eccentric training regimine increases collagen synthesis in injured achilles tendons

any comments?

I came across that also. I think it makes sense. I am pretty sure this was one of the mechanisms proposed in the first place, when Alfredson's group found eccentrics to be so effective a few years back. Some of the original thoughts were increased collagen synthesis (which this group found), helping to align collagen fibers in parallel properly when they are regenerated, and also squeezing out fluids associated with inflammation.

Now, with hard evidence that it collagen synthesis is itself the mechanism, that adds support to why eccentrics work so well for mid-tendon tendinosis, but not so much for insertional (as the tissue at the insertion is a lot different).

I like how they compared to healthy tendon as well. Since healthy tendon had no change in collagen synthesis, this implies tha eccentric training may not be used as a preventative measure for Achilles tendinosis based on improving the tendon itself. That said, it is still possible that preventative eccentric training may be used to strengthen the gastrox and soleus muscles, so that the tendon is potentially less likely to be put into danger from weak calf muscles. However, this is assuming we don't know if tendinosis is a primary injury or secondary to tight/weak calf muscles with each case.

this stuff works

Thanks for the additional insight Doc. Somehow this model for recovery makes me feel better about the program than the suggestion that the raises/drops perminantly stretch the tendon. I'm 2 months into the program right now and feeling somewhat though not 100% better. Hopefully in the next 4 weeks the tendon will heal to the point that I can return to full training without pain.

Your idea that the program may not work as a preventitive program also seems to me an interesting implication of this study.

I really hope so. This is a really disappointing time for me to have such a serious injury. I got hurt when I was just on the cusp of fulfilling some of the ambitious goals that I have set for myself. (I was coming of off 3 really big PRs.) This can be such a cruel sport.

Eccentric calf raises are often prescribed by physios for achilles tendonitis. I swear by them

sorry for my stupidy but what are eccentric calf raises?

They are actually more like heel drops. This website has some photos of how to do them:

http://www.nismat.org/ptcor/eccentric_achilles

How long have you been out? Have you tried running? This is so frustrating! It's hard to be positive when it feels like with rest the injury is getting worse if anything.

I've been out for 5 months now. I think the fact that I kept on trying to resume training too early has greatly prolonged the injury. Now I am just cross training and doing a lot of strengthening stuff including the eccentric raises twice a day and elastic band excercizes. I'm done trying to salvage a road racing/XC season because I have realized that I am putting my entire career at risk. Be careful with this injury and do not try to come back too soon.

five months, geez I feel bad for you. I don't understand this injury because the only time I ever felt it, I took two days off and was fine. I have been out three weeks and Tried jogging once a week and it feels worse if anything. thanks and I hope you can get back soon. i did a search and saw some people have tried dsmo, have you? do you still ice?

oh what have you been doing for cross training?

thanks

I have personal experience with my own injuries with this also. I was out for a while (forget exactly, but at least 8 months of no running) and had tried everything, and eccentrics worked for me. I have also helped a few others with them - generally they work really well. In fact, less than 8 months after starting them, not only was I recovered, but I set new PR's at every distance. My previous PR's were set 5 years earlier, so this was a really big deal to me.

Heavy is the way to go. An eccentric contraction can produce more force than an isometric or concentric contraction. This puts the greatest load on the tendon, hence the greatest stimulus for the Achilles to resynthesize collagen. Slow controlled heavy movements put stress on the tendon and help it to regenerate, and when done correctly, the regeneration exceeds the breakdown. Running through it puts a different type of stress on it (high repetition, quick motions) which usually result in more/equal degeneration than regeneration.

Do them often - twice per day if you can. Two to three sets, varied with rep ranges anywhere from 5-15... just use enough weight that you really can't do an up (concentric) motion with... So lift up with both legs, and then SLOWLY (at least 2 sec) drop with the injured leg. Try to go below parallel.

The other thing to consider is doing them standing and seated. For me personally, standing eccentric exercises seemed to help a little, but the seated were amazing. Within three weeks I was running again nearly pain free. The gastrocnemius and soleus muscles both control ankle plantarflexion standing, but only the soleus does sitting, and in my case, I think my soleus was weak. Everybody is different.

I was putting together a website, which has been on hold for a while, and started putting up some Achilles info. It is by no means complete, but may have some useful information on it. Hopefully in the next few months I can finish the site up and have a more detailed explanation of everything up there. Let me know if you have questions. Follow the link below and click on "Injury Resources."

Good luck and let me know any questions you have.

I bike and pool run. Some people have suggested that biking may hurt the tendon, but this does not seem to be my experience with it.

Are the seated raises the same as the "bent leg" eccentric drops? I currently do three sets of straight knee and three sets of bent leg ecc. raises twice a day. What you are saying also makes me think that I should up the weight on my back (I currently do them with 40lbs) and do fewer reps/sets.

Oh yes, and thanks again for all of the good information. Your website doesn't really have anything that I haven't seen on achilles tendon injuries (I have been pretty obcessed with this injury for the past 5 months for obvious reasons), but it does provide an excellent collection of the existing information on this injury.

Thanks - I spent a while gathering information about it from a scientific/medical perspective, and then tried to condense it all into one text. Eventually it will have more text, photos, scientific references, etc. to really be a top source.

The standing bent-legged raises you are doing will help. I do recommend the seated ones though because they basically take the gastrocnemius out of the equation. Everybody is different, and some will respond better to standing, some seated, some a mix, but I definitely recommend you try it.

Be sure to lightly warm-up with some easier sets before you hit the heavier eccentrics. The whole key is slow and controlled, and try to do them at least daily.

owen Anderson, who is frequently lambasted on this board has been advocating these types of exercises for years.

I guess I don't understand exactly how to do the seated raises. Can anyone help?