how long before eccentric raises will clear up achilles problems?

So many people have recommended this program to me, but no one can say anything about the recovery timeframe? Most of the studies have taken place over 12 weeks and have had excellent results, but does it actually take the entire 3 month period to fully recover?

it looks like 12 weeks based on the original 1998 AmJSports Med article:

Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.Alfredson H, Pietilä T, Jonsson P, Lorentzon R.

Department of Orthopaedic Surgery, University Hospital of Northern Sweden, Umeå, Sweden.

We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 +/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.

But...there are several other studies out now comparing different types of treatment. here is one that says the AirHeel Brace is just as effective:

Am J Sports Med. 2007 Jun 14; [Epub ahead of print] Links

Chronic Achilles Tendinopathy: A Prospective Randomized Study Comparing the Therapeutic Effect of Eccentric Training, the AirHeel Brace, and a Combination of Both.Petersen W, Welp R, Rosenbaum D.

Department of Trauma-, Hand-, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany.

BACKGROUND: Previous studies have shown that eccentric training has a positive effect on chronic Achilles tendinopathy. A new strategy for the treatment of chronic Achilles tendinopathy is the AirHeel brace. HYPOTHESIS: AirHeel brace treatment improves the clinical outcome of patients with chronic Achilles tendinopathy. The combination of the AirHeel brace and an eccentric training program has a synergistic effect. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: One hundred patients were randomly assigned to 1 of 3 treatment groups: (1) eccentric training, (2) AirHeel brace, and (3) combination of eccentric training and AirHeel brace. Patients were evaluated at 6, 12, and 54 weeks after the beginning of the treatment protocol with ultrasonography, visual analog scale (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and Short Form-36 (SF-36). RESULTS: The VAS score for pain, AOFAS score, and SF-36 improved significantly in all 3 groups at all 3 follow-up examinations. At the 3 time points (6 weeks, 12 weeks, and 54 weeks) of follow-up, there was no significant difference between all 3 treatment groups. In all 3 groups, there was no significant difference in tendon thickness after treatment. CONCLUSIONS: The AirHeel brace is as effective as eccentric training in the treatment of chronic Achilles tendinopathy. There is no synergistic effect when both treatment strategies are combined. CLINICAL RELEVANCE: The AirHeel brace is an alternative treatment option for chronic Achilles tendinopathy.

however, the article i have says "all 3 authors received funds for research from Aircast Europe"...this doesn't necessarily mean its garbage but read it with a grain of salt...and do a search here with keywords "eccentric" "chronic" "achilles"

it comes up with articles that compare the eccentric loading exercises to other treatments.

http://www.ncbi.nlm.nih.gov/sites/entrez

It never did work for me. It all depends on your injury..

Yeah, it's amazing how much money I have put into myriad treatments for this stupid injury. I wonder why the AirHeel (TM) would work with eccentric loading.

Anyway, can anyone experienced with this treatment help me with a timeframe? It really seems to be improving, but it's still a little thick and achey (sp).

Did you ever find something that did work?

The eccentric calf raises were the only thing that worked for me, and I tried a lot of different stuff. As well as I can remember, I began noticing improvement after doing them for about 2 weeks, and it was probably somewhere in the 2-3 month range before I was pain free. I did them 2-3 times a day. Good luck!

milers left out wrote:

Yeah, it's amazing how much money I have put into myriad treatments for this stupid injury. I wonder why the AirHeel (TM) would work with eccentric loading.

Anyway, can anyone experienced with this treatment help me with a timeframe? It really seems to be improving, but it's still a little thick and achey (sp).

the study compared 1)eccentric loading, with 2)airheel, with 3) both.

both was they did the eccentric exercises and wore the AirHeel during the day. there is a picture of the airheel in the article and it looks just like an neoprene brace.

one thing i noticed about this article compared with the eccentric study is that the mean time of symptoms was 7.5 +- 2.3 or so months for all groups. in the original eccentric study the range of injury time for the eccentric group was 18.3 months with a range of 3-100 months. so it's possible that in the short term, using the airheel would be beneficial but i would think that long term, if you just do passive recovery, you're just going to get injured again.

Thanks. It seesm like my experience is similar to yours: nothing, including long periods of rest, seemed to help very much, but the eccentric training is definately helping. The first week I actually felt a bit worse because of the added stress, but by the end of the second week my achilles felt less painful, stronger, and the bump was starting to go away. I'm currently in the forth week and running no longer hurts, but it still feels a little funky if you know what I mean. It's good to hear that it worked for you.

the eccentric raises have helped, but not cured the problem. if i stop or maybe even if i keep going when the heel is sore, things worsen. but i have never tried to do them several times a day. just ten per foot, three times, once a day.

hi milers left out-

i responded to one of your posts a few weeks back. i haven't been running for basically 8 weeks now. i can give your more details on my x-training if you want.

i decided not to do eccentric raises at first, because i was worried it would put stress on my achilles and make things worse. maybe that is not a correct fear to have - i'm not sure.

my achilles (my pain is insertional pain, right on the heel) has gotten a lot better, so i decided it might be safe to try doing some eccentric raises. i have done 3 sets of 15 on each leg, on three different days this week. my calves are pretty sore the next day (mostly the first time), so i don't do them for a day or two, before doing them again.

the day after my first set of raises, it seemed my heel pain was slightly worse in the morning (this is my tell tale sign of the problem, pain right when getting out of bed in morning). after the 2nd and third day, i did not notice any increase in pain the next morning.

right now, i can't tell if the raises are helping my achilles to heal or not. i don't really understand how strengthening your calf muscles can help a tendon to repair itself. if there is damage in your tendon, it has to heal itself. i don't understand how working out the calf muscle helps the tendon to heal.

i do understand how strengthening a calf muscle on a healthy leg can help to prevent a tendon problem.

Soul_runner,

Needless to say my strategy of running through it was not completely sucessful, but the eccentric raises do seem to be helping. From my understanding, what the exercizes do is to encourage the tendon to heal properly. It's good to hear that yours is getting better. How long since you injured it?

i just did a literature search on insertional achilles tendonitis.

eccentric calf raises may not be any good for insertional type injury! (mine)

the swedish study by Alfredson et. al. was done on runner's who had pain in the midportion of the achilles. From the Alfredson study: "All patients in both groups had degenerative changes(tendinosis) in the tendon 2 to 6 cm above the Achilles tendon insertion on the calcaneus."

milers left out, if your injury is midportion, then i think the Alfredson study bodes well for you!

I found another paper which emphasizes the need to distinguish between type of achilles problems...

Knobloch et. al.

Achilles Tendon and Paratendon Microcirculation in Midportion and Insertional Tendinopathy in Athletes

Am. J. Sports Med., Jan 2006; 34: 92 - 97.

"Physical exercise has been applied in patients with chronic

Achilles tendon problems in insertional as well as midportion

tendinopathy.(25) Eccentric training has been found to

be associated with reasonably good results in a preliminary

study not differentiating between conditions.(24) A prospective controlled trial published on this issue demonstrated good clinical results after 12 weeks of eccentric

calf-muscle training in patients with midportion

tendinopathy (2-6 cm) but not in patients with chronic

insertional problems of the Achilles tendon.(5)"

here are the papers which are referenced above:

(5) Fahlström M, Jonsson P, Lorentzon R, Alfredson H. Chronic Achilles

tendon pain treated with eccentric calf-muscle training. Knee Surg

Sports Traumatol Arthrosc. 2003;11:327-333.

(24) Silbernagel KG, Thomee R, Thomee P, Karlsson J. Eccentric overload

training for patients with chronic Achilles tendon pain: a randomised

controlled study with reliability testing of the evaluation methods.

Scand J Med Sci Sports. 2001;11:197-206.

(25) Stanish W, Rubinovich M, Curvin S. Eccentric exercise in chronic tendonitis.

Clin Orthop Relat Res. 1986;208:65-68.

it started bothering me about 12 weeks ago, or said another way, it was hurting for 4 weeks before I finally stopped running.

soul_runner and anyone else interested,

I'm a little over a month into the eccentric raise/drop program and my achilles is feeling A LOT better. In fact there is no pain at all even with moderate running, and the morning aches are completely gone. I would seriously suggest this program.

wow, really?

so you are doing 3x20 reps twice a day with 15 lbs in a backpack?

i've done it only a little, i will try stepping it up (originally no pun intended, but...)

i've been pretty down about not being able to run, and the pool running is driving me nuts.

is your pain midportion? my pain is where the tendon attaches to the heal, "insertional achilles tendinosis"

if anyone out there that is reading this thread has had the insertional type of achilles pain and has benefited (or not) from eccentric heal raises, please chime in.

Mine is midportion: there is/was a bump abou 1.5cm above the insertion point that hurt after runs, but at its worst nt achilles also hurt somewhat at the insertion point.

Can anyone post a reference to the 'program'. I have significant achilles issues, and have heard about these exercises, but haven't seen how it should be done.

below are some links. also, search this message board for "eccentric" and "achilles". there is a lot of good discussion and references to websites.

video clips of exercise:

http://www.athletics-weekly.com/back-issues/2007/62-24-02.htm

progressively difficult:

http://www.pponline.co.uk/encyc/0832.htm

variation on straight up and down movement:

http://www.pponline.co.uk/encyc/0031.htm

thanks for the info. good stuff.