Gender and eccentric training in Achilles mid-portion tendinopathy

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation Science

Background:

• Achilles tendinopathy is a common condition affecting athletes and the general population.
• The role of gender in Achilles tendinopathy and its response to treatment remains unclear.
• Eccentric training is a common treatment for Achilles tendinopathy, but its efficacy may differ between genders.

Purpose of the Study:

• To investigate the gender-specific response of Achilles tendinopathy patients to 12 weeks of eccentric training.
• To compare the effectiveness of eccentric training in reducing pain and improving function between male and female patients.
• To analyze microcirculatory changes in the tendon and paratendon in response to eccentric training, stratified by gender.

Main Methods:

• A cohort study analyzed 63 patients (25 females, 38 males) with mid-portion Achilles tendinopathy.
• Patients underwent 12 weeks of painful eccentric training.
• Outcomes included pain (visual analogue scale), VISA-A score, Foot Ankle Outcome Score (FAOS), and microcirculatory parameters (capillary blood flow, oxygen saturation, venous filling pressures).

Main Results:

• Eccentric training reduced resting pain by 44% in males (P=0.001) and 27% in females (P=0.08).
• VISA-A scores improved significantly more in males (27%) than in females (20%) (P<0.05 for gender difference).
• Males showed improvement in four FAOS items, while females only improved in one (sport). Microcirculation showed greater venous filling pressure reduction in females, with inconclusive blood flow changes.

Conclusions:

• Symptomatic females with Achilles tendinopathy do not benefit as much from 12 weeks of eccentric training as symptomatic males.
• Pain reduction and functional improvements (VISA-A, FAOS) are significantly less pronounced in females compared to males.
• Alternative or supplementary treatment options should be explored for symptomatic females with Achilles tendinopathy.