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New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy: Results of a pilot-study
  1. Per Jonsson (per.jonsson{at}
  1. Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, S-901 86 Umeå, Sweden
    1. Håkan Alfredson
    1. Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, S-901 86 Umeå, Sweden
      1. Kerstin Sunding
      1. Capio Artro Clinic, Box 6505, S-114 86 Stockholm, Sweden
        1. Martin Fahlström
        1. Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
          1. Jill Cook, Professor
          1. Musculoskeletal Health School of Exercise Sciences and Nutrition, Deakin Univ, Burwood, Victoria, Australia


            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.

            • Achilles
            • eccentric
            • insertional
            • tendinopathy
            • training

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