Historically, one of the most wellestablished exercise regimens for achilles tendinopathy is eccentric strength training. Eccentric training for the treatment of tendinopathies bryan murtaugh, md and joseph m. New regimen for eccentric calfmuscle training in patients with chronic insertional achilles tendinopathy. While most of the studies on eccentric exercises have concentrated on pathology of the midportion of the tendon, this protocol has been less studied in the. The patients in both groups were told that the exercises they should perform had a positive e. Pdf cronic achilles pain treated with eccentric calf.
Eccentric calf muscle training in nonathletic patients. Eccentric achilles training for achilles pathology. Chronic achilles tendon pain treated with eccentric calfmuscle training received. The purpose was to examine the reliability of measurement techniques and evaluate the effect of a treatment protocol including eccentric overload for patients with chronic pain from the achilles tendon.
Achilles tendonitis eccentric exercise indy podiatry. Achilles eccentric heavy load protocol new jersey sports medicine. It uses the concept of eccentric loading of your achilles tendon to improve the tendons ability to withstand forces and stressors. Clinical commentary of the evolution of the treatment for. Heavyload eccentric calf muscle training for the treatment of chronic achilles tendinosis article pdf available in the american journal of sports medicine 263.
Despite being the largest tendon in the body, the achilles. Pdf eccentric exercise protocols for chronic noninsertional. This guide demonstrates exactly how to perform certain eccentric calf strengthening exercises as part of your rehabilitation while managing your achilles tendinitis pain. A new model for eccentric training was designed for patients with insertional achilles tendinopathy. Alfredson versus silbernagel exercise therapy in chronic midportion. However, only 32% of patients with insertional achilles tendinopathy had good clinical results with that type of eccentric training regimen. Overuse injuries involving the achilles tendon are com. Injuries involving the achilles tendon and manifested as chronic tendon pain are common, especially among recreational athletes. Achilles tendonitis heel drop exercises should be done both with the knee straight and bent to isolate the gastrocnemius and soleus muscles. We prospectively studied the effect of heavyload eccentric calf muscle training in 15 recreational athletes 12 men and 3 women.
Review eccentric overload training in patients with. Eccentric calf muscle exercises for achilles tendinopathy part 4. Eccentric exercise also has been less effective in patients with insertional tendinosis. In another group of patients who underwent a training regimen that included an eccentric exercise program for midportion achilles tendinopathy, 65% had no symptoms at 5year followup. Eccentric training in the treatment of tendinopathy core. Review eccentric exercise training in chronic midportion achilles tendinopathy.
In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric calf muscle training on patients with painful chronic achilles tendinosis located at the 26 cm level in the tendon. New regimen for eccentric calfmuscle training in patients. This particular type of controlled exercise helps your swollen achilles tendon return to. Chronic achilles tendon pain treated with eccentric calf muscle training. Achilles tendonitis massachusetts general hospital. The patients were examined with grey scale ultrasonography before and 3.
Eccentric exercise training in chronic midportion achilles. In the group with insertional achilles tendinopathy the results were poor. Phased achilles tendon loading program as per silbernagel et al. Group a performed a regimen of daily eccentric training associated with. Eccentric training in patients with chronic achilles. There is some evidence that eccentric strengthening programmes may be effective in the management of tendinopathy of the main body of the achilles tendon 15, 16. This lack of understanding may be hindering therapeutic care and preventing. Twelve weeks of isolated heavy eccentric training using few repetitions of high load 100% mvc, approximately 170% body weight has been compared with isolated eccentric squats on a decline board using a larger number of repetitions at lower load 100% body weight, approximately 60% mvc.
Achilles tendinopathy is prevalent in athletes, but can also affect sedentary patients. Eccentric loading versus eccentric loading plus shockwave. The gastrocnemius is the larger muscle which originates from the femur thigh bone so needs to be stretched and strengthened with the knee straight. With this new regimen 67% of the patients were satisfied and back in previous activities. Unlike the alfredson protocol, the silbernagel protocol also comprises concentric and even plyometric loading of the achilles tendon. April 20, 2012 page 1 appendix a achilles tendinopathy. Avoid creating pain discomfort is okay but pain should not occur and persist 3 days in a row.
The efficacy of eccentric overload training on the outcome measures of pain and physical functioning are not exactly clear. Effects of lowlevel laser therapy and eccentric exercises. Thirtytwo patients with proximal achillodynia 44 involved achilles tendons participated in tests for reliability measures. Superior shortterm results with eccentric calf muscle. The effectiveness of a loading regimen for treatment of achilles tendinopathy is wellestablished, and when it comes to what kind of regimen to useeccentric training ecc or heavy resistance training hsrresearchers were surprised to find that both work equally well. Achilles repair rehabilitation protocol key considerations. Resistance as effective as eccentric training for achilles tendinopathy.
During the 12week training regimen, running activity is allowed if it can be performed with only mild discomfort and no pain. Pdf eccentric loading for achilles tendinopathy strengthening or. Avoid all passive motion into df for 1st 6 weeks postop 3. Chronic achilles tendinopathy treated with eccentric stretching. The alfredson protocol is a specialized exercise program for people with achilles tendonitis or tendinopathy. Despite multiple studies assessing this treatment regime little is known about the mechanism of effect. The use of eccentric training as a part of the rehabilitation of tendon injuries was established as early as 1984 by curwin and stanish 7. Patients in both treatment groups were instructed to perform the exercise regimen for the injured leg twice daily for a period of 12 weeks. Learn the alfredson protocol exercise for achilles. Research has shown that an eccentric exercise program can be effective in the treatment of tendinopathies. Eccentric calf muscle training in nonathletic patients with achilles tendinopathy. Chronic achilles tendon pain treated with eccentric calfmuscle training. In medical studies worldwide, this programme has been shown to provide excellent pain and symptom relief in many patients avoiding the need for surgery later on. Achilles tendon eccentric exercises london foot and ankle.
To compare eccentric training and the combination of eccentric training with the airheel brace for the management of tendinopathy of the main body of the achilles tendon. Achilles tendonitis exercises hakan alfredsons heel. Eccentric or concentric exercises for the treatment of. We recruited 116 subjects with unilateral tendinopathy of the main body of the achilles tendon, who were randomized in two groups. The goal is to improve your ankle and calf strength and to. Eccentric exercise in treatment of achilles tendinopathy.
Alfredsons protocol consisted of a 12week program where the subjects performed solely eccentric strengthening exercises three sets of 15. Achilles tendinopathy is a complex problem, with the most common conservative treatment being eccentric exercises. Eccentric overload training for patients with chronic. Eccentric heel raises standing on the floor 3 sets of 10. Electronic databases were searched for randomised clinical trials concerning eccentric overload training in patients with chronic achilles tendinopathy. To prospectively investigate tendon thickness and tendon structure by ultrasonography in patients treated with eccentric calf muscle training for painful chronic achilles tendinosis located at the 26 cm level in the tendon. Alfredson protocol for achilles tendonitis treatment. A program of eccentric exercise for treatment of achilles tendinopathy was first described by alfredson and coworkers in 1998. We studied the effects of eccentric exercises in sedentary nonathletic patients with achilles tendinopathy. Eccentric exercises ees are recommended for the treatment of achilles tendinopathy, but the clinical effect from ee has a slow onset. If it does, rest the patient until pain level is clearly decreasing.
Pdf 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 midportion achilles tendinosis, eccentric calfmuscle training was shown to give good clinical results. The goal is to improve your ankle and calf strength and to help the injured tissue heal properly. Achilles tendinitis an overview sciencedirect topics. As per alfredson h, pietila t, jonsson p, lorentzon r. Eccentric training in the treatment of tendinopathy 9 original papers this thesis is based on the following papers, which will be referred to by their corresponding roman numerals. Achilles minneapolis achilles eccentric mn sports and. Achilles tendonitis is often associated with an increase in activity level such as starting a new training regimen or attempting to resume a normal activity level after an injury to another part of the foot or ankle. Achilles tendinopathy exercise programs final apr 2012 draft.
Cronic achilles pain treated with eccentric calf muscle training article pdf available in knee surgery sports traumatology arthroscopy 115. In 1998, 15 recreational athletes with chronic achilles tendinopathy performed a calf muscle strength training 12 weeks, with all 15 patients back at their preinjury levels with full running activity after the eccentric training regimen. Achilles tendon, eccentric, exercise, jumping, running, tendinosis. Eccentric exercises for the management of tendinopathy of. Chronic achilles tendon pain treated with eccentric calf. Ihm, md abstract tendinopathy can result from overuse and is experienced in the affected tendonaspainwith activity, focal tendernessto palpation,and decreased ability to tolerate tension, which results in decreased functional strength. The programme to treat achilles pain is designed to eccentrically load or stretch the tendon. A proposed returntosport program for patients with. Alfredson first published on eccentric training in a classic 1998 study and i have been. The training program included eccentric training over a step 3x15 reps with straight and flexed knee performed 2. From an upright body position and standing with all body weight on the forefoot and the ankle joint in plantar flexion lifted by the non. Eccentric training increases type 1 collagen without reactive. Eccentric training in the treatment of tendinopathy0902. In general,the overall trend suggested a positive effect of an exercise program, with no study reporting adverse effects.
Achilles tendon oxygen saturation was not decreased after the 12week eccentric training regimen throughout the insertion to the proximal midportion area insertion 72 vs 73 10, proximal midportion 63 vs 62 11, both ns. Continued sports activity using a pain monitoring model during rehabilitation in patients with achilles tendinopathy. One of the first steps taken in the treatment of achilles tendinopathy is typically an exercise regimen that aims to eccentrically load the tendon. Such exercises have some degree of clinical utility in comparison with concentric training and are often referred to as a strengthening programme. Graded eccentric exercises regimen was proven to be effective in casecontrol studies and in prospective randomized control trials. Efficacy of customised foot orthoses in the treatment of achilles tendinopathy. Pdf heavyload eccentric calf muscle training for the. Patients are to be instructed on proper mechanics on how to perform the eccentric exercises and to do their eccentric exercises 2 x daily, 7 daysweek, for 12 weeks. Pdf eccentric exercises for the calf muscles have been shown to be effective for chronic noninsertional achilles tendinopathy at. The eccentric calf muscle training was done from tiptoe to floor level study ii. Painful eccentric training, where the patients load the achilles tendon into full dorsiflexion, has shown good results in patients with midportion achilles tendinosis. Eccentric training for the treatment of tendinopathies.
872 1448 149 940 299 465 954 684 697 1566 1038 1625 952 1302 1633 806 132 463 283 1235 1523 1544 729 1290 390 908 404 298 765 1493 250