Scand J Med Sci Sports 2001: 11: 197–206 COPYRIGHT C MUNKSGAARD 2001 ¡ ISSN 0905-7188 Printed in Denmark ¡ All rights reserved Eccentric overload training for patients with chronic Achilles tendon pain – a randomised controlled study with reliability testing of the evaluation methods K. Gra¨vare Silbernagel 1 , R. Thomee´ 2 , P. Thomee´ 1 , J. Karlsson 3 1 Sportrehab – Physical Therapy & Sports Medicine Clinic, Göteborg, 2 Muscle Laboratory, Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Göteborg, 3 Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden Corresponding author: Karin Grävare Silbernagel, Sportrehab, Stampgatan 14, S-411 01 Göteborg, Sweden Accepted for publication 15 December 2000 The purpose was to examine the reliability of measure- ment techniques and evaluate the effect of a treatment protocol including eccentric overload for patients with chronic pain from the Achilles tendon. Thirty-two pa- tients with proximal achillodynia (44 involved Achilles tendons) participated in tests for reliability measures. No significant differences and strong (rΩ0.56–0.72) or very strong (rΩ0.90–0.93) correlations were found between pre-tests, except for the documentation of pain at rest (P∞0.008, rΩ0.45). To evaluate the effect of a 12-week treatment protocol for patients with chronic proximal achillodynia (pain longer than three months) 40 patients (57 involved Achilles tendons) with a mean age of 45 years (range 19–77) were randomised into an experiment group (nΩ22) and a control group (nΩ18). Evaluations were performed after six weeks of treatment and after three and six months. The evaluations (including the pre- tests), performed by a physical therapist unaware of the group the patients belonged to, consisted of a ques- tionnaire, a range of motion test, a jumping test, a toe- It is estimated that 30–50% of all sport injuries are overuse injuries (Orava, 1980; Järvinen, 1992). These types of injuries may occur when the body’s repara- tive capability is exceeded by repetitive microtrauma. Achilles tendon disorders are considered to be one of the most common overuse injuries in elite and rec- reational athletes (Leach, James, Wasilewski, 1981; Clement, Taunton, Smart, 1984; Allenmark, 1992; Soma & Mandelbaum, 1994; Jozsa & Kannus, 1997). Several studies report the incidence of Achilles ten- don disorders in runners to be 6–18% of all injuries (Leach et al., 1981; Clement et al., 1984; Allenmark, 1992; Gross, 1992; Soma & Mandelbaum, 1994; De- Maio, Paine, Drez, 1995; Rolf, 1995; Jozsa & Kannus, 1997). This type of injury also frequently occurs in other sports, such as soccer, basketball, ten- nis and ballet dancing, that include running and jumping. Most commonly afflicted are middle-aged 197 raise test, a pain on palpation test and pain evaluation during jumping, toe-raises and at rest. A follow-up was also performed after one year. There were no significant differences between groups at any of the evaluations, ex- cept that the experiment group jumped significantly lower than the control group at the six-week evaluation. There was, however, an overall better result for the experiment group with significant improvements in plantar flexion, and reduction in pain on palpation, number of patients having pain during walking, having periods when asymp- tomatic and having swollen Achilles tendon. The controls did not show such changes. Furthermore, at the one-year follow-up there were significantly more patients in the ex- periment group, compared with the control group, that were satisfied with their present physical activity level, considered themselves fully recovered, and had no pain during or after physical activity. The measurement tech- niques and the treatment protocol with eccentric overload used in the present study can be recommended for pa- tients with chronic pain from the Achilles tendon. men, but Achilles tendon disorders occur in both men and women at various ages (Clement et al., 1984; De- Maio et al., 1995; Åström & Rausing, 1995; Alfred- son, Pietilä, Jonsson, Lorentzon, 1998). Achilles tendon disorders can be divided into acute or chronic problems (Leadbetter, 1992; DeMaio et al., 1995). Acute disorders may become chronic if not treated properly (Leadbetter, 1992). Historically, all types of injuries and pain disorders of the Achilles tendon have been called ‘‘Achilles tendinitis’’. Several recent studies, however, indicate that pain disorders of the Achilles tendon can be due to various types of tendon problems (Allenmark, 1992; Leadbetter, 1992; Kvist, 1994; DeMaio et al., 1995; Åström & Rausing, 1995). Based on histopathological research, Achilles tendon disorders have been classified as paratenonitis (inflammation of the paratenon), paratenonitis with tendinosis (degenerative changes of tendon), tend-