Alfredson H, Nordström P, Pietilä T, Lorentzon R
Sports Medicine Unit, University of Umeå, S-90185, Umeå, Sweden.
Calcif Tissue Int. 1999 May;64(5):450-5. doi: 10.1007/pl00005827.
In an ongoing prospective study of 14 recreational athletes (12 males and 2 females, mean age 44.2 +/- 7.1 years) with unilateral chronic Achilles tendinosis, we investigated the effect of treatment with heavy-loaded eccentric calf-muscle training. Pain during activity (recorded on a VAS scale) and isokinetic concentric and eccentric calf-muscle strength (peak torque at 90 degrees /second and 225 degrees /second) on the injured and noninjured side were evaluated. In this group of patients, we examined areal bone mineral density (BMD) of the calcaneus after 9 months (range 6-14 months) of training. BMD of the injured side (subjected to heavy-loaded eccentric training) was compared with BMD of the noninjured side. Before onset of heavy-loaded eccentric training, all patients had Achilles tendon pain which prohibited running activity, and significantly lower concentric and eccentric plantar flexion peak torque on the injured compared with the noninjured side. The training program consisted of 12 weeks of daily, heavy-loaded, eccentric calf-muscle training; thereafter the training was continued for 2-3 days/week. The clinical results were excellent-all 14 patients were back at their preinjury level with full running activity at the 3 month follow-up. The concentric and eccentric plantar flexion peak torque had increased significantly and did not significantly differ from the noninjured side at the 3 and 9 month follow-up. There were no significant side-to-side differences in BMD of the calcaneus. There was no significant relationship between BMD of the calcaneus and calf-muscle strength. As a comparison group, we used 10 recreational athletes (5 males and 5 females) mean age 40.9 years (range 26-55 years), who were selected for surgical treatment of chronic Achilles tendinosis localized at the 2-6 cm level. Their duration of symptoms and severity of disease were the same as in the experimental group. There were no significant side-to-side differences in BMD of the calcaneus preoperatively, but 12 months postoperatively BMD of the calcaneus was 16.4% lower at the injured side compared with the noninjured side. Heavy-loaded eccentric calf-muscle training resulted in a fast recovery in all patients, equaled the side-to-side differences in muscle strength, and was not associated with side-to-side differences in BMD of the calcaneus. In this group of middle-aged recreational athletes, BMD of the calcaneus was not related to calf-muscle strength.
在一项针对14名患有单侧慢性跟腱病的休闲运动员(12名男性和2名女性,平均年龄44.2±7.1岁)的前瞻性研究中,我们调查了重负荷离心小腿肌肉训练的治疗效果。评估了活动期间的疼痛(采用视觉模拟评分法记录)以及受伤侧和未受伤侧等速向心和离心小腿肌肉力量(90度/秒和225度/秒时的峰值扭矩)。在这组患者中,我们在训练9个月(6 - 14个月)后检查了跟骨的骨密度(BMD)。将受伤侧(接受重负荷离心训练)的骨密度与未受伤侧的骨密度进行比较。在开始重负荷离心训练之前,所有患者均有跟腱疼痛,这使得他们无法进行跑步活动,并且受伤侧的向心和离心跖屈峰值扭矩明显低于未受伤侧。训练计划包括为期12周的每日重负荷离心小腿肌肉训练;此后,训练以每周2 - 3天的频率持续进行。临床结果非常好——所有14名患者在3个月随访时均恢复到受伤前水平,能够完全进行跑步活动。在3个月和9个月随访时,向心和离心跖屈峰值扭矩显著增加,且与未受伤侧无显著差异。跟骨的骨密度在两侧之间没有显著差异。跟骨骨密度与小腿肌肉力量之间没有显著关系。作为对照组,我们使用了10名休闲运动员(5名男性和5名女性),平均年龄40.9岁(范围26 - 55岁),他们因慢性跟腱病定位在2 - 6厘米水平而被选择进行手术治疗。他们的症状持续时间和疾病严重程度与实验组相同。术前跟骨的骨密度在两侧之间没有显著差异,但术后12个月,受伤侧跟骨的骨密度比未受伤侧低16.4%。重负荷离心小腿肌肉训练使所有患者快速康复,使两侧肌肉力量差异相等,并且与跟骨骨密度的两侧差异无关。在这组中年休闲运动员中,跟骨的骨密度与小腿肌肉力量无关。