title: Plantar flexor muscle architecture changes as a result of eccentric exercise in patients with Achilles tendinosis.
abstract: Eccentric training for Achilles tendinosis (AT) has been reported to significantly improve patient symptoms. There has been no biomechanical explanation on the mechanism for specific rehabilitation technique. The purpose of this study was to determine changes in muscle architecture that occurred as a result of Achilles tendinosis injury and a subsequent eccentric rehabilitation program. Twenty-five patients (age, 53.3 ± 17.5 years) diagnosed with AT participated in 6 weeks of rehabilitation. Specific exercises for the ankle plantar flexors consisted of maximal load eccentric muscle action using 3 sets of 15 repetitions. Patients also completed a protocol for AT, which consisting of traditional rehabilitation. Medial gastrocnemius (GM) and lateral gastrocnemius (GL) muscle fascicle length and thickness were measured with ultrasound at 2-week intervals from initial treatment day to the end of 6 weeks of rehabilitation. Medial gastrocnemius fascicle length increased (45.1 ± 10.5 mm to 51.4 ± 10.5 mm; P = .22) between the initial day of rehabilitation and after 6 weeks of rehabilitation. But, GM thickness (16.3 ± 3.5 mm to 16.8 ± 2.0 mm), GL fascicle length (47.2 ± 10.0 mm to 47.1 ± 7.4 mm), and GL thickness (14.9 ± 5.2 mm to 14.4 ± 2.7 mm) did not change as a result of rehabilitation. A 6-week eccentric-biased exercise increased the GM muscle fascicle length by 12%, but GM thickness, GL fascicle length, and GL thickness did not change as a result of rehabilitation. Eccentric training for the treatment of AT is well recognized, but the mechanism of action has not been previously reported. A 6-week eccentric training protocol increased the GM muscle fascicle length by 12%, and this correlated with improvement in a validated patient outcome scoring system. Further study is warranted to determine a predictive relationship between improvement of GM fascicle length and outcome scores.
  
  
  METHODS
  Therapeutic, Level IV: Case series.
authors.affiliation: OhioHealth, Columbus, Ohio, USA (MTC)Orthopedic Foot & Ankle Center, Westerville, Ohio, USA (GB, CH) matthew.crill@ohiohealth.com.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Crill
authors.affiliation: OhioHealth, Columbus, Ohio, USA (MTC)Orthopedic Foot & Ankle Center, Westerville, Ohio, USA (GB, CH).
authors.forename: Gregory
authors.initials: G
authors.lastname: Berlet
authors.affiliation: OhioHealth, Columbus, Ohio, USA (MTC)Orthopedic Foot & Ankle Center, Westerville, Ohio, USA (GB, CH).
authors.forename: Christopher
authors.initials: C
authors.lastname: Hyer
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology*; D055070:Resistance Training; D052256:Tendinopathy / Q000473:pathology* / Q000534:rehabilitation*; D014463:Ultrasonography
keywords: Achilles tendinosis; FOTO; eccentric training; muscle architecture; rehabilitation