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Abstracts

75 PLANTARFLEXOR MUSCLE POWER DEFICITS IN RUNNERS

WITH ACHILLES TENDINOPATHY
1
Seth O’Neill, 1Paul Watson, 2Simon Barry. 1University of Leicester, UK; 2Coventry
University, UK

10.1136/bjsports-2014-094114.74

Introduction Muscle power of the Plantarflexors has been shown

to be a prospective risk factor for Achilles Tendinopathy (AT).1
Several studies have shown associations between Achilles tendin-
opathy and Plantarflexor power, but little thought has been given
to how the individual muscles of the Triceps Surae are affected.
Aim – Compare the Triceps Surae power of runners with and
without AT.
Method 41 runners with AT and 27 runners without a history of Abstract 75 Figure 2 The peak Plantarflexor power for participants
AT (control group) have participated in this study. Plantarflexor with AT and the control group in knee flexion (Gastrocnemius
muscle power was measured during concentric and eccentric significantly inhibited)
muscle contractions at 90º/sec using an Isokinetic dynamometer.
Testing utilised a knee extended position (both Gastrocnemius REFERENCES
and Soleus) and an 80º knee flexed position (significantly inhibit- Lauber, et al. Physiological reports. 2014;2, doi:10.14814/phy2.12044
ing Gastrocnemius).2,3 Mahieu, et al. Am J Sports Med. 2006;34:226–235
Reid, et al. Physical Therapy in Sport. 2012;13:150–155
Results Independent t tests revealed statistically significant dif-
ferences between healthy controls and participants with AT for
both test speeds and positions (p = 0.004 for concentric 90º/
sec in knee flexion, p ≤ 0.001 for all other test speeds and 76 ECCENTRIC EXERCISES FOR ACHILLES TENDINOPATHY
positions). DO NOT FULLY RESOLVE PLANTARFLEXOR MUSCLE
Discussion This study shows that participants with AT have POWER DEFICITS
weaker Plantarflexors than healthy runners. It also shows that the 1
Seth O’Neill, 1Paul Watson, 2Simon Barry. 1University of Leicester, UK; 2Coventry
deficits in power appear similar whether testing was performed University, UK
with knee extension or flexion, since Gastrocnemius does not
contribute significantly to force generation in knee flexion it 10.1136/bjsports-2014-094114.75
seems feasible that the Soleus is responsible for the majority of
Introduction Our previous work has shown a clear clinical and
observed deficits in both positions.
statistical significant difference in Plantarflexor power between
Pain was not reproduced during testing for any individual and
healthy controls and participants with Achilles tendinopathy
therefore did not limit performance.
(AT), p ≤ 0.004 for all test positions and speeds. This data
It is possible these neuromuscular deficits are due to central
showed that the Soleus is responsible for the majority of the
motor inhibition or potentially pre-existing weakness. Resolution
observed power deficits.
of these muscle deficits may be essential to return to normal
Aim - Determine how an eccentric regime alters Plantarflexor
function, it is unclear whether normal rehabilitation successfully
muscle power.
resolves these deficits.
Method 24 runners with AT completed an eccentric training
Conclusion Weakness of Soleus maybe responsible for the major-
regime for 12 weeks.1 Muscle power was measured at baseline and
ity of the deficits observed in participants with AT. Further work
12 weeks follow up using an Isokinetic dynamometer. Testing uti-
needs to determine how current clinical interventions alter these
lised a knee extended and knee flexed position and concentric and
deficits.

Abstract 75 Figure 1 The peak Plantarflexor power for participants Abstract 76 Figure 1 The peak Plantarflexor power for participants
with AT and the control group in knee extension (both Gastrocnemius with AT and the control group in knee extension (both Gastrocnemius
and Soleus active) and Soleus active) at baseline and post 12 weeks eccentric regime

Br J Sports Med 2014;48(Suppl 2):A1–A76 A49

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Abstracts

Methods 1-Image processing: Normal SDFT were obtained from

different aged horses, wrapped in foil and frozen (-20C). The frozen
SDFT samples were sectioned transversely; the thickness of the slices
varied between 2–3 mm and each section was photographed using a
Canon EOS 5D Mark III camera (100 mm focal length). Dedicated
software (Corel PaintShop Pro X4) was used to convert raw images
into grey scale Tiff images which were then processed through
ImageJ and IMOD to obtain better contrast and create a 3D model
of the macroscopic tendon fascicular structure.
2-Histological scoring: The specimens from three different
regions (proximal, mid metacarpal and distal) of different ages
(from foetal to 20 years old) were fixed in 4% paraformalde-
hyde, pH 7.4, at room temperature and dehydrated overnight.
The specimens were embedded in paraffin and sectioned to 5-µ
m-thick (longitudinally), on polylysine slides and stained with
Haematoxylin and Eosin. A scoring method was developed to
Abstract 76 Figure 2 The peak Plantarflexor power for participants define specific tendon structural features and used to describe
with AT and the control group in knee flexion (significantly inhibiting how these features were altered with age.
Gastrocnemius) at baseline and post 12 weeks eccentric regime Results Fascicles were defined as being delineated by a well-
defined interfascicular septum which is further subdivided into sec-
eccentric speeds of 90º/sec. The control group comprised 27
ondary sub fascicles with a thinner endotenon when they were
healthy runners without AT tested on a single occasion.
measured using ImageJ4 (Figure 1). The numbers of the secondary
Results Paired t tests show significant changes from baseline to
and tertiary fascicles were not constant and they are progressively
post intervention for both test speeds and positions (p = 0.008 –
increased from the proximal to distal regions of the tendon. Fur-
p < 0.001). After the intervention there were still significant dif-
thermore, specific fascicles either terminated or branched progres-
ferences between healthy controls and the AT group for both test
sively from the proximal to distal region through the tendon
speeds in knee extension (p = 0.048 – p < 0.001) but only
(Figure 2). The tissue histology parameters including fascicular
eccentric power differed in the flexed knee position (p = 0.26
angulation, interfascicular thickness and the cellular morphology
for concentric and 0.026 for eccentric).
were found to be altered with age.
Discussion This is the first study to compare Plantarflexor
power pre and post intervention between participants with AT
and healthy controls. The eccentric regime significantly improved
Plantarflexor power for the tested parameters, however the
regime did not fully resolve the deficits in muscle function.
The concentric deficits vary markedly between test positions,
since they are greatest in knee extension we may assume Gastro-
cnemius is responsible and not fully rehabilitated.2 The eccentric
deficits are similar in both knee extension and flexion and it may
be that Soleus was not fully rehabilitated with the intervention.
These residual deficits in muscle power may explain why pre-
vious injury is a risk factor for further tendinopathy.
Conclusion A 12 week eccentric protocol does not completely
resolve muscle deficits associated with AT.

REFERENCES
Alfredson, et al. AJSM. 1998;26:360–366
Lauber, et al. Physiological reports. 2014;2, doi1 0.14814/phy2.12044
Abstract 77 Figure 1 3D view of the proximal part of SDFT, left
forelimb, 6 year old processed through ImageJ showing different sized
and shaped fascicles
77 THREE DIMENSIONAL AND HISTOLOGICAL STUDY OF
THE EQUINE SUPERFICIAL DIGITAL FLEXOR TENDON
Othman Ali, Peter Clegg, Eithne Comerford, Elizabeth Canty-Laird. Department of
Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool,
Leahurst Campus, Neston, Cheshire. CH64 7TE, UK

10.1136/bjsports-2014-094114.76

Introduction The equine superficial digital flexor tendon (SDFT)

is a complex hierarchal structure that transmits force from muscle
to bone and stores energy by its stretching and recoiling func-
tion1,2,3. The aim of this study was to describe the three-dimen-
sional (3D) anatomy of this tendon and further to evaluate its
histological architecture: specifically to determine the organisa- Abstract 77 Figure 2 3D reconstruction of the mid metacarpal region
tion of the individual sub-units (fascicles) and how this may vary of the SDFT, 12 years old, created using IMOD, each colour represents
between individuals and during ageing. individual fascicle

A50 Br J Sports Med 2014;48(Suppl 2):A1–A76

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76 Eccentric Exercises For Achilles Tendinopathy Do

Not Fully Resolve Plantarflexor Muscle Power Deficits
Seth O'Neill, Paul Watson and Simon Barry

Br J Sports Med 2014 48: A49-A50

doi: 10.1136/bjsports-2014-094114.75

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