Changes in the symptoms and ultrasound signs of achilles tendinopathy during a twelve week course of loaded eccentric training: a pilot study

Background 12 weeks of eccentric exercise has been shown to be a useful therapy for Achilles tendinopathy, but little is known of the time-course of recovery, or the nature of any structural changes during therapy. Objectives To assess the time-course and pattern of Achilles tendon symptoms, thickness, stiffness, and ultrasound (US) signs during 12 weeks of eccentric exercise (EE). Methods Five subjects of age range (mean) 38–52 (46) years with main-body AT were included. For each subject, serial measurements of VISA-A score, the presence of neovascularisation and grey-scale US signs within the tendon, and the thickness of the Achilles tendon at 3 points were recorded for the first three weeks of a twelve week EE programme. Results Median VISA-A score increased from 48.5 to 54.5 (p=0.116). Median mid-tendon thickness decreased from 0.834 cm to 0.790 cm (p=0.107). A trend towards a decrease in tendon thickness was noted directly superior to the retrocalcaneal bursa and at the soleus myotendinous junction. Neovascularisation, paratenon blurring and hypoechoic areas improved in 1/3, 1/3 and 2/5 tendons respectively. No significant change occurred in median tendon stiffness. Conclusion 3 weeks of EE do not produce significant changes in AT symptoms and tendon thickness or stiffness, but improve US signs and neovascularisation in some subjects. The non-significance of findings may be a type II error and further work with larger sample sizes is planned.