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Eccentric training in the treatment of tendinopathy
Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Sports Medicine.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic painful tendinopathies are common, not only in sports and recreationally active people, but also among people with a sedentary lifestyle. Both the lower and upper limbs are affected. There is lack of knowledge about the etiology and pathogenesis to tendinopathy, and many different treatments options have been presented. Unfortunately, most treatments have not been tested in scientific studies. Conservative (non-surgical) treatment has since long shown unsatisfactory results and surgical treatment is known to give unpredictable results.

The aim of this thesis was to evaluate new models of painful eccentric training for the conservative treatment of different chronic tendinopathies. After promising results in a pilot study, using painful eccentric calf muscle training in patients with chronic mid-portion Achilles tendinopathy, we investigated if these results could be reproduced in a larger group of patients with both mid-portion and insertional Achilles tendinopathy (study I). After 12 weeks, 89% of the patients with pain from the mid-portion were satisfied and back in previous activities. In the group with insertional Achilles tendinopathy the results were poor. A new model for eccentric training was designed for patients with insertional Achilles tendinopathy. The eccentric calf muscle training was done from tip-toe to floor level (study II). With this new regimen 67% of the patients were satisfied and back in previous activities. The next step was to investigate the effects of painful eccentric quadriceps training on patients with jumper´s knee/patellar tendinopathy (study III). Two different training protocols were used. Eccentric training performed on a 250 decline board showed promising results with reduced pain and a return to previous activities, while eccentric training without the decline board had poor results. In a following prospective study, patients with jumper´s knee/patellar tendinopathy were randomised to either concentric or eccentric painful quadriceps training on a 250 decline board (study IV). After 12 weeks of training, there were significantly better results in the group that did eccentric training. In a pilot study (study V), we investigated painful eccentric deltoideus and supraspinatus muscle training on a small group of patients on the waiting list for surgical treatment of subacromial impingement syndrome. After 12 weeks of training, 5 out of 9 patients were satisfied with the results of treatment and withdrew from the waiting list for surgery.

In conclusion, the present studies showed good clinical results with low risks of side effects and low costs. Thus, we suggest that painful eccentric training should be tried in patients with Achilles and patellar tendinopathy before intratendinous injections and surgery are considered. For patients with chronic painful impingement syndrome, the results of our small pilot study are interesting, and stimulates to randomised studies on larger materials.

Place, publisher, year, edition, pages
Umeå: Department of Surgical and Perioperative Sciences, Sports Medicine , 2009. , 89 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1279
Keyword [en]
Eccentric training, Achilles tendon, patellar tendon, supraspinatus tendon, impingement, tendinopathy, tendinosis
Identifiers
URN: urn:nbn:se:umu:diva-25856ISBN: 978-91-7264-821-0 (print)OAI: oai:DiVA.org:umu-25856DiVA: diva2:234360
Distributor:
Idrottsmedicin, 901 87, Umeå
Public defence
2009-10-09, KBC-huset, hörsal KB3B1, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-09-17 Created: 2009-09-08 Last updated: 2010-01-18Bibliographically approved
List of papers
1. Chronic Achilles tendon pain treated with eccentric calf-muscle training
Open this publication in new window or tab >>Chronic Achilles tendon pain treated with eccentric calf-muscle training
2003 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 11, no 5, 327-333 p.Article in journal (Refereed) Published
Abstract [en]

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 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 reinjury 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 ignificantly 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 withchronic insertional Achilles tendon pain.

Keyword
Achilles, Pain, Tendinosis, Eccentric training
National Category
Medical and Health Sciences Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-25850 (URN)10.1007/s00167-003-0418-z (DOI)000186030500010 ()
Note

Originally published in M Fahlström's doctoral thesis in manuscript forms.

Available from: 2009-09-08 Created: 2009-09-08 Last updated: 2017-12-13Bibliographically approved
2. New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot-study
Open this publication in new window or tab >>New regimen for eccentric calf muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot-study
Show others...
2008 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 42, no 9, 746-749 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-8334 (URN)10.1136/bjsm.2007.039545 (DOI)18184750 (PubMedID)
Available from: 2008-01-17 Created: 2008-01-17 Last updated: 2017-12-14Bibliographically approved
3. A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy
Open this publication in new window or tab >>A pilot study of the eccentric decline squat in the management of painful chronic patellar tendinopathy
Show others...
2004 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 38, no 4, 395-397 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: This non-randomised pilot study investigated the effect of eccentric quadriceps training on 17 patients (22 tendons) with painful chronic patellar tendinopathy.

Methods: Two different eccentric exercise regimens were used by subjects with a long duration of pain with activity (more than six months). (a) Nine consecutive patients (10 tendons; eight men, one woman; mean age 22 years) performed eccentric exercise with the ankle joint in a standard (foot flat) position. (b) Eight patients (12 tendons; five men, three women; mean age 28 years) performed eccentric training standing on a 25° decline board, designed to increase load on the knee extensor mechanism. The eccentric training was performed twice daily, with three sets of 15 repetitions, for 12 weeks. Primary outcome measures were (a) 100 mm visual analogue scale (VAS), where the subject recorded the amount of pain during activity, and (b) return to previous activity. Follow up was at 12 weeks, with a further limited follow up at 15 months.

Results: Good clinical results were obtained in the group who trained on the decline board, with six patients (nine tendons) returning to sport and showing a significantly reduced amount of pain over the 12 week period. Mean VAS scores fell from 74.2 to 28.5 (p  =  0.004). At 15 months, four patients (five tendons) reported satisfactory results (mean VAS 26.2). In the standard squat group the results were poor, with only one athlete returning to previous activity. Mean VAS scores in this group were 79.0 at baseline and 72.3 at 12 weeks (p  =  0.144).

Conclusion: In a small group of patients with patellar tendinopathy, eccentric squats on a decline board produced encouraging results in terms of pain reduction and return to function in the short term. Eccentric exercise using standard single leg squats in a similar sized group appeared to be a less effective form of rehabilitation in reducing pain and returning subjects to previous levels of activity.

 

Place, publisher, year, edition, pages
Loughborough: British Assoc. of Sport and Medicine, 2004
Keyword
Adult, Athletic Injuries/*therapy, Chronic Disease, Exercise Therapy/*methods, Female, Follow-Up Studies, Humans, Knee Injuries/*therapy, Male, Muscular Diseases/*therapy, Pain/etiology/*therapy, Pain Measurement, Patella/*injuries, Pilot Projects, Tendons, Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-16892 (URN)10.1136/bjsm.2003.000053 (DOI)15273169 (PubMedID)
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2017-12-14Bibliographically approved
4. Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study
Open this publication in new window or tab >>Superior results with eccentric compared to concentric quadriceps training in patients with jumper's knee: a prospective randomised study
2005 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 39, no 11, 847-850 p.Article in journal (Refereed) Published
Keyword
Adolescent, Adult, Athletic Injuries/*prevention & control, Exercise Therapy/*methods, Female, Humans, Knee Injuries/*prevention & control, Male, Pain/*prevention & control, Patella, Prospective Studies, Sports, Tendinopathy/*therapy, Treatment Outcome
Identifiers
urn:nbn:se:umu:diva-16961 (URN)10.1136/bjsm.2005.018630 (DOI)16244196 (PubMedID)
Available from: 2007-10-23 Created: 2007-10-23 Last updated: 2017-12-14Bibliographically approved
5. Eccentric training in chronic painful impingement syndrome of the shoulder: results of a pilot study
Open this publication in new window or tab >>Eccentric training in chronic painful impingement syndrome of the shoulder: results of a pilot study
2006 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 14, no 1, 76-81 p.Article in journal (Refereed) Published
Keyword
Adult, Aged, Chronic Disease, Exercise Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Muscle; Skeletal/physiopathology, Pain Measurement, Patient Satisfaction, Pilot Projects, Prospective Studies, Shoulder Impingement Syndrome/physiopathology/*rehabilitation, Treatment Outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-16999 (URN)10.1007/s00167-004-0611-8 (DOI)15877219 (PubMedID)
Available from: 2007-10-25 Created: 2007-10-25 Last updated: 2017-12-14Bibliographically approved

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