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Effects of eccentric exercise training in patients who underwent Achilles tendon repair
Achilles tendon rupture,eccentric exercise training,fascicle morphology,muscular fitness,functional performance,
|Publication Year :||2019|
Background: Ruptured Achilles tendons are often treated through surgical repair. After such repair, the morphology of the muscle-tendon unit and the fascicle behavior change, leading to decreased muscle thickness, a lengthened tendon, and shortened muscle fascicles. These morphological changes are correlated with lower muscle strength and poorer functional performance, and the differences between the injured side and the non-injured side can persist for several years after the injury. Previous studies have reported that eccentric exercise training increases fascicle length, increases muscle strength, and improves functional performance in healthy people. However, there has been no evidence that has clarified the effects of eccentric exercise training for patients who have undergone an Achilles tendon repair.
Purpose: The aim of this study was to investigate the effects of an 8-week eccentric exercise training program for patients who have undergone an Achilles tendon repair. A pre-training and post-training comparison of the morphology of the muscle-tendon unit, fascicle behavior, functional performance, and muscular fitness was performed, so as to investigate any correlations with respect to the trends of change in each parameter, to observe if the effects of this eccentric exercise training were the same for the experimental and control groups, and to determine if the effects could be maintained up to 4 weeks after the exercise training had ended.
Design: This study was a quasi-experimental nonequivalent control group study.
Participants: The experimental group consisted of patients who had undergone a unilateral Achilles tendon repair in the past 6 months to 5 years. The healthy control group consisted of patients with no history of surgery in the lower extremities. The participants in both groups were aged between 20 and 65 years old, had no systemic diseases, and had not experienced any other lower limb injury in the preceding 6 months.
Methods: The participants attended an 8-week eccentric exercise training program that consisted of 2 lab training sessions and 1 home exercise session per week. Data collection was conducted before and after the eccentric exercise training program. The parameters measured included the morphology of the muscle-tendon unit, fascicle behavior, muscle activation, functional performance, and muscular fitness. Patient-reported outcomes and microcirculation were assessed in the experimental group only. At the follow-up conducted 4 weeks after the training had ended, data regarding functional performance, muscular fitness, and patient-reported outcomes (experimental group only) was collected.
Statistical analysis: The Wilcoxon signed-rank test or paired t-test was used, according to the distribution of the data, to compare the within-group differences between the pre-training and post-training states for each parameter. The independent t-test was used to compare the levels of change in the parameters between the two groups. Spearman’s rank correlation coefficient was used to analyze the correlations between the levels of change in each parameter of the experimental group.
Results: After the eccentric exercise training program, the patients with an Achilles tendon repair (experimental group) presented thicker medial gastrocnemius muscle (p=0.016), and those in the control group presented greater fascicle angles (p=0.021). The fascicle angles during isometric contraction became greater in both groups (p=0.002-0.046). The muscular fitness and functional performance levels improved in both groups (p=0.001-0.047), and the patient-reported outcomes improved in the experimental group (p=0.006-0.047). The only change in muscle activation was that the soleus muscles of the experimental group showed increased muscle activation after training (p=0.016). No other change was seen in the muscle activation of other muscles nor in microcirculation. The trends of change were similar in most parameters between the experimental and control groups. In the experimental group, there was a significant correlation (r=0.769) between the levels of change for one-legged hopping performance and the total work as measured via the isokinetic test. Some of the training effects lasted up to 4 weeks after the training had ended.
Conclusions: The investigated eccentric exercise training undertaken at least 6 months after an Achilles tendon repair counteracted muscle atrophy and, in turn, enhanced the muscle activation, muscular fitness, functional performance, and self-reported functional status of the experimental group participants. However, the training had no significant effect on their fascicle lengths and tendon microcirculation. The eccentric exercise training induced changes similar to those mentioned above in the healthy participants, and the levels of change were similar between the two groups. To regain better functional performance, it is recommended that eccentric exercise training be emphasized in the physical therapy programs for patients with an Achilles tendon repair, as long as (1) such training is begun at least 16 weeks after the surgery, (2) the patient presents no range of motion limitation, and (3) the limb symmetry index of functional performance has reached 45%.
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