title: New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study.
abstract: BACKGROUND
  Chronic painful insertional Achilles tendinopathy is seen in both physically active and non-active individuals. Painful eccentric training, where the patients load the Achilles tendon into full dorsiflexion, has shown good results in patients with mid-portion Achilles tendinosis. However, only 32% of patients with insertional Achilles tendinopathy had good clinical results with that type of eccentric training regimen.
  
  
  OBJECTIVE
  To investigate whether a new model of painful eccentric training had an effect on chronic painful insertional Achilles tendinopathy.
  
  
  METHODS
  27 patients (12 men, 15 women, mean age 53 years) with a total of 34 painful Achilles tendons with a long duration of pain (mean 26 months), diagnosed as insertional Achilles tendinopathy, were included. The patients performed a new model of painful eccentric training regimen without loading into dorsiflexion. This was done as 3x15 reps, twice a day, 7 days/week, for 12 weeks. Pain during Achilles-tendon-loading activity (VAS) and patient's satisfaction (back to previous activity) were evaluated.
  
  
  RESULTS
  At follow-up (mean 4 months) 18 patients (67%, 23/34 tendons) were satisfied and back to their previous tendon-loading activity. Their mean VAS had decreased from 69.9 (SD 18.9) to 21 (SD 20.6) (p<0.001). Nine patients (11 tendons) were not satisfied with the treatment, although their VAS was significantly reduced from 77.5 (8.6) to 58.1 (14.8) (p<0.01).
  
  
  CONCLUSIONS
  In this short-term pilot study this new model of painful eccentric calf-muscle training showed promising clinical results in 67% of the patients.
authors.affiliation: Department of Surgical and Perioperative Sciences, Sports Medicine, Umeå University, S-901 87 Umeå, Sweden. per.jonsson@idrott.umu.se
authors.forename: P
authors.initials: P
authors.lastname: Jonsson
authors.forename: H
authors.initials: H
authors.lastname: Alfredson
authors.forename: K
authors.initials: K
authors.lastname: Sunding
authors.forename: M
authors.initials: M
authors.lastname: Fahlström
authors.forename: J
authors.initials: J
authors.lastname: Cook
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D010865:Pilot Projects; D052256:Tendinopathy / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology