The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis

Skeletal Radiol. 2010 May;39(5):435-42. doi: 10.1007/s00256-009-0798-3. Epub 2009 Sep 23.

Abstract

Purpose: To evaluate the long-term results following eccentric calf-muscle training in patients with chronic Achilles tendinopathy.

Materials and methods: A total of 24 patients with chronic Achilles tendinopathy were included in a study evaluating MRI findings and clinical symptoms before and after 3 months of daily eccentric calf-muscle strength training. Median duration of symptoms was 18 months (range 6-120). Four of the patients did not perform the prescribed treatment for different reasons and were followed for 14 months. The resulting 20 treated patients completed 4.2-year (range 29-58 months) follow up. Tendon volume was evaluated by using 3D seed growing technique and signal abnormalities were visually semi-quantitatively graded. Level of pain and performance was categorized using a questionnaire completed by the patient.

Results: In the symptomatic treated patients, median intensity level of pain decreased from moderate/severe at time of inclusion to mild at follow up (p < 0.05). Median level of performance increased from severe impairment at time of inclusion to normal at follow up (p < 0.05). 12 out of 20 patients had raised intratendinous signal at time of inclusion compared to 2 out of 20 patients at follow up (p < 0.001). Mean tendon-volume measured 6.7 cm(3) (SD 2.0) at time of inclusion and 6.4 cm(3) (SD 2.0) at follow up (p = 0.18). The four symptomatic non-treated tendons did not improve regarding pain, performance, intratendinous signal or tendon volume.

Conclusion: We found decreased pain, improved performance and decreased intratendinous signal both compared to index examination and immediately after the 3 months training regimen in a 4.2-year clinical and MRI follow up, in a group of patients treated with heavy loaded eccentric calf-muscle training for chronic Achilles tendinopathy. The improvements were greater at 4.2-year follow up, despite no further active treatment, than immediately after the treatment. This may indicate a good long-term prognosis for Achilles tendinosis patients.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Longitudinal Studies
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Muscle, Skeletal / pathology*
  • Tendinopathy / diagnosis*
  • Tendinopathy / rehabilitation*
  • Thigh / pathology
  • Treatment Outcome