Elsevier

Manual Therapy

Volume 15, Issue 1, February 2010, Pages 37-42
Manual Therapy

Original Article
Ultrasonographically detected changes in Achilles tendons and self reported symptoms in elite gymnasts compared with controls – An observational study

https://doi.org/10.1016/j.math.2009.05.008Get rights and content

Abstract

There are no published data on the prevalence of Achilles tendinopathy in gymnasts. 40 elite gymnasts and 41 controls of mean (SD) age 16.3 (2.1) years had bilateral AT thickness (at 3 points along the tendon in longitudinal and transverse views) and abnormality measured using ultrasound (US). Data on a history of AT symptoms were gathered using a questionnaire.

Among female gymnasts there were 17.5% of Achilles tendons (ATs) with current symptoms, compared with none of the controls (χ2 = 6.2, p < 0.05). Similarly, among male gymnasts 12.5% of ATs were currently symptomatic, compared with none of the controls (χ2 = 6.62, p < 0.01). US scanning showed gymnasts had significantly (p < 0.001 to p < 0.05) thicker ATs for 5 out of 6 measures, and had more irregular longitudinal AT thickness (p < 0.05). 32.5% of female gymnast ATs had US abnormalities, compared with 6.2% of female control ATs (χ2 = 7.43, p < 0.01). Similarly, 35% of male gymnast ATs had US abnormalities, compared with 4% of male control ATs (χ2 = 7.43, p = 0 < 01). There was no relationship between AT symptoms and US-detected abnormalities in the gymnasts. Achilles tendinopathy is a common problem in gymnasts. The poor correlation between signs and symptoms suggests pathology is not always symptomatic.

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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