Eccentric calf muscle training in athletic patients with Achilles tendinopathy

Nicola Maffulli, Gayle Walley, Murali K Sayana, Umile Giuseppe Longo, Vincenzo Denaro
Disability and Rehabilitation 2008, 30 (20-22): 1677-84

PURPOSE: To evaluate the effects of eccentric strengthening exercises (ESE) in athletic patients with Achilles tendinopathy.

METHODS: Forty-five athletic patients (29 men, average age 26 years +/- 12.8, range 18 - 42; 16 women, average age 28 years +/- 13.1, range 20 - 46; average height: 173 +/- 16.8, range 158 - 191; average weight 70.8 kg +/- 15.3, range 51.4 - 100.5) with a clinical diagnosis of unilateral tendinopathy of the main body of the Achilles tendon completed the VISA-A questionnaire at first attendance and at their subsequent visits. The patients underwent a graded progressive eccentric calf strengthening exercises programme for 12 weeks.

RESULTS: The mean pre-management VISA-A scores of 36 (SD 23.8; 95% CI: 29 - 46) improved to 52 (SD 27.5; 95% CI: 41.3 - 59.8) at the latest follow up (p = 0.001). Twenty seven of the 45 patients responded to the eccentric exercises. Of the 18 patients who did not improve with eccentric exercises, 5 (mean age: 33 years) improved with two peritendinous aprotinin and local anaesthetic injections. 10 of the 18 patients (9 men, mean age 35 years; 1 woman aged 40 years) who did not improve with eccentric exercises and aprotinin injections proceeded to have surgery. The remaining three patients (3 women, mean age 59.6 years) of the 18 non-responders to eccentric exercises and aprotinin injections declined surgical intervention.

CONCLUSIONS: ESE in athletic patients provide comparable clinical outcome compared to our previous results in non-athletic patients. ESE are a viable option for the management of AT in athletes, but, in our hands, only around 60% of our athletic patients benefited from an intensive, heavy load eccentric heel drop exercise regimen alone. If ESE fail to improve the symptoms, aprotinin and local anaesthetic injections should be considered. Surgery is indicated in recalcitrant cases after 3 to 6 months of non operative management.

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