Int J Sports Med 2012; 33(07): 567-571
DOI: 10.1055/s-0032-1304644
Orthopedics & Biomechanics
© Georg Thieme Verlag KG Stuttgart · New York

Leg Stiffness Changes in Athletes with Achilles Tendinopathy

J. Maquirriain
1   Orthopaedics, High Performance National Sports Center, (CeNARD) Buenos Aires, Argentina
› Author Affiliations
Further Information

Publication History



accepted after revision 30 January 2012

Publication Date:
12 April 2012 (online)

Abstract

Overuse injuries of the Achilles tendon cause impairment in lower leg muscle-tendon function. The purpose of this study was to evaluate leg stiffness in patients suffering unilateral Achilles tendinopathy. 51 athletes with unilateral Achilles tendinopathy underwent leg stiffness testing by modeling the vertical ground reaction force in a contact mat, measuring flight and contact time during hopping. Clinical status was estimated with a pain VAS and a validated questionnaire (VISA-A). The ‘leg stiffness ratio’ (LSR=stiffness of injured leg/stiffness of healthy leg) was calculated to determine the relative patient affectation and for intra-group comparison. 84 percent of subjects showed lower leg stiffness in the affected side during hopping. Leg stiffness was significantly lower in the limb affected by Achilles tendinopathy than in the healthy side (14.07±3.74 kN/m vs. 15.61±4.01 kN/m, p=0.047); overall LSR was 0.90±0.09. Intra-group comparison did not show significant differences related to patients’ age, gender, sport level, and site of tendon injury (midportion or insertional). Leg stiffness was significantly reduced in patients with unilateral Achilles tendinopathy probably related to increasing ankle compliance. Regular leg stiffness assessment would be beneficial for athletes suffering Achilles tendon problems in terms of quantifying performance capabilities and providing objective data for a safer return to sport activity.

 
  • References

  • 1 Arampatzis A, Brüggermann GP, Metzler V. The effect of speed on leg stiffness and joint kinetics in human running. J Biomech 1999; 32: 1349-1353
  • 2 Arya S, Kulig K. Tendinopathy alters mechanical and material properties of the Achilles tendon. J Appl Physiol 2010; 108: 670-675
  • 3 Blickhan R. The spring mass model for running and hopping. J Biomechanics 1989; 22: 1217-1227
  • 4 Church BC, Wiggind MS, Moode ME, Crist R. Effect of warm-up and flexibility treatments on vertical jump performance. J Strength Cond Res 2001; 15: 332-336
  • 5 Cornu C, Goubel M. Influence of plyometric training on the mechanical impedance of the human ankle joint. Eur J Appl Physiol 1997; 76: 282-288
  • 6 Dalleau G, Belli A, Viale F, Viale F, Lacour JR, Bourding M. A simple method for field measurements of leg stiffness in hopping. Int J Sports Med 2004; 25: 170-176
  • 7 Dalleau G, Belli A, Bourdin M, Lacour JR. The spring mass model and the energy cost of treadmill running. Eur J Appl Physiol 1998; 77: 257-263
  • 8 Ettema GJ. Muscle efficiency: the controversial role of elasticity and mechanical energy conversion in stretch-shortening cycle. Eur J Appl Physiol 2001; 85: 457-465
  • 9 Farley CT, Gonzales O. Leg stiffness and stride frequency in human running. J Biomech 1996; 29: 181-186
  • 10 Farley CT, Morgenroth DC. Leg stiffness primarily depends on ankle stiffness during human hopping. J Biomechanics 1999; 32: 267-273
  • 11 Garcia-López J, Peleteiro J, Rodriguez-Arroyo JA, Morante JC, Herrero JA, Villa JG. The validation of a new method that measures contact and flight times during vertical jump. Int J Sports Med 2005; 26: 294-302
  • 12 Harriss DJ, Atkinson G. Update – ethical standards in sport and exercise science research. Int J Sports Med 2011; 32: 819-821
  • 13 Hunter JP, Marshall RN. Effects of power and flexibility training on vertical jump technique. Med Sci Sports Exerc 2002; 34: 478-486
  • 14 Komi PV. Training of muscle strength and power: interaction of neuromotoric, hypertrophic, and mechanical factors. Int J Sports Med 1986; 7: 10-15
  • 15 Komi PV. Stretch-shortening cycle: a powerful model to study normal and fatigued muscle. J Biomech 2000; 33: 1197-1206
  • 16 Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998; 14: 840-843
  • 17 Maffulli N, Longo UG, Denaro V. Novel approaches for the management of tendinopathy. J Bone Joint Surg Am 2010; 92: 2604-2613
  • 18 Maquirriain J, Ayerza MA, Costa-Paz M, Muscolo DL. Endoscopic surgery in chronic Achilles tendinopathies: a preliminary report. Arthroscopy 2002; 18: 298-303
  • 19 McMahon TA, Cheng GC. The mechanics of running: how does stiffness couple with speed?. J Biomech 1990; 23: 65-78
  • 20 Owen G, Cronin J, Gill N, McNair P. Knee extensor stiffness and functional performance. Phys Ther Sport 2005; 6: 38-44
  • 21 Porter MM, Andersson M, Hellstrom U, Miller M. Passive resistive torque of the plantar flexors following eccentric loading as assessed by isokinetic dynamometry. Can J Appl Physiol 2002; 27: 612-617
  • 22 Robinson JR, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 2001; 35: 335-341
  • 23 Roos EM, Engström M, Lagerquist A, Söderberg B. Clinical improvement after 6 weeks of eccentric exercises in patients with mid-portion Achilles tendinopathy: a randomized trial with 1-year follow-up. Scand J Med Sci Sports 2004; 14: 286-295
  • 24 Silbernagel KG, Gustavsson A, Thomeé R, Karlsson J. Evaluation of lower function in patients with Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 2006; 14: 1207-1217
  • 25 Silbernagel KG, Thomeè R, Eriksson BI, Karlsson J. Full symptomatic recovery does not ensure full recovery of muscle-tendon function in patients with Achilles tendinopathy. Br J Sports Med 2007; 41: 276-280
  • 26 VanDijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc 2011; 19: 835-841
  • 27 Wilson GJ, Wood GA, Elliot BC. Optimal stiffness of series elastic component in a stretch-shorten cycle activity. J Appl Physiol 1991; 70: 825-833
  • 28 Wren TAL, Lindsey DP, Beaupré GS, Carter DR. Effects of creep and cyclic loading on the mechanical properties and failure of human Achilles tendon. Ann Biomedicals Engineer 2003; 31: 710-717