9:07 a.m., Dec. 15, 2010----Technology has served up a smorgasbord of treatments for tendon injuries, including ultrasound, shockwave therapy, low-level lasers, and growth factor and stem cell treatments.
But it turns out that the simplest approach may be the best.
Karin Silbernagel, a postdoctoral researcher at the University of Delaware, is the lead author on a paper reporting that the majority of patients with Achilles tendon injuries recover fully when treated with exercise alone. The paper appeared in the online version of the American Journal of Sports Medicine on Nov. 17.
The Achilles tendon, which connects the calf muscles to the heel bone, is frequently the site of an overuse injury, known as Achilles tendinopathy or tendinitis, in runners. In more extreme cases, usually resulting from “explosive” sports-related movements, it can rupture.
Silbernagel and her co-authors, Annelie Brorsson and Mari Lundberg of the Department of Orthopaedics at the University of Gothenburg in Sweden, carried out a study to evaluate the five-year outcome of patients treated with exercise alone and to examine whether certain characteristics -- for example, fear of movement, age, and gender -- were related to the effectiveness of the treatment.
“What we found was that exercise actually promotes healing in Achilles tendinopathy,” she says. “It goes beyond just helping the patient to become stronger and better able to handle the injury -- mechanical loading can actually treat the tendon.”
As a clinician, Silbernagel has been working on Achilles tendon injuries for 20 years. Her two-year stay at UD, which is funded by the Swedish Research Council, is aimed at improving her understanding of the biomechanics of such injuries and learning new techniques for measuring tendon healing and recovery and muscle force production.
Silbernagel's overall goal is to fill some important gaps in knowledge about effective implementation of prescriptive exercise for Achilles tendinopathy and rupture.
“We need some clinical outcomes measures to help us determine the most effective types of exercise, the optimal amount of load, and the ideal point during the healing process for exercise to be initiated,” she says. “We also want to know whether the regimen should be different for men and women.”
To that end, she is conducting several studies at UD aimed at measuring scar tissue and tendon length, width, and stiffness following Achilles rupture; evaluating how a rupture affects the attached muscle; assessing the ability of patients with this injury to perform standing heel raises, an exercise commonly used to treat Achilles injuries; and evaluating the effect of a rupture on gait and running patterns.
“An understanding of all of these mechanisms is critical to our ability to design better treatment plans,” Silbernagel says.
“The other important message coming out of our previous work is that we need to give this approach time,” she adds. “Too often, the strategy has been to try exercise first but then turn to more invasive treatments including surgery if it doesn't work within three months or so. In real life, three months may not be enough for a complete recovery.”
“Karin is an internationally recognized expert in the treatment of Achilles tendon injuries,” Manal says. “Her expertise in this area, her experience in conducting clinical trials, and her background as a treating clinician will undoubtedly lead to a better understanding of the pathomechanics and healing of tendon injuries. I am very happy to have the opportunity to work with Karin and to be involved in this exciting area of research that she has brought to UD.”
Article by Diane Kukich
Photo by Evan Krape