Chronic Achilles tendinosis--a runner's real Achilles heel.

Chronic Achilles tendinosis is the degeneration of tendon fibers due to chronic overuse. Pain occurs with loading; in other words, with every running step you take. Male recreational runners in the 35 to 45 age group most commonly suffer this injury. Chronic tendinosis can make the runner vulnerable to a partial or complete rupture of the tendon. It is classically a difficult injury to treat since often it doesn't respond to the usual repertoire of overuse treatments--rest, non-steroidal anti-inflammatory medications, stretching, and strengthening. In one review, at least 25% of patients end up with surgery to remove the damaged tissue.

Researchers in Sweden have been pursuing other options. In one recent prospective multicenter study, patients with chronic Achilles tendinosis were randomized to treatment with either an eccentric or concentric training regimen for the calf muscles. Eccentric exercises consisted of lowering their body weight from the elevated position on the ball of the foot to below level (as in standing on the edge of a step). The uninjured leg was used to return to the elevated position. Concentric exercises involved lifting the body weight with the injured leg, lowering with the uninjured leg, and progressing to include other standard concentric strength exercises. As strength increased, weights were added to increase resistance.

After 12 weeks of treatment, 18 of the 22 patients in the eccentric loading group had returned to their level of running before injury, compared to eight of 22 who were treated with the concentric regimen. If you have Achilles tendon pain, make sure you get an accurate diagnosis and ask about different strength training options.

(Knee Surgery, Sports Trauma, and Arthroscopy, 2001. Vol. 9, No. 1, pp. 42-7; American Journal of Sportsmedicine, 1998, Vol. 26, No. 3, pp. 360-3 66; Sports Medicine, 2000, Vol. 29, No. 2, pp. 135-146)