Chronic Achilles tendon pain treated with eccentric calf-muscle training

Abstract

Injuries involving the Achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. In a pilot study on a small group of patients with chronic painful mid-portion Achilles tendinosis, eccentric calf-muscle training was shown to give good clinical results. The aim of this prospective study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients, and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain. Seventy-eight consecutive patients, having chronic painful Achilles tendinosis at the mid-portion (2–6 cm level) in a total of 101 tendons (55 unilateral and 23 bilateral), and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons (29 unilateral and one bilateral) were treated with eccentric calf-muscle training for 12 weeks. Most patients were recreational athletes. Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale (VAS), before and after treatment. In 90 of the 101 Achilles tendons (89%) with chronic painful mid-portion Achilles tendinosis, treatment was satisfactory and the patients were back on their pre-injury activity level after the 12-week training regimen. In these patients, the amount of pain during activity, registered on the VAS-scale (mean±SD), decreased significantly from 66.8±19.4 to 10.2±13.7. On the contrary, in only ten of the tendons (32%) with chronic insertional Achilles tendon pain was treatment satisfactory, with a significant decrease on the VAS-scale (mean±SD), from 68.3±7.0 to 13.3±13.2. Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis, but not in patients with chronic insertional Achilles tendon pain.

This is a preview of subscription content, log in to check access.

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

References

  1. 1.

    Alfredson H, Lorentzon R (2000) Chronic Achilles tendinosis. Crit Rev Phys Rehab Med 12:103–117

    Google Scholar 

  2. 2.

    Alfredson H, Lorentzon R (2000) Chronic Achilles tendinosis. Sports Med 29:135–146

    CAS  PubMed  Google Scholar 

  3. 3.

    Alfredson H, Pietilä T, Jonsson P, Lorentzon R (1998) Heavy-load eccentric calf-muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 26:360–366

    CAS  PubMed  Google Scholar 

  4. 4.

    Åström M, Rausing A (1995) Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop 316:151–164

    PubMed  Google Scholar 

  5. 5.

    Clement DB, Taunton JE, Smart GW, McNicol KL (1981) A survey of overuse running injuries. The Physician and Sportsmed 9:47–58

    Google Scholar 

  6. 6.

    James SL, Bates BT, Osternig LR (1978) Injuries to runners. Am J Sports Med 6:40–50

    CAS  Google Scholar 

  7. 7.

    Järvinen M, Józsa L, Kannus P, Järvinen TLN, Kvist M, Leadbetter W (1997) Histopathological findings in chronic tendon disorders. Scand J Med Sci Sports 7:86–95

    PubMed  Google Scholar 

  8. 8.

    Khan KM, Cook JL, Bonar F, Harcourt P, Åström M (1999) Histopathology of common tendinopathies. Sports Med 27:393–408

    CAS  PubMed  Google Scholar 

  9. 9.

    Kvist M (1991) Achilles tendon injuries in athletes. Ann Chir Gynaecol 80:188–201

    CAS  PubMed  Google Scholar 

  10. 10.

    Kvist M (1994) Achilles tendon injuries in athletes. Sports Med 18:173–201

    CAS  PubMed  Google Scholar 

  11. 11.

    Leppilahti J, Orava S, Karpakka J, Takala T (1991) Overuse injuries of the Achilles tendon. Ann Chir Gynaecol 80:202–207

    CAS  Google Scholar 

  12. 12.

    Mafi N, Lorentzon R, Alfredson H (2001) Superior short-term results with eccentric calf-muscle training compared to concentric training in a randomized prospective study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 9:42–47

    CAS  PubMed  Google Scholar 

  13. 13.

    Movin T (1998) Aspects of aetiology, pathoanatomy and diagnostic methods in chronic mid-portion achillodynia. Dissertation, Huddinge Hospital/Karolinska Institute, Sweden

  14. 14.

    Nelen G, Martens M, Burssens A (1989) Surgical treatment of chronic Achilles tendinitis. Am J Sports Med 17:754–759

    CAS  PubMed  Google Scholar 

  15. 15.

    Paavola M, Kannus P, Järvinen TAH, Khan K, Józsa L, Järvinen M (2002) Achilles tendinopathy. J Bone Joint Surg Am 84:2062–2076

    Google Scholar 

  16. 16.

    Schepsis A A, Wagner C, Leach R E (1994) Surgical management of Achilles tendon overuse injuries. Am J Sports Med 22:611–619

    CAS  PubMed  Google Scholar 

  17. 17.

    Silbernagel KG, Thomeé R, Thomeé P, Karlsson J (2001) Eccentric overload training for patients with chronic Achilles tendon pain–a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports 11:197–206

    CAS  Google Scholar 

  18. 18.

    Stanish W, Rubinovich M, Curvin S (1986) Eccentric exercise in chronic tendinitis. Clin Orthop 208:65–68

    PubMed  Google Scholar 

  19. 19.

    Svernlöv B, Adolfsson L (2001) Non-operative treatment regime including eccentric training for lateral humeral epicondylalgia. Scand J Med Sci Sports 11:328–334

    Google Scholar 

  20. 20.

    Vega MR, Cavolo DJ, Green RM, Cohen RS (1984) Haglund's deformity. J Am Podiatr Assoc 74:129–135

    CAS  Google Scholar 

  21. 21.

    Welsh RP, Clodman J (1980) Clinical survey of Achilles tendinitis in athletes. Can Med Assoc J 122:193–195

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Håkan Alfredson.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fahlström, M., Jonsson, P., Lorentzon, R. et al. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc 11, 327–333 (2003). https://doi.org/10.1007/s00167-003-0418-z

Download citation

Keywords

  • Achilles
  • Pain
  • Tendinosis
  • Eccentric training