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Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading : implications for Achilles tendinopathy

Lauren Pringels (UGent) , Luc Vanden Bossche (UGent) , Evi Wezenbeek (UGent) , Arne Burssens (UGent) , Hannes Vermue (UGent) , Jan Victor (UGent) and Amélie Chevalier (UGent)
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Abstract
Mechanical overload is considered the main cause of Achilles tendinopathy. In addition to tensile loads, it is believed that the Achilles tendon may also be exposed to compressive loads. However, data on intratendinous pressures are lacking, and consequently, their role in the pathophysiology of tendinopathy is still under debate. Therefore, we aimed to evaluate the intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading. Twelve pairs of human cadaveric legs were mounted in a testing rig, and a miniature pressure catheter was placed through ultrasound-guided insertion in four different regions of the Achilles tendon: the insertion (superficial and deep layers), mid-portion, and proximal portion. Intratendinous pressure was measured during three simulated loading conditions: a bent-knee calf stretch, a straight-knee calf stretch, and an eccentric heel-drop. It was found that the intratendinous pressure increased exponentially in both the insertion and mid-portion regions of the Achilles tendon during each loading condition (p < 0.001). The highest pressures were consistently found in the deep insertion region (p < 0.001) and during the eccentric heel-drop (p < 0.001). Pressures in the mid-portion were also significantly higher than in the proximal portion (p < 0.001). These observations offer novel insights and support a role for compression in the pathophysiology of Achilles tendinopathy by demonstrating high intratendinous pressures at regions where Achilles tendinopathy typically occurs. To what extent managing intratendinous pressure might be successful in patients with Achilles tendinopathy by, for example, avoiding excessive stretching, modifying exercise therapy, and offering heel lifts requires further investigation.
Keywords
Physical Therapy, Sports Therapy and Rehabilitation, Orthopedics and Sports Medicine, tendon compression, tendon biomechanics, stretching, intratendinous pressure, eccentric loading, compressive load, Achilles tendon

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MLA
Pringels, Lauren, et al. “Intratendinous Pressure Changes in the Achilles Tendon during Stretching and Eccentric Loading : Implications for Achilles Tendinopathy.” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS, vol. 33, no. 5, 2023, pp. 619–30, doi:10.1111/sms.14285.
APA
Pringels, L., Vanden Bossche, L., Wezenbeek, E., Burssens, A., Vermue, H., Victor, J., & Chevalier, A. (2023). Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading : implications for Achilles tendinopathy. SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS, 33(5), 619–630. https://doi.org/10.1111/sms.14285
Chicago author-date
Pringels, Lauren, Luc Vanden Bossche, Evi Wezenbeek, Arne Burssens, Hannes Vermue, Jan Victor, and Amélie Chevalier. 2023. “Intratendinous Pressure Changes in the Achilles Tendon during Stretching and Eccentric Loading : Implications for Achilles Tendinopathy.” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS 33 (5): 619–30. https://doi.org/10.1111/sms.14285.
Chicago author-date (all authors)
Pringels, Lauren, Luc Vanden Bossche, Evi Wezenbeek, Arne Burssens, Hannes Vermue, Jan Victor, and Amélie Chevalier. 2023. “Intratendinous Pressure Changes in the Achilles Tendon during Stretching and Eccentric Loading : Implications for Achilles Tendinopathy.” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS 33 (5): 619–630. doi:10.1111/sms.14285.
Vancouver
1.
Pringels L, Vanden Bossche L, Wezenbeek E, Burssens A, Vermue H, Victor J, et al. Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading : implications for Achilles tendinopathy. SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS. 2023;33(5):619–30.
IEEE
[1]
L. Pringels et al., “Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading : implications for Achilles tendinopathy,” SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS, vol. 33, no. 5, pp. 619–630, 2023.
@article{01GPGG2NB59MQ9ZH3BXRKE96KQ,
  abstract     = {{Mechanical overload is considered the main cause of Achilles tendinopathy. In addition to tensile loads, it is believed that the Achilles tendon may also be exposed to compressive loads. However, data on intratendinous pressures are lacking, and consequently, their role in the pathophysiology of tendinopathy is still under debate. Therefore, we aimed to evaluate the intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading. Twelve pairs of human cadaveric legs were mounted in a testing rig, and a miniature pressure catheter was placed through ultrasound-guided insertion in four different regions of the Achilles tendon: the insertion (superficial and deep layers), mid-portion, and proximal portion. Intratendinous pressure was measured during three simulated loading conditions: a bent-knee calf stretch, a straight-knee calf stretch, and an eccentric heel-drop. It was found that the intratendinous pressure increased exponentially in both the insertion and mid-portion regions of the Achilles tendon during each loading condition (p < 0.001). The highest pressures were consistently found in the deep insertion region (p < 0.001) and during the eccentric heel-drop (p < 0.001). Pressures in the mid-portion were also significantly higher than in the proximal portion (p < 0.001). These observations offer novel insights and support a role for compression in the pathophysiology of Achilles tendinopathy by demonstrating high intratendinous pressures at regions where Achilles tendinopathy typically occurs. To what extent managing intratendinous pressure might be successful in patients with Achilles tendinopathy by, for example, avoiding excessive stretching, modifying exercise therapy, and offering heel lifts requires further investigation.}},
  author       = {{Pringels, Lauren and Vanden Bossche, Luc and Wezenbeek, Evi and Burssens, Arne and Vermue, Hannes and Victor, Jan and Chevalier, Amélie}},
  issn         = {{0905-7188}},
  journal      = {{SCANDINAVIAN JOURNAL OF MEDICINE & SCIENCE IN SPORTS}},
  keywords     = {{Physical Therapy, Sports Therapy and Rehabilitation,Orthopedics and Sports Medicine,tendon compression,tendon biomechanics,stretching,intratendinous pressure,eccentric loading,compressive load,Achilles tendon}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{619--630}},
  title        = {{Intratendinous pressure changes in the Achilles tendon during stretching and eccentric loading : implications for Achilles tendinopathy}},
  url          = {{http://doi.org/10.1111/sms.14285}},
  volume       = {{33}},
  year         = {{2023}},
}

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