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Prevalence of morphological and mechanical stiffness alterations of mid Achilles tendons in asymptomatic marathon runners before and after a competition

Abstract

Objective

To determine the prevalence of morphological and mechanical stiffness alterations at the mid Achilles tendon in asymptomatic marathon runners before and after a competition. To assess the relationship between pre-existing Achilles tendon alterations and pain after running.

Materials and methods

All marathon runners from a local running club who were participating in the Melbourne Marathon 2013 (full marathon category) were invited for conventional ultrasound and sonoelastography 1 week leading up to the marathon and again within 3 days post-marathon. Another group of active, healthy individuals not involved in running activities were recruited as controls. Intratendinous morphological (tendon thickness, hypoechogenicities), Doppler as well as stiffness properties of the Achilles were recorded. Achilles tendon pain was evaluated using the visual analogue scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A).

Results

Twenty-one asymptomatic runners (42 Achilles tendons) and 20 healthy controls (40 Achilles tendons) were examined. On the pre-marathon evaluation, runners showed significantly more morphological changes on B-mode ultrasound compared to the controls (p < 0.001). Marathon running induced a significant reduction in tendon stiffness (p = 0.049) and an increase in Doppler signals (p = 0.036). Four runners (4/21, 19 %) reported Achilles tendon pain after the race [VAS 4.0 (±1.9), VISA 74.2 (±10.1)]. Reduced tendon stiffness at baseline was associated with post-marathon Achilles tendon pain (p = 0.016).

Conclusion

Marathon runners demonstrate a higher prevalence of morphological alterations compared to non-runners. Marathon running caused a significant change in Achilles tendon stiffness and Doppler signals. Pre-existing soft Achilles tendon properties on sonoelastography may be a predisposing risk for development of symptoms post-running.

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Acknowledgments

This study was supported by a RANZCR (Royal Australian and New Zealand College of Radiologists) Research Grant in 2013. The authors would like to thank Dr Andrew Dixon and Ms Donna Jones for their assistance in recruiting runners to participate in this research study and all the runners and controls for their enthusiasm and commitment to this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to C. C. Ooi.

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Ooi, C.C., Schneider, M.E., Malliaras, P. et al. Prevalence of morphological and mechanical stiffness alterations of mid Achilles tendons in asymptomatic marathon runners before and after a competition. Skeletal Radiol 44, 1119–1127 (2015). https://doi.org/10.1007/s00256-015-2132-6

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  • DOI: https://doi.org/10.1007/s00256-015-2132-6

Keywords

  • Ultrasonography
  • Elasticity imaging techniques
  • Sonoelastography
  • Achilles tendon
  • Marathon runners