Achilles Tendinopathy and Pilates Reformer


Achilles Tendinopathy and Pilates Reformer : A great match.
Tendinopathy describes a diverse clinical syndrome that can involve any tendon and is associated with pain, swelling and decreased performance. Achilles tendinopathy is a not an inflammatory, but a degenerative condition. Achilles Tendinopathy and Pilates Reformer can help.
The Achilles tendon is known to be one of the most frequently injured tendons in the human body despite its strength. Not only it is the most common tendon to ruptures but, along with the patellar tendon, it happens to be one of the two tendons most frequently damaged as a result of overuse causing impairment.

The Achilles tendon may respond to repetitive overload beyond physiological threshold by either inflammation of its sheath or degeneration of its body, or by a combination of the two. Damage to the tendon can occur even if it is stressed within its physiological limits when the frequent cumulative microtrauma applied do not leave enough time for repair.(Kader et al. 2002).
It was commonly thought that tendinopathy was a disease which involved only tendinous tissue. Recent papers have demonstrated that healthy tendons are not innervated, excluding the presence of mechanoreceptors at the musculo-tendinous junction, while the paratenon is highty vascularised and innervated. Consecuently, the interest has slowly moved from the tendon to the paratenon to explain the pain reported by the patients with tendinopathy.
The paratenon is a thick fibrous layer continuous with the crural fascia. It is well vascularised and innervated and forms a sheath around the tendon similar to a synovial layer but less organised. (Stecco, C. et al 2014).
It also happens to be very rich in hylouronan which acts as lubrication as the tendon glides under the paratenon.Therefore, a well vascularised paratenon is quite crucial for the nutrition of the tendon, and that continuous microtraumas to the paratendinous tissue may cause ischemia and thus a degenerative process of the tendon itself follows.
So if the gastrocnemius (calf muscle) contracts too much, as it happens in overuse syndromes, also the crural fascia and the paratenon are excessively stretched. Stecco, C. et al (2014) found that the paratenon and the crural fascia are thicker in patients with tendinopathy. This is because all connective tissues respond to mechanical loads with an increase of collagen. (see David’s law)
We must first consider that excessive loading during the recovery process may lead to material failure, i.e. partial tears or complete rupture. Additionally, studies show that tendons have a maximum modulus of approximately 800 MPa; thus, any additional loading will not result in a significant increase in modulus strength. Aggressive training of the tendon does not strengthen the structure beyond its baseline mechanical properties; therefore, patients are still as susceptible to tendon overuse and injuries (Wren et al, 2001).
Current literature regarding AT suggests that eccentric exercises are effective in the treatment of pain and the restoration of function. (O’Neil et al, 2015). Exercise is known to induce a statistically significant elevation of collagen synthesis in the patellar tendon by some 1% to 3%, and the rate remains elevated for 2 to 3 days after exercise. During the last 10 years or so, eccentric exercises have emerged as an effective exercise choice for the treatment of tendinopathy (Tumilty et al. 2012).
Pilates is generally known for re balancing your muscles by working on your stabilising muscles (Type I fibers, Slow Oxidative, and Type IIA fibers or Fast Oxidative/Glycolytic); and most contractions are focused on the eccentric control of these muscles. These are the muscles that will help with joint stabilisations and controlled mobilisation.
Likewise, the Pilates reformer can provide controlled ankle strengthening in inversion and eversion ankle sprains by eccentrically loading the muscles in the ankle. Thus, achilles tendinopathy and Pilates Reformer are a great match.
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Achilles Tendinopathy and Pilates Reformer
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Kader, D. et al., 2002. Achilles tendinopathy: some aspects of basic science and clinical management. British journal of sports medicine, 36(4), pp.239–249.
Stecco, C. et al., 2014. The paratendineous tissues: An anatomical study of their role in the pathogenesis of tendinopathy. Surgical and Radiologic Anatomy, 36(6), pp.561–572.
Tumilty, S. et al., 2012. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: a randomized controlled trial. Archives of physical medicine and rehabilitation, 93(5), pp.733–9. Available at:
O’NEILL, S; WATSON, PJ; BARRY, S. WHY ARE ECCENTRIC EXERCISES EFFECTIVE FOR ACHILLES TENDINOPATHY?. International Journal Of Sports Physical Therapy. United States, 10, 4, 552-562, Aug. 2015. ISSN: 2159-2896.
T. Wren, S. Yerby, G. Beaupré, C. Carter (2001). “Mechanical properties of the human Achilles tendon”. Clinical Biomechanics 16: 245–251