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      Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

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          Abstract

          Objective

          This study evaluates the intra-rater and inter-rater reliability of the MyotonPRO and its construct validity for the assessment of Achilles tendon stiffness.

          Design

          Reliability and construct validity study.

          Methods

          Forty healthy participants were assessed using the MyotonPRO by two raters on two different occasions. Tendon was evaluated in three different positions (relaxed, 0° plantarflexion and standing) and during different isometric contractions (range 0–3 kg). Reliability was calculated using intraclass correlation coefficient (ICC and 95% CI) standard error of measurement and minimal detectable change. Construct validity was evaluated between the different positions and the different contraction intensities using Friedman test.

          Results

          Intra-rater reliability was very high ICC 2,k 0.87–0.98. The reliability of the 0.5 kg contraction was moderate with an ICC 2,k of 0.59. Inter-rater reliability ranged from high to very high with an ICC 2,k of 0.76–0.86. The reliability of the 0.5 kg, 1 kg contraction and the standing position was moderate with an ICC 2,k of 0.55, 0.54 and 0.56 respectively. Inter-session reliability ranged from high to very high with an ICC 2,k of 0.70–0.89. The reliability of the 0.5 kg contraction was moderate with an ICC 2,k of 0.54. Construct validity was demonstrated between different contraction levels and different positions.

          Conclusion

          MyotonPRO is a reliable tool for the evaluation of Achilles tendon stiffness during different contraction levels and in different positions. Construct validity was supported by changes of tendon stiffness during the explored conditions. MyotonPRO can be implemented, as a ready to use device, in the evaluation of tendon tissue mechanical properties.

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          Most cited references32

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          Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults.

          Sebastian Bohm, Falk Mersmann, Adamantios Arampatzis (2015)
          The present article systematically reviews recent literature on the in vivo adaptation of asymptomatic human tendons following increased chronic mechanical loading, and meta-analyzes the loading conditions, intervention outcomes, as well as methodological aspects.
          Article 0 comments Cited 133 times – based on 0 reviews     Review now
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            Adaptational responses of the human Achilles tendon by modulation of the applied cyclic strain magnitude.

            Adamantios Arampatzis, Kiros Karamanidis, K Albracht (2007)
            Tendons are able to remodel their mechanical and morphological properties in response to mechanical loading. However, there is little information about the effects of controlled modulation in cyclic strain magnitude applied to the tendon on the adaptation of tendon's properties in vivo. The present study investigated whether the magnitude of the mechanical load induced as cyclic strain applied to the Achilles tendon may have a threshold in order to trigger adaptation effects on tendon mechanical and morphological properties. Twenty-one adults (experimental group, N=11; control group, N=10) participated in the study. The participants of the experimental group exercised one leg at low-magnitude tendon strain (2.85+/-0.99%) and the other leg at high-magnitude tendon strain (4.55+/-1.38%) of similar frequency and volume. After 14 weeks of exercise intervention we found a decrease in strain at a given tendon force, an increase in tendon-aponeurosis stiffness and tendon elastic modulus and a region-specific hypertrophy of the Achilles tendon only in the leg exercised at high strain magnitude. These findings provide evidence of the existence of a threshold or set-point at the applied strain magnitude at which the transduction of the mechanical stimulus may influence the tensional homeostasis of the tendons. The results further show that the mechanical load exerted on the Achilles tendon during the low-strain-magnitude exercise is not a sufficient stimulus for triggering further adaptation effects on the Achilles tendon than the stimulus provided by the mechanical load applied during daily activities.
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              Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study.

              Jon Karlsson, Bengt I Eriksson, Karin Gravare-Silbernagel … (2007)
              Achilles tendinopathy is a common overuse injury, especially among athletes involved in activities that include running and jumping. Often an initial period of rest from the pain-provoking activity is recommended. To prospectively evaluate if continued running and jumping during treatment with an Achilles tendon-loading strengthening program has an effect on the outcome. Randomized clinical control trial; Level of evidence, 1. Thirty-eight patients with Achilles tendinopathy were randomly allocated to 2 different treatment groups. The exercise training group (n = 19) was allowed, with the use of a pain-monitoring model, to continue Achilles tendon-loading activity, such as running and jumping, whereas the active rest group (n = 19) had to stop such activities during the first 6 weeks. All patients were rehabilitated according to an identical rehabilitation program. The primary outcome measures were the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S) and the pain level during tendon-loading activity. No significant differences in the rate of improvements were found between the groups. Both groups showed, however, significant (P < .01) improvements, compared with baseline, on the primary outcome measure at all the evaluations. The exercise training group had a mean (standard deviation) VISA-A-S score of 57 (15.8) at baseline and 85 (12.7) at the 12-month follow-up (P < .01). The active rest group had a mean (standard deviation) VISA-A-S score of 57 (15.7) at baseline and 91 (8.2) at the 12-month follow-up (P < .01). No negative effects could be demonstrated from continuing Achilles tendon-loading activity, such as running and jumping, with the use of a pain-monitoring model, during treatment. Our treatment protocol for patients with Achilles tendinopathy, which gradually increases the load on the Achilles tendon and calf muscle, demonstrated significant improvements. A training regimen of continued, pain-monitored, tendon-loading physical activity might therefore represent a valuable option for patients with Achilles tendinopathy.
              Article 0 comments Cited 99 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Sport Exerc Med
                Journal ID (iso-abbrev): BMJ Open Sport Exerc Med
                Journal ID (hwp): bmjosem
                Journal ID (publisher-id): bmjosem
                Title: BMJ Open Sport — Exercise Medicine
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2055-7647
                Publication date Collection: 2020
                Publication date (Electronic): 12 February 2020
                Volume: 6
                Issue: 1
                Electronic Location Identifier: e000726
                Affiliations
                [1 ] departmentRehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care , University of Applied Sciences and Arts of Southern Switzerland , Manno/Landquart, Switzerland
                [2 ] departmentCentre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise Rehabilitation Sciences, College of Life Environmental Sciences , University of Birmingham , Birmingham, UK
                [3 ] departmentUniversity College Physiotherapy , Thim van der Laan AG , Landquart, Switzerland
                Author notes
                [Correspondence to ] Alessandro Schneebeli; alessandro.schneebeli@ 123456supsi.ch
                Author information
                http://orcid.org/0000-0002-8411-2012
                http://orcid.org/0000-0003-1689-6190
                http://orcid.org/0000-0001-7125-5332
                http://orcid.org/0000-0001-8579-0686
                Article
                Publisher ID: bmjsem-2019-000726
                DOI: 10.1136/bmjsem-2019-000726
                PMC ID: 7047478
                PubMed ID: 32153987
                SO-VID: b004da4a-d067-41e8-9e51-e8dc98966098
                Copyright © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date accepted : 24 January 2020
                Categories
                Subject: Original Research
                Subject: 1506
                Custom metadata
                special-feature unlocked

                Keywords: ankle,tendon,achilles
                Data availability:
                Keywords: ankle, tendon, achilles

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