1 months) from chronic Achilles tendinosis before treatment. At follow up, 22 of 25 patients were satisfied with treatment and active in Achilles tendon loading activities at the desired level. Ultrasonography showed that tendon thickness (at the widest part) had decreased significantly (p<0.005) after treatment (7.6 (2.3) v 8.8 (3) mm; mean (SD)). In untreated normal tendons, there was no significant difference in thickness after treatment (5.3 (1.3) mm before and 5.9 (0.8) mm after). All tendons with tendinosis had structural abnormalities (hypoechoic areas and irregular structure) before the start of treatment. After treatment, the structure was normal in 19 of the 26 tendons. Six of the seven patients with remaining structural abnormalities experienced pain in the tendon during loading. 


Conclusions: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon


The above is from: http://bjsm.bmjjournals.com/cgi/content/abstract/38/1/8 


Shortly after that I started doing eccentric stretching using this Paramount leg press machine:


 

 

Below where the heels of the shoes are in the above picture, there is a small portion of the plate that is angled away from the main plate. Using one leg/foot at a time, I placed the front part/toes of my foot on that plate and straightened my leg allowing my calf muscle to relax and have the tendon stretched as much as possible. There was a lot of pain involved and it took me a couple of months to develop the strength to hold the stretch so that I could maintain the position for about 30 seconds.

I started running again about four months ago and am gradually regaining some of the body and cardio-vascular fitness that I lost.

I have just finished my outdoor track season and am taking a short break prior to starting to build a good base for next year. During this break, I am only running enough to get my body "warmed-up". After that, I have gone back to doing the eccentric stretch along with other weight work. At the end of the stretching/weight work, I do a "cool-down" that involves some running and the movement of my legs/ankles and feet through their full range of motion. I will return to doing the base building in a couple of weeks.


Let me know if you have any questions.

Regards,

http://www.coachr.org 

 


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