Laurie's Blogs.

I read a very interesting paper recently:  Fast, non-eccentrically loaded exercise worsens tendinopathic healing responses in a murine model

Okay, so the whole title gives away the final summation, but bear with me, as it’s interesting never the less!

The Gist of the Study

“Given that few therapeutic interventions have proven superior to controlled exercise alone in the treatment of Achilles tendinopathy, the objective of this study was to advance the understanding of how alterations of speed and grade (flat vs incline vs decline) of exercise-based rehabilitation affect the quality of tendon healing.”

Simplified Methodology

A study took 35 mice, pre-conditioned them to running on a treadmill, and then induced a tendinopathy lesion in their Achilles tendon via a double injection of stuff that makes tendons unhappy (TGF1).  The researchers then divided them into 7 intervention groups consisting of various speeds and angles of treadmill running, as well as one control group! (see Figure below)

After the exercise interventions, they did a histological evaluation, blood serum evaluation, and immunohistochemistry evaluation of various biomarkers for tendon healing / degradation.

Main Findings

1. The results of this study demonstrated that a fast-flat (non-eccentrically loaded) exercise protocol was the most detrimental to tendinopathic healing (histologically). This was substantiated by impaired braking and propelling gait abilities and histopathologic evidence of chondroid metaplasia.
2. Blood serum concentrations of CXM (a collagen X breakdown product) were highest in the cage rest group.
3. All exercise groups showed significantly less serum CXM than mice who did not receive exercise post-injury (cage activity). Within the exercise groups, CXM was lowest in the slow-flat group and highest in the decline groups irrespective of speed.

Why do you care?

Well, rest for tendons is not the right prescription.  Good.  We’ve been saying that for years!

What works best?  Inclines, Declines, & Slow Flat.

Other than rest, what DIDN’T work well for tendon healing?  Fast and flat.  (Think ‘speed’ on a land treadmill or underwater treadmill)

Of the inclination angles, it would seem that INCLINES or SLOW flat allowed for the best stresses on the tendons.  The declines apparently didn’t stress the Achilles tendons as much as in the inclines, and as such were not as useful for Achilles tendon healing as compared to the inclines.

Fascinating.  You don’t need much more interpretations on this study.  Spells it out for you right there!  Of course, there are other exercises you could add in, but this study tells us that adding in some Inclines or Declines make sense with an Achilles tendinopathy.

Have fun out there!

Cheers,  Laurie