Calf Exercise Relieves Chronic Achilles Injury

People with chronic Achilles tendinosis may relieve pain and restore normal tendon structure with specific calf muscle exercises, reports the British Journal of Sports Medicine (2004;38:8–11).

Achilles tendinosis is a thickening of the middle portion of the tendon at the back of the ankle, which is tender to the touch and causes pain with activity. It is most common in active middle-aged men, especially runners. The cause is unknown, but tendon overuse, poor circulation, and genetic and biochemical causes have been suggested. Therapy typically includes the use of nonsteroidal anti-inflammatory medicines, shoe orthotics, physical therapy, and strength training; however, none of these are consistently effective and surgery often becomes necessary. Two recent studies have found that eccentric (resisted stretching and pushing) calf muscle exercises were more effective in reducing pain and restoring ankle joint function than concentric (tightening or contracting) calf muscle exercises and other nonsurgical therapies.

In the current study, 26 Achilles tendons of 25 people with chronic tendinosis were evaluated before after a 12-week eccentric calf-muscle exercise program and again between 1.6 and 7.75 years afterward (with an average of 3.8 years). Prior to the study, participants had experienced an average of 17 months of pain in the middle portion of the Achilles tendon and ultrasound evaluation revealed abnormal thickening, widening, and other structural problems in all of the affected Achilles tendons.

The calf exercise consisted of standing on the painful leg with the toes of that foot on the edge of a step, and allowing the heel slowly to drop below the toes. Then the calf muscles were engaged by pushing up against the body’s weight, first with the leg straight, and then with the leg slightly bent at the knee. This exercise was repeated two times per day for 12 weeks in three sets of 15 repetitions.

As pain levels diminished over the course of the exercise period shoulder weights or weighted backpacks were added. At the end of the study, 22 of the 25 participants were satisfied with their response to the treatment and reported that pain no longer limited their activities. Follow-up ultrasounds showed significant reductions in Achilles tendon thickness and width and improvements in tendon structure compared with the beginning of the study; 19 of the 26 tendons were normal at the end of the study.

The results of this study show that an eccentric calf-muscle exercise program can provide long-term relief from the symptoms of chronic Achilles tendinosis. Previous studies have found that an eccentric calf-muscle exercise program can relieve pain and allow increased activity, but this is the first study to further demonstrate that this training can repair the disorder’s characteristic structural damage and have a lasting benefit. Future studies are needed to determine the mechanism by which this form of exercise brings about structural improvements, as such understanding could provide insights that would be useful in developing other treatment and prevention strategies.

Maureen Williams, ND, received her bachelor’s degree from the University of Pennsylvania and her Doctorate of Naturopathic Medicine from Bastyr University in Seattle, WA. She has a private practice in Quechee, VT, and does extensive work with traditional herbal medicine in Guatemala and Honduras. Dr. Williams is a regular contributor to Healthnotes Newswire.

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