Achilles Tendonopathy - Can Eccentric Exercises Help?

Achilles tendon pain, specifically Achilles tendonopathyaggressive strengthening of the calf muscle has been
is a common and sometimes debilitating problem.used in what is called the 'Eccentric exercise
Tendons attach muscle to bone and the Calcanealprogramme'.
Tendon, more commonly known as the AchillesEccentric is a particular type of muscle action which
tendon, attaches the calf muscle to the heel boneinvolves the muscle creating tension as it lengthens.
(calcaneus). The Achilles tendon can be easily felt andThe programme consists of two key exercises; first
is found at the back of the ankle joint. It is thefor the Gastrocnemius and then for the Soleus. The
strongest and thickest tendon in the body and iseccentric action contributes to re-organisation of the
formed by a fusion of the Gastrocnemius and Soleuscollagen fibres and is thought to breakdown the
muscles as they travel down towards the heel.neovascularisation (3) which causes the problem;
It was thought for some time that Achilles tendon painhence your Achilles pain is resolved. The exercises
was due to inflammation and for this reason it wascan increase pain levels initially and it is for this reason
commonly described as Achilles tendonitis ('itis' meaningthat it is strongly recommended that you have your
inflammation). We now know that this is not the caseprogramme supervised by a physical therapist.
and the problem is in fact related to structural issuesThe overall treatment of Achilles tendonopathy should
within the components of the tendon (1). Hence, thetake a systematic approach and can be thought of in
term tendonopathy has been adopted as a morestages. Initially the acute pain should be treated and
accurate description of the problem.any aggravating activity should be avoided;
Tendons transmit forces from muscle to bone and arepredisposing factors such as flat feet or poor
subject to great tensile stresses. They consist of tightfootwear should be investigated and rectified. Next
bundles of organized collagen fibers. Even undercomes strengthening and stretching of the calf
normal circumstances, these loads will create damagemuscles.
to the tendon's fibers at a microscopic level. UsuallyAlthough these stages are listed separately, it is
the body's rate of repair is able to match the rate ofimportant to remember that the stages of treatment
microscopic damage and no harm occurs.described are complex and often inter-related. It is not
If the body's rate of repair is not able to match thealways necessary to fully resolve one stage before
microscopic damage, then tendonopathy occurs.moving on to the next the tendon is not at significant
Collagen fibers become disorganized and poor qualityrisk of tearing and so an appropriate program should
blood vessels are created (neovessels) in a processbe instituted very early.
called neovascularization. This process causes the painReferences
of Achilles tendonopathy.1. Current concepts in the management of tendon
Achilles Tendonopathy can be a very difficult conditiondisorders. Rees, J D, Wilson, A M and Wolman, R L.
to treat and often fails to respond to normal physical2006, Rheumatology, pp. 508-521.
therapy treatments. There have been many advances2. Long Term Prognosis of Achilles Tendonopathy -
in the knowledge of this condition over the last 10-15An observational 8 Year study. Paavola, M, et al. 2000,
years, better understanding of the pathological processThe American Journal of Sports Medicine, pp. 634-641.
involved means that treatments have been developed3. The chronic painful Achilles and patellar tendon;
to target the specific problem and outcomes areresearch on basic biology and treatment. Alfredson, H.
improving (2).2005, Scandinavian journal of medicine and science in
Based on the knowledge that Achilles tendonopathy issports, pp. 252-259.
caused by disorganization of collagen fibres