Patients with Achilles tendinopathy use compensation strategies to reduce tendon load during rehabilitation exercises

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL Clinical Biomechanics Pub Date : 2025-02-01 DOI:10.1016/j.clinbiomech.2024.106403

Frea Deroost , Davide Petrella , Ine Mylle , Benedicte Vanwanseele

{"title":"Patients with Achilles tendinopathy use compensation strategies to reduce tendon load during rehabilitation exercises","authors":"Frea Deroost , Davide Petrella , Ine Mylle , Benedicte Vanwanseele","doi":"10.1016/j.clinbiomech.2024.106403","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to determine differences in the Achilles tendon loading during rehabilitation exercises for Achilles tendinopathy and the ranking of these exercises, based on load, in patients with tendinopathy and controls.</div></div><div><h3>Methods</h3><div>Sixteen patients with Achilles Tendinopathy (5F & 11 M, 44.1 ± 12.9 yr) and sixteen controls (4F & 12 M, 39.4 ± 15.6 yr) performed rehabilitation exercises while 3D motion and ground reaction forces were measured. Musculoskeletal modeling was used to compute joint kinematics and estimate Achilles tendon load by summing the forces of individual triceps surae muscles. Subsequently, peak Achilles tendon loading, loading impulse, loading rate, loading indexes (a combination of the previous parameters), and joint angles at the time of peak loading were determined and compared between patients and controls.</div></div><div><h3>Findings</h3><div>Patients with tendinopathy exhibited significantly reduced peak Achilles tendon loading compared to controls during the exercises with the highest peak loading: unilateral heel drop with flexed knee (3.66 ± 0.90BW [AT] vs. 4.65 ± 1.10BW [Control], <em>p</em> = 0.003, d = 0.979) and walking (3.37 ± 0.49BW [AT] vs. 3.68 ± 0.33BW [Control], <em>p</em> = 0.044, d = 0.742). Additionally, during the heel drop exercise, patients with tendinopathy showed reduced ankle dorsiflexion and knee flexion. The ranking of exercises by peak loading or loading index was similar for both groups but varied depending on which loading parameter was used to define Achilles tendon loading.</div></div><div><h3>Interpretation</h3><div>During the highest load-imposing exercises, patients with tendinopathy employ compensatory strategies to reduce the load on their Achilles tendon. Clear instructions and feedback on the patient's performance are crucial as altered exercise execution influences Achilles tendon loading.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"122 ","pages":"Article 106403"},"PeriodicalIF":1.4000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Biomechanics","FirstCategoryId":"5","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0268003324002353","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ENGINEERING, BIOMEDICAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background

This study aimed to determine differences in the Achilles tendon loading during rehabilitation exercises for Achilles tendinopathy and the ranking of these exercises, based on load, in patients with tendinopathy and controls.

Methods

Sixteen patients with Achilles Tendinopathy (5F & 11 M, 44.1 ± 12.9 yr) and sixteen controls (4F & 12 M, 39.4 ± 15.6 yr) performed rehabilitation exercises while 3D motion and ground reaction forces were measured. Musculoskeletal modeling was used to compute joint kinematics and estimate Achilles tendon load by summing the forces of individual triceps surae muscles. Subsequently, peak Achilles tendon loading, loading impulse, loading rate, loading indexes (a combination of the previous parameters), and joint angles at the time of peak loading were determined and compared between patients and controls.

Findings

Patients with tendinopathy exhibited significantly reduced peak Achilles tendon loading compared to controls during the exercises with the highest peak loading: unilateral heel drop with flexed knee (3.66 ± 0.90BW [AT] vs. 4.65 ± 1.10BW [Control], p = 0.003, d = 0.979) and walking (3.37 ± 0.49BW [AT] vs. 3.68 ± 0.33BW [Control], p = 0.044, d = 0.742). Additionally, during the heel drop exercise, patients with tendinopathy showed reduced ankle dorsiflexion and knee flexion. The ranking of exercises by peak loading or loading index was similar for both groups but varied depending on which loading parameter was used to define Achilles tendon loading.

Interpretation

During the highest load-imposing exercises, patients with tendinopathy employ compensatory strategies to reduce the load on their Achilles tendon. Clear instructions and feedback on the patient's performance are crucial as altered exercise execution influences Achilles tendon loading.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

跟腱病患者在康复训练中使用补偿策略来减少肌腱负荷。

背景：本研究旨在确定跟腱病康复训练中跟腱负荷的差异，以及这些训练在跟腱病患者和对照组中基于负荷的排名。方法：16例跟腱病变患者（5F和11m， 44.1±12.9 yr）和16例对照组（4F和12m， 39.4±15.6 yr）进行康复训练，同时测量三维运动和地面反作用力。肌肉骨骼模型被用来计算关节运动学和估计跟腱负荷累加单个三头肌表面肌肉的力量。随后，测定患者与对照组跟腱峰值负荷、负荷冲量、负荷率、负荷指标（综合上述参数）和峰值负荷时关节角度，并进行比较。结果：与对照组相比，肌腱病变患者在峰值负荷最高的运动中表现出明显降低的跟腱峰值负荷：单侧跟下垂膝关节（3.66±0.90BW [AT]对4.65±1.10BW[对照]，p = 0.003, d = 0.979）和步行（3.37±0.49BW [AT]对3.68±0.33BW[对照]，p = 0.044, d = 0.742）。此外，在低跟运动中，肌腱病变患者的踝关节背屈和膝关节屈曲减少。两组的峰值负荷或负荷指数的运动排名相似，但根据使用哪种负荷参数来定义跟腱负荷而有所不同。解释：在高负荷运动中，肌腱病变患者采用代偿策略来减少其跟腱的负荷。明确的指导和对患者表现的反馈是至关重要的，因为改变运动执行会影响跟腱负荷。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.