Friday, October 12, 2012

New in the Literature: Eccentric Strengthening for Achilles Tendinopathy (Am J Phys Med Rehabil. 2012. Oct 5. [Epub ahead of print])

Eccentric strengthening was more effective than concentric strengthening in reducing pain and improving function in patients with Achilles tendinopathy, say authors of an article published online in American Journal of Physical Medicine & Rehabilitation.

Thirty-two men with Achilles tendinopathy were assigned to either the experimental group (n = 16) that performed eccentric strengthening or the control group (n = 16) that performed concentric strengthening for 8 weeks (50 minutes per day, 3 times per week). A visual analog scale, isokinetic muscle testing equipment, the side-step test, and the Sargent jump test were used to assess pain, muscle strength, endurance, and functional fitness factors before and after the intervention.

In comparison with the control group, the experimental group showed significant improvement in pain, ankle dorsiflexion endurance, total balance index, and agility after the intervention. However, there was no significant difference in dexterity between the 2 groups.

Comments

What were the eccentric exercises?

Posted by John Marshall, PTA on 10/12/2012 4:34 PM
I'd also like to know the eccentric exercises and how they were performed for 50 minutes. Did both groups also perform stretches and any other common treatment techniques?

Posted by Luke Gordon on 10/14/2012 1:57 PM
I frequently use eccentric exercises with manual resistance on my pediatric and geriatric pts. who are able to understand and tolerate them. I would also like to know the specific exercises that were used in the study.

Posted by Kathy Gamble, PTA on 10/14/2012 2:23 PM
What about a group that did both eccentric and concentric exercises - you know, "normal" exercise? I just hope this is one small part of a group of studies being done.

Posted by Sean on 10/15/2012 10:24 AM
Received an order for eccentric exercise on a 72 year old thinly muscled female tennis player who is de-conditioned. She has C/S and L/S spinal stenosis, scoliosis, and had a dog carrying a stick puncture her calf which led to a whopping cellulitis doing some ms. damage to her soleus and had some Achilles' tendonopathy along with it. Long story short, after a year of no interventions, her ankle orthopedist wanted eccentric Achilles' tendon strengthening per the relevant research he cited. Nowhere in the literature are there studies of septagenarians doing eccentric Achilles' tendon strengthening after pathologic infection to surrounding soft tissue. Easily could tear her Achilles. Perhaps someone with less experience following a "protocol" would have done this. Not me. Not in my 35 years experience. 1/3 research, 1/3 clinician experience, 1/3 patient values. That's how I learned "Best Evidence." In 2 months, 2-3x/wk of 90 minute sessions, she has progressed nicely with concentric strengthening, passive and active stretching, soft tissue mobilization, post modalities to reduce pain, swelling and reduction of fibrotic soft tissue/scarring in the area. She was told she had muscle damage and at best would have residual scar tissue. Well, why chance a tear if she was going to have scar tissue anyway. Meanwhile, I teased that soleus deeply everywhich way to Sunday and have a 1cm defect remaining from a 10 cm defect. Maybe she wouldn't have torn under eccentric loading, but I wouldn't do it. Best of luck to those of you that would have! Larry Greenberg, PT, MS, M.Ed.

Posted by Larry Greenberg on 10/15/2012 12:44 PM

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