The Role of Targeted Exercises in the Management of Achilles and Patellar Tendinopathy in Sport

Mark Young, Craig Ranson
European Musculoskeletal Review, 2011;6(2):131-136
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Abstract

Abstract
Achilles and patellar tendinopathy are painful and often performance-limiting conditions highly prevalent among the sporting population. There is a plethora of management options available, including pharmacology, injection therapy, extracorporeal shock wave therapy, exercise rehabilitation and surgery. Of these, only targeted exercise therapy has been consistently shown to be effective. This clinical commentary gives a brief overview of the nature of, and treatment options for, Achilles and patellar tendinopathy in sport before examining the evidence for exercise-based management. Guidelines for appropriate exercise prescription are provided, highlighting that important components of this type of rehabilitation are exercise choices that specifically load the tendon, utilising a high number of repetitions performed over an appropriate range of motion, at a slow speed, with heavy loads that induce pain. The article also recognises that specific tendon exercises should form part of a rehabilitation programme that appropriately integrates other therapies, training and competition load management and comprehensive conditioning.

Keywords
Achilles tendinopathy, patellar tendinopathy, exercise, rehabilitation, sport

Disclosure: The authors have no conflicts of interest to declare.
Received: 10 January 2011 Accepted: 16 March 2011 Citation: European Musculoskeletal Review, 2011;6(2):131–6
Correspondence: Craig Ranson, Cardiff School of Sport, University of Wales Institute, Cyncoed Rd, Cardiff CF23 6XD, UK. E: cranson@uwic.ac.uk

The Nature and Prevalence of Achilles and Patellar Tendinopathy in Sport
Achilles and patellar tendon injury has been associated with various diagnostic terms including tendinitis, tendinosis and paratenonitis (Achilles). Other diagnoses such as tendon calcification, neovascularisation and bursitis have also been linked to painful overuse tendon injury. With a view to reducing confusion associated with these various labels, Maffulli et al.1 proposed the term tendinopathy to describe the combination of pain, swelling and impaired performance associated with tendon injury that is not due to an acute tendon tear. Achilles and patellar tendinopathies are highly prevalent in the athletic population. Athletes in running-based sports are particularly susceptible to Achilles injury, while jumping athletes are prone to patellar tendinopathy. For example, there is a 40–50% prevalence of patellar tendinopathy among elite volleyball players,2–4 while Achilles tendinopathy is known to have a high prevalence in athletes who participate in international-level running-based sports.5

Normal Tendon Structure and Function
The primary role of tendons is to transmit tensile forces produced by muscles to the skeleton in order to produce and control joint movement.6 The largest human tendon, the Achilles, attaches the calf muscles (gastrocnemius and soleus) to the superior tuberosity of the calcaneus, forming a broad and flat aponeurosis at its proximal muscle attachment. The Achilles becomes rounder in the midsection due to spiralling of its fibres before broadening out again at the distal attachment, approximately two-thirds of which are contributed by the soleus portion.7 While the mid-portion spiralling adds to its strength, it also concentrates load, which may be a significant factor as this region is the most common location of tendinopathy within the Achilles.8 The cylindrical patellar tendon attaches the inferior angle of the patella to the tibial tuberosity, and as it attaches bone to bone, there are some who suggest it should be labelled a ‘ligament’.9

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