Achilles Tendinopathy, Treatment With eXercise Comparing Men and Women

Achilles tendinopathy has an incidence rate of 2.35 per 1000 in the general population and is
most prevalent in middle-aged individuals (35-55 y/o), but occurs in men and women of all
ages. The primary symptom is pain during daily activities such as walking and exercising such
as running. Aside from the pain, Achilles tendinopathy has been shown to significantly
decrease physical activity level, resulting in further negative effects on overall health and
well-being. The treatment for Achilles tendinopathy with the highest level of evidence is
eccentric exercise, providing mechanical loading of the muscle-tendon unit. In a recent
systematic review, all studies reported significant improvements in patient-reported symptoms
but at 12 weeks the means ranged from 69-80 (100 being fully recovered) indicating that even
with the most effective treatment individuals continued to have symptoms. At this time, other
more invasive interventions such as injection therapies (ex. platelet-rich plasma) and
surgery are recommended for patients who fail exercise treatment despite a lack of
understanding of what factors are related to continued problems. Just achieving a reduction
in pain and symptoms with treatment also does not ensure resolution of the tendon's
structural abnormalities. In fact, studies evaluating the recovery of tendon structure with
exercise suggest that at least 24 weeks may be needed to observe a significant change. Other
individual factors such as sex, degree of tendon structural damage and functional deficits
are also proposed to influence both the time course and success rate of recovery. The
long-term goal of our research is to advance understanding of tendon injuries and repair,
enabling tailored treatments to be developed. This study begins to address this long-term
goal by evaluating the time-course of recovery in terms of tendon structure (ultrasound
imaging) and viscoelastic properties (elastography) along with symptoms (patient-reported
outcomes) and muscle-tendon function (functional test-battery) in males and females with
Achilles tendinopathy treated with an exercise program. Aim 1 is to evaluate if there are
differences in change over time in symptoms, muscle-tendon function, tendon structure, and
mechanical properties between males and females with Achilles tendinopathy receiving exercise
treatment. Aim 2 is to investigate whether the presence and magnitude of tendon structural
abnormality at baseline will affect the ability and time-course of recovery with exercise
treatment for Achilles tendinopathy. Aim 3 is to explore if patients who continue to have
symptoms at the 16-week evaluation will further improve in symptoms, muscle-tendon function,
tendon structure and mechanical properties over the course of one year.

Inclusion Criteria:

- Diagnosis of midportion Achilles tendinopathy

Exclusion Criteria:

- Previous Achilles tendon rupture

- Diagnosis of only insertional Achilles tendinopathy or bursitis