Review Question - QID 211836

Eccentric strengthening, in which the force remains constant as the muscle lengthens, has been shown in numerous studies to be the most effective form of nonsurgical treatment for achilles tendinopathy.

Achilles tendinopathy is a relatively common cause of posterior lower leg pain, particularly in active, middle aged men. The mid-portion of the achilles, approximately 2-6 cm proximal to the insertion, is the most commonly affected region. Patients present with pain, warmth, and swelling along the tendon, that is also made worse with activities. Treatment is mostly non-operative, with eccentric training being the cornerstone of effective treatment.

Magnussen et al. reviewed non-operative treatments for mid-portion achilles tendinopathy in a systematic review. They reported on numerous physical therapy techniques, including extracorporeal shockwave therapy, eccentric exercises, concentric exercises, wait-and-see treatment, injections and topical creams, all of which provided some relief. They concluded, however, that eccentric exercises have the most evidence of effectiveness in the treatment of mid-portion achilles tendinopathy.

Verrall et al. reviewed the use of eccentric exercises for the treatment of chronic mid-portion achilles tendinopathy. They reported that patients had a significant improvement in VAS scores, 7.2 to 2.9, following a 6-week eccentric exercise program, in which exercises were held for at least 15 seconds. They concluded that eccentric exercises provide a high degree of patient satisfaction, reduced pain and successful return to previous activity levels when used for the treatment of mid-portion achilles tendinopathy.

Incorrect Answers:
Answer 1: An isotonic contraction is one in which the force remains constant throughout range of motion.
Answer 2: Constant muscle length and tension is descriptive of isometric exercises.
Answer 3: A concentric contraction is one in which the muscle is shortened as it overcomes the resistance.
Answer 5: Isokinetic contractions occur as the muscle contracts at a constant velocity through varied resistance.