Original ArticleUltrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls – An observational study
Introduction
Achilles tendinopathy is a common complaint in sportspeople, and is associated with tendon pathology. It may lead to impaired performance (Adirim and Cheng, 2003) and the temporary or even permanent cessation of training or competition (Fernandez-Palazzi et al., 1990). Gymnasts may be susceptible to Achilles tendon (AT) pathology due to the significant plantarflexion loading characteristic of this sport. Despite this, and studies showing the high rate of acute traumatic injuries in gymnasts (Singh et al., 2008), there have been no studies to our knowledge assessing the existence of Achilles tendinopathy symptoms in gymnasts.
Furthermore, AT pathology in this group has not been previously investigated using US imaging, a reliable, sensitive and safe method (Maffulli et al., 1987, Harris and Peduto, 2006). Ultrasound (US) investigations may be potentially important because the sonographic tendinopathy signs of hypoechoic areas, focal thickening, paratenon blurring and neovascularisation (Maffulli et al., 1987, Astrom et al., 1996, Harris and Peduto, 2006) have been shown to precede symptoms in other sports (Cook et al., 2000b, Fredberg and Bolvig, 2002, Fredberg et al., 2008). If asymptomatic US signs are found to exist in gymnasts this would suggest a need for a further longitudinal study to assess the association between such asymptomatic signs and later symptoms. In turn, this might endorse future US screening programmes to identify those at risk of developing Achilles tendinopathy symptoms or rupture (Fredberg and Bolvig, 2002).
The primary aim of this study was to compare gymnasts and age-matched controls in terms of symptoms and US findings. Secondary aims were to investigate relationships between US abnormalities and symptom history in gymnasts.
Section snippets
Subjects
All artistic gymnasts in the British squad, and national level tumblers training under the national coach, were invited to take part. Control subjects were recruited from two local schools and a university. The only exclusion criterion for both groups was age less than 12 years. Current or previous gymnastics training was an exclusion criterion for controls. The study was approved by Queen Mary University of London Research Ethics Committee. Sample size calculation showed the need for 80 ATs in
Subjects
41 controls and 40 elite gymnasts (29 artistic gymnasts and 11 tumblers) participated. The control group consisted of a greater proportion of males than the gymnast group (Table 1), and so gender was added as a co-factor to the GLM univariate analysis models. The groups were matched for age but differed in height, weight and training time (Table 1). Height and weight correlated closely (r = 0.87) and so only height was added as a covariate for the GLM univariate analysis models.
Validation study
There was good
Discussion
This study is the first to suggest that AT symptoms are more prevalent in gymnasts than the general population. The point prevalence rates of 12.5% and 17.5% for male and female gymnasts are higher than the 9% prevalence reported in dancers and the 11% prevalence in runners (Kader et al., 2005). This suggests that gymnastic coaching and medical teams need to be vigilant about the possibility of this condition developing, and to ensure that they are fully aware of the evidence-based preventative
Conclusion
This is the first study of its kind to investigate Achilles pathology in young gymnasts, showing that gymnasts have significantly more symptoms of Achilles pathology than age-matched controls. Gymnasts also have significantly thicker ATs, and more evidence of pathological changes on US scanning.
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