Title: Eccentric Training Decreases Paratendon Capillary Blood Flow and Preserves Paratendon Oxygen Saturation in Chronic Achilles Tendinopathy
Authors: Karsten Knobloch, MD, PhD, Robert Kraemer, MD, Michael Jagodzinski, MD, PhD, Johannes Zeichen, MD, PhD, Rupert Meller, MD, Peter M. Vogt, MD, PhD
Source: Journal of Orthopaedic & Sport Physical Therapy. May 2007; 37-5: 269-276.
PODIATRIC RELEVANCE:
This article provides evidence that eccentric training exercise programs over a 12 week period improve microcirculatory abnormalities in Achilles tendinopathy, versus the control group and may support a more active approach to therapy for this condition versus cryotherapy and rest.
METHODS:
Twenty patients prospectively selected with three months of Achilles tendon pain were recruited for the study. All patients where at least 18 years of age. Exclusions included prior surgery, and either venous or arterial disease. Fifteen patients were entered in to the exercise group and five were entered into the control group. Laser Doppler was used to assess the venous and arterial flow patterns of the paratenon at 2 and 8mm depths. The exercise group performed three sets of fifteen eccentric contractions daily over a twelve week period. The control group used standard cryotherapy and rest.
RESULTS:
The exercise group at the conclusion for the twelve week period demonstrated a large, but not statistically significant improvement in levels of pain based on an analog pain scale. However, statistically significant improvements in the degree of microcirculatory abnormalities were seen between the exercise group and the control. Oxygen saturation at the paratenon, despite reductions in neo-vascualrization, was not altered between the two groups at the end of the study.
COMMENTS:
The study supports earlier findings that neo-visualization plays an important role in tendinopathy and that exercise helps reduce this abnormal development and may improve rates of healing. The overall study is weak in terms of the study size, and in particular imbalances in the control arm versus the study group. A larger study would be indicated to firmly establish the findings as reliable.
________________________________________________________________________________________
Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.