New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy: Results of a pilot-study

Per Jonsson ^1*, Håkan Alfredson ¹, Kerstin Sunding ², Martin Fahlström ³ and Jill Cook Professor⁴

¹ Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, S-901 86 Umeå, Sweden
² Capio Artro Clinic, Box 6505, S-114 86 Stockholm, Sweden
³ Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
⁴ Musculoskeletal Health School of Exercise Sciences and Nutrition, Deakin Univ, Burwood, Victoria, Australia

^* To whom correspondence should be addressed. E-mail: per.jonsson{at}idrott.umu.se.

Accepted 29 November 2007

Abstract

Background: Chronic painful insertional Achilles tendinopathy is seen in both physically active and non-active individuals. Painful eccentric training, where the patients load the Achilles tendon into full dorsiflexion, has shown promising results in patients with mid-portion Achilles tendinosis. However, only 32% of patients with insertional Achilles tendinopathy had good clinical results with that type of eccentric training regimen.

Aim: To investigate if a new model of painful eccentric training had an effect on chronic painful insertional Achilles tendinopathy.

Patients and methods: Twenty-seven patients (12 males, 15 females, mean age 53 years) with a total of 34 painful Achilles tendons with a long duration of pain (mean 26 months), diagnosed as insertional Achilles tendinopathy, were included. The patients performed a new model of painful eccentric training regimen without loading into dorsiflexion. This was done 3x15 reps, 2 times/day, 7 days/week, for 12 weeks. Pain during Achilles tendon loading activity (VAS) and patient’s satisfaction (back to previous activity), were evaluated.

Results: At follow-up (mean 4 months), 18 patients (67% of patients, 23/34 tendons) were satisfied and back to their previous tendon loading activity. Their mean VAS had decreased from 69.9±18.9 to 21±20.6 (p<0.001). Nine patients (11 tendons) were not satisfied with the treatment, although their VAS was significantly reduced from 77.5±8.6 to 58.1±14.8 (p<0.006).

Conclusion: In this short-term pilot-study, this new model of painful eccentric calf muscle training showed promising clinical results in 67% of the patients.

Key Words: Achilles, eccentric, insertional, tendinopathy, training

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