Deroost Frea, Petrella Davide, Mylle Ine, Vanwanseele Benedicte
Departement of Movement Sciences, KU Leuven, Leuven, Belgium.
Departement of Movement Sciences, KU Leuven, Leuven, Belgium.
Clin Biomech (Bristol). 2025 Feb;122:106403. doi: 10.1016/j.clinbiomech.2024.106403. Epub 2024 Dec 2.
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.
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.
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.
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.
本研究旨在确定跟腱病康复锻炼期间跟腱负荷的差异，以及根据负荷对这些锻炼进行排序，研究对象为患有跟腱病的患者和对照组。
16例跟腱病患者（5名女性和11名男性，年龄44.1±12.9岁）和16名对照组（4名女性和12名男性，年龄39.4±15.6岁）进行康复锻炼，同时测量三维运动和地面反作用力。采用肌肉骨骼建模来计算关节运动学，并通过汇总腓肠肌各部分肌肉的力量来估计跟腱负荷。随后，确定并比较患者和对照组之间跟腱负荷峰值、负荷冲量、负荷率、负荷指数（前几个参数的组合）以及负荷峰值时的关节角度。
在负荷峰值最高的锻炼中，与对照组相比，跟腱病患者的跟腱负荷峰值显著降低：屈膝单足跟下落（3.66±0.90体重[跟腱病组] 对 4.65±1.10体重[对照组]，p = 0.003，d = 0.979）和行走（3. [跟腱病组]±0.49体重 对 3.68±0.33体重[对照组]，p = 0.044，d = 0.742）。此外，在足跟下落锻炼期间，跟腱病患者的踝关节背屈和膝关节屈曲减少。两组按负荷峰值或负荷指数对锻炼的排序相似，但取决于用于定义跟腱负荷的负荷参数。
在负荷最大的锻炼中，跟腱病患者采用代偿策略来减轻跟腱的负荷。由于运动执行的改变会影响跟腱负荷，因此对患者表现的明确指导和反馈至关重要。
