Mafi (2001) — Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis.

Superior Short-Term Results with Eccentric Calf Muscle Training Compared to Concentric Training in a Randomized Prospective Multicenter Study on Patients with Chronic Achilles Tendinosis.

·Knee Surg Sports Traumatol Arthrosc·2001·461 citations·Foot & Ankle

Randomized prospective multicenter RCT comparing eccentric versus concentric calf muscle training over 12 weeks in 44 patients with chronic mid-portion Achilles tendinosis (2–6 cm from calcaneal insertion), all of whom had failed prior conservative measures and were surgical candidates. Outcome measures: VAS pain during activity and patient satisfaction/return to prior activity level.

Study Snapshot

Design

Multicenter RCT

Blinding: Open-label

Setting: 2 centers, Sundsvall and Umeå

Objective

Whether eccentric calf training outperforms concentric training in chronic Achilles tendinosis

Outcome(s)

Patient satisfaction and return to prior activity level at 12 weeks

Subjects

44 patients, 22 per group

22Eccentric calf muscle training, daily 12 weeks
22Concentric calf muscle training, daily 12 weeks

Inclusion

Chronic Achilles tendinosis, 2–6 cm level
Painful tendon during activity

Follow-up

12 weeks

Statistics

Visual analogue scaleChi-square or Fisher's exact test

Key Findings

82% of eccentric-trained patients (18/22) were satisfied and returned to prior activity at 12 weeks vs. 36% of concentric-trained patients (8/22) — a significant difference (P<0.002)
Eccentric responders saw mean VAS pain drop from 69 → 12; concentric responders from 63 → 9. But only 8 of 22 concentric patients reached that threshold
Protocol: 3×15 reps of two exercises (knee straight + knee bent) twice daily, 7 days/week, 12 weeks, with progressive loading via backpack or weight machine. Performed through mild pain
43% of patients were non-athletes (walking only), questioning the pure overuse model for Achilles tendinosis
Biopsy literature cited confirms absence of inflammatory cells in tendinosis; NSAIDs shown equivalent to placebo in a prior RCT. Reinforcing rehabilitation over anti-inflammatory treatment

Clinical Relevance

When you see a patient with chronic mid-portion Achilles tendinosis (pain and ultrasound-confirmed tendon widening at 2–6 cm from insertion) who has failed rest and NSAIDs, prescribe the Alfredson eccentric protocol — 3×15 reps twice daily for 12 weeks with progressive loading.

Before considering surgery; 82% of patients in this RCT avoided the operating room.

Core

Superior Short-Term Results with Eccentric Calf Muscle Training Compared to Concentric Training in a Randomized Prospective Multicenter Study on Patients with Chronic Achilles Tendinosis.

Mafi, Alfredson, et al.·Knee Surg Sports Traumatol Arthrosc·2001·461 citations·Foot & Ankle

Superior Short-Term Results with Eccentric Calf Muscle Training Compared to Concentric Training in a Randomized Prospective Multicenter Study on Patients with Chronic Achilles Tendinosis.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Superior Short-Term Results with Eccentric Calf Muscle Training Compared to Concentric Training in a Randomized Prospective Multicenter Study on Patients with Chronic Achilles Tendinosis.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Superior Short-Term Results with Eccentric Calf Muscle Training Compared to Concentric Training in a Randomized Prospective Multicenter Study on Patients with Chronic Achilles Tendinosis.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Superior Short-Term Results with Eccentric Calf Muscle Training Compared to Concentric Training in a Randomized Prospective Multicenter Study on Patients with Chronic Achilles Tendinosis.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles