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The Role of AchilloTrain® & AchilloTrain® Pro
in the Management of Achilles Tendinopathy
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AchilloTrain and AchilloTrain Pro are elastic ankle supports featuring calcanear and paraAchilean silicon inserts and an ideal anatomical adaptation to rear foot and tibio-tarsal
joint. This is particularly important because the form of the viscoelastic inserts determines
function and efficiency of the massage performed by the support during rehabilitation of
Achilles tendinopathy.
Achilles tendinopathy affects athletes, recreational exercisers and even inactive people.
The pathology is not inflammatory; it is a failed healing response. The source of pain in
tendinopathy could be related to the neurovascular ingrowths seen in the tendon’s
response to injury. The treatment of Achilles tendinopathy is primarily conservative with an
array of effective treatment options now available to the primary care practitioner.
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AcilloTrain and AchilloTrain Pro are indicated in conjunction with all above options and
also, in case of symptoms persistence with surgery, in the post-operative phase
Tendons transmit forces generated from muscle
to bone making joint movements possible.
Mechanical load regulates the collagen synthesis
and determines the structure –with specific
hierarchical association levels – of tendons.
Overload and overuse are factors triggering the
derangement of tendon structure and pain.
Achilles tendonitis is due to microtraumata
resulting from repetitive overloading. Severity is
related to duration and intensity of various
activities.
The onset mechanism of Achilles tendonitis is
similar to that observed in epicondylitis and
patello-femoral pain syndrome.
In all cases the histological evaluation shows:
(1) cellular activation and increase in cell
numbers, (2) increase in ground substance,
(3) collagen disarray and
[1].
(4) neovascularisation .
Proximal to their insertion tendons are relatively
hypovascular. (The blood supply of the calcaneal
tendon. J Bone Joint Surg Br 1989; 71:100-1).
This hypovascularity may predispose the
tendon to hypoxic degeneration.
Pain comes from nociceptive neuropeptide substance P, calcitonin-gene-related-peptide and
glutamate- found in high levels in painful tendons
(but not in normal tendons).
Tendons are enclosed by loose connective
sheaths in continuity with muscle sheaths.
The peritendinous sheath can be also exposed to
inflammatory disease such as tenosynovitis.
The cause of true tendon pain however is nearly
always confined to the Achilles tendon itself.
Many treatment options are offered to patients
with painful tendons.
There are no randomized or prospective studies
that compare different conservative and surgical
treatment regimens.
Conservative treatment is recommended as the
[1] [2]. [3].
.
initial strategy by most authors
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AchilloTrain and AchilloTrain Pro have
been designed to support the management of
Achilles tendon injuries according to the following
[1].
protocol
1. Reduce pain and swelling /edema
(mucoid degeneration)
(a) ice
(b) magnetic field therapy, laser, HVGS
(c) grade I transverse mobilization
(d) medication
2. Reduce load on tendon
(a) rest from aggravating activities until able to
tolerate eccentric exercise program
(b) heel raise
(c) massage therapy
(i) gastrocnemius
(ii) soleus
(d) joint mobilization
(i) subtalar joint
(ii) talocrural joint
(iii) midtarsal joint
3. Regain extensibility
(a) massage therapy
(b) stretching
4. Improve strength of calf and tendon
(a) eccentric strengthening program beginning
as soon as patient can tolerate the
exercise program.
5. Biomechanical assessment and correction of
abnormalities.
Return to activity gradually according to clinical
features while maintaining a program of
stretching / strengthening / icing.
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The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy
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09/02/2010
Product Features
AchilloTrain® Pro
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AchilloTrain Pro is an ankle support featuring
a specially designed viscoelastic anatomical
silicon insert.
The main features of the insert are:
the wing shape, designed to cover the paraAchilean area from the retro-malleolar to the
calf muscle tendon-transition levels;
the longitudinal groove - aimed to center the
insert on the Achilles’ tendon-, allows for the
application of pressure on the target areas;
and the nubs, with a distribution and a profile
allowing for permanent superficial friction
during movement.
The pressure on the insert is exerted by the
three-dimensional fold-free flat knitting fabric.
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•
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A stretch zone in the tibial area,
Compression-reduced borders,
Seamless (but elastic) welding -of the
inserts- and
• Breathable / moisture dissipating
knitting,
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make wearing and removing AchilloTrain Pro
extremely easy and comfortable.
Maximal wearing comfort is necessary to avoid
interferences with nociceptors.
Edema and hematoma reabsorption is improved, by
the elastic massage of the insert, during flexionextension.
AchilloTrain®
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AchilloTrain is an ankle support featuring a
specially designed viscoelastic anatomical
silicon insert and a removable heel wedge.
The last raises the heel (approx. 6mm) in order
to comply with the requirements of point 2 (b)
of the rehabilitation protocol described at
Pag.1.
The integrated -anatomically contouredviscoelastic insert exerts intermittent
compression during movement generated by
the bielastic three-dimensional fold-free flat
knitting fabric of the support.
Comfort is achieved by:
•
•
•
•
A particularly stretchy new knitting
concept,
compression-reduced borders,
seamless (but elastic) welding -of the
inserts- and
breathable / moisture dissipating knitting
Indications
2
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The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy
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Achillodynia (Tendinosis, paratendinitis, bursitis subachillea, [Haglund’s deformity],
Post-op treatment after Achilles tendon ruptures).
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AchilloTrain and AchilloTrain Pro have been
designed to support the management of Achilles
tendinopathy. The classification of tendinopathy
encompasses a variety of histopathologic
changes classified by Puddu et al. as follows:
(1)- acute tendonitis alone;
(2)- chronic tendinosus with acute tendonitis;
(3)- chronic tendinosus alone.
(A classification of Achilles tendon disease. Puddu G;
Ippolito E; Postacchini F;- Am J Sport Med 1976;4:145150.)
Massage therapy - with and /or without heel raise
– is “the approach” common to most rehabilitation
protocols. The goal of this treatment is to reduce
pain and swelling /edema as well as the load on
tendon.
Once pain has subsided, strengthening and
stretching exercises are necessary to promote
the formation of new collagen.
The time to full recovery of Achilles tendinopathy
is normally two to three months. During this
period tendon swelling and paratenonitis are
treated with massages techniques including
sliding the paratenon over the tendon
longitudinally and in a rotatory movement in
[2].
the transverse plane
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AchilloTrain and AchilloTrain Pro support
and continue the soft tissue massage
maintaining this action –during movementlong after the rehabilitation session.
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Further AchilloTrain and AchilloTrain Pro
contribute to pain reduction by two possible
coexisting mechanisms related to their ability
to generate intermittent compression.
The first involves the interaction with the
(neuro) inflammation process.
By reducing edema, at superficial and interfascias tissue levels, compression reduces the
onset of the inflammation cycle (eritema,
edema, tenderness )and pain.
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The second is the result of friction massage of
the affected region when the tissue is under
tension (sustained myofascial tension
treatment of calf muscle thickening) . (CLINICAL
SPORT MEDICINE Peter Brukner; Karim Khan -III
Edition- Ch.28 - Pain in the Achilles Region by Håkan
Alfredson)
Consistent with the “gate control theory” the
skin contact with the support generates tactile
stimulations interfering (with) and reducing
pain perception.
(Pain Mechanism: A New Theory –Melzack R.; Wall P.; Science: 150, 171-9, 1965
AchilloTrain® Pro
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AchilloTrain Pro is indicated when pain is
located (mainly) at mid–tendon level.
Treatment of focal tendon nodules can be best
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treated with AchilloTrain
Pro. Tendon
nodules are lesions of the tendinosis causing
pain and tenderness without much swelling.
The nodules move as the tendon is moved
trough full range in contrast to the lesion of the
paratendon, which remains fixed as tendon
slides. The action of tissue massage produced
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by the insert of AchilloTrain Pro is focused
on the whole length of the tendon.
AchilloTrain®
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AchilloTrain is indicated when pain is located
(mainly) at tendon insertion level.
The effect of the viscoelastic heel pad -inserted
in the calcaneal area of the support- is
important through all three phases of
tendininopathy evolution. The magnitude of
unloading - heel height- necessary to achieve
pain relive remains a very subjective matter.
When tendinopathy treatment has to be started
with a more gradual progression (as for partial
tendon tears) the heel pad insert justify the use
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of AchilloTrain .
The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy
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Conclusion
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AchilloTrain and AchilloTrain Pro have a synergistic effect in the rehabilitation of Achilles
tendinopathy.
Massage and unloading effects, during and after rehabilitation, are valuable adjuncts to the
therapeutic effect of eccentric training.
Though few data support definitive conclusions regarding their effectiveness, elastic supports
are safe and helpful in the management of most musculoskeletal disorders.
Beside reducing pain –“gate control mechanism”-, the compression effect of AchilloTrain
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and AchilloTrain Pro produce friction massage having a beneficial effect on all three
phases of both tendinopathy –as classified by Puddu et al.- and repair:
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Friction stimulates phagocytosis (mobilization of tissue fluids).
•
Friction stimulates fibre orientation in regenerating connective tissue.
•
Friction prevents adhesion formation and ruptures unwanted adhesions.
•
Friction induces a traumatic hyperemia (vasodilatation increased blodflow).
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References
1.
A TREATMENT ALGORITHM FOR
MANAGING ACHILLES TENDINOPATHY:
NEW TREATMENT OPTIONS.
Håkan Alfredson, J Cook - Br J Sports
Med 2007;41:211–216. doi:
10.1136/bjsm.2007.035543
2. CLINICAL SPORT MEDICINE
Peter Brukner; Karim Khan -III EditionCh.28 - Pain in the Achilles Region by
Håkan Alfredson.
3. PRINCIPLE OF REHABILITATION
AFTER CHRONIC TENDON
INJURIES. - Kibler W.B.; Chandler
T.J.; Pace B.K.;- Clin. Sports Med 11,
pp.661-671; 1992-.
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The Role of AchilloTrain & of AchilloTrain Pro in the Management of Achilles Tendinopathy
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