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Int J Sports Med
DOI: 10.1055/a-2617-6942
Orthopedics & Biomechanics

Achilles Tendon Echo Intensity Changes Across a 5-Day Training Cycle in Elite Athletes

Saule Salatkaite Urbone
1   Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania (Ringgold ID: RIN162594)
,
Leonardo Cesanelli
1   Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania (Ringgold ID: RIN162594)
,
Sigitas Kamandulis
1   Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania (Ringgold ID: RIN162594)
,
Danguole Satkunskiene
1   Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania (Ringgold ID: RIN162594)
› Author Affiliations
Supported by: This project has received funding from the Research Council of Lithuania (LMTLT), agreement No S-PD-22-27. Lietuvos Mokslo Taryba No S-PD-22-27
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Abstract

The aim of this study was to determine if a 5-day training cycle in professional sports team athletes caused acute and subacute alterations in Achilles tendon (AT) echo intensity (EI). The study included 24 men and 24 women of football, handball, and volleyball teams from the top national leagues. During their respective competition periods, eight players from each team were monitored in every training session over a 5-day training cycle. It involved monitoring AT EI, cross-sectional area with ultrasound, subjective feelings of fatigue, and perceived exertion throughout the training cycle. The results revealed a significant acute and subacute effect on EI at distal (p<0.001), middle (p<0.001), and proximal (p<0.001) AT locations. The acute effect had a significant impact on the subacute changes in EI at all locations (p<0.001). A significant interaction of athletes' biological sex, the acute effect was only observed in the distal AT (p=0.013). The study revealed a significant decrease in AT EI following team sports training sessions for men and women. A consistently reduced EI of the AT during the 5-day training cycle suggests that repetitive loading likely induces structural changes in the tendon.

Keywords

ultrasound - sports - grayscale - B-mode - Achilles tendon


Publication History

Received: 19 November 2024

Accepted after revision: 20 May 2025

Accepted Manuscript online:
21 May 2025

Article published online:
23 June 2025

© 2025.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Åström M, Gentz CF, Nilsson P. et al. Imaging in chronic achilles tendinopathy: A comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 1996; 25: 615-620
    CrossrefPubMedSearch in Google Scholar
  • 2 Jacobson JA. Fundamentals of Musculoskeletal Ultrasound E-Book: Fundamentals of Musculoskeletal Ultrasound E-Book. Elsevier Health Sciences; 2017
    Search in Google Scholar
  • 3 Khan KM, Cook JL, Bonar F. et al. Histopathology of Common Tendinopathies. Sports Med 1999; 27: 393-408
    CrossrefPubMedSearch in Google Scholar
  • 4 Maffulli N, Kenward MG, Testa V. et al. Clinical Diagnosis of Achilles Tendinopathy With Tendinosis. Clin J Sport Med 2003; 13: 11-15
    CrossrefPubMedSearch in Google Scholar
  • 5 Sunding K, Fahlström M, Werner S. et al. Evaluation of Achilles and patellar tendinopathy with greyscale ultrasound and colour Doppler: Using a four-grade scale. Knee Surg Sports Traumatol Arthrosc 2016; 24: 1988-1996
    CrossrefPubMedSearch in Google Scholar
  • 6 Cushman DM, Petrin Z, Eby S. et al. Ultrasound evaluation of the patellar tendon and Achilles tendon and its association with future pain in distance runners. Phys Sportsmed 2021; 49: 410-419
    CrossrefPubMedSearch in Google Scholar
  • 7 Hullfish TJ, Hagan KL, Casey E. et al. Achilles tendon structure differs between competitive distance runners and nonrunners despite no clinical signs or symptoms of midsubstance tendinopathy. J Appl Physiol (1985) 2018; 125: 453-458
    CrossrefPubMedSearch in Google Scholar
  • 8 Nowak AS, Miro EW, Eby SF. et al. Identification of pre-race ultrasonographic abnormalities of the Achilles tendon and association with future injuries in runners. Phys Sportsmed 2024; 52: 299-303
    CrossrefPubMedSearch in Google Scholar
  • 9 McAuliffe S, McCreesh K, Culloty F. et al. Can ultrasound imaging predict the development of Achilles and patellar tendinopathy? A systematic review and meta-analysis. Br J Sports Med 2016; 50: 1516-1523
    CrossrefPubMedSearch in Google Scholar
  • 10 Chimenti RL, Flemister AS, Tome J. et al. Altered Tendon Characteristics and Mechanical Properties Associated With Insertional Achilles Tendinopathy. J Orthop Sports Phys Ther 2014; 44: 680-689
    CrossrefPubMedSearch in Google Scholar
  • 11 Collinger JL, Fullerton B, Impink BG. et al. Validation of Grayscale-Based Quantitative Ultrasound in Manual Wheelchair Users: Relationship to Established Clinical Measures of Shoulder Pathology. Am J Phys Med Rehabil 2010; 89: 390-400
    CrossrefPubMedSearch in Google Scholar
  • 12 Kuo CY, Lee WN, Fong SSM. et al. Ultrasound Tissue Characteristics of Diabetic Muscles and Tendons: Associations with Strength and Laboratory Blood Tests. Muscles Ligaments Tendons J 2020; 10: 399-407
    CrossrefPubMedSearch in Google Scholar
  • 13 Molina-Payá FJ, Ríos-Díaz J, Carrasco-Martínez F. et al. Infrared Thermography, Intratendon Vascular Resistance, and Echotexture in Athletes with Patellar Tendinopathy: A Cross-Sectional Study. Ultrason Imaging 2023; 45: 47-61
    CrossrefPubMedSearch in Google Scholar
  • 14 Sato Y, Kösters A, Rieder F. et al. Quantitative Analysis of Patellar Tendon After Total Knee Arthroplasty Using Echo Intensity: A Nonrandomized Controlled Trial of Alpine Skiing. J Arthroplasty 2020; 35: 2858-2864
    CrossrefPubMedSearch in Google Scholar
  • 15 Schneebeli A, Visconti L, Cescon C. et al. Tendon morphological changes after a prolonged ski race can be detected by ultrasound echo intensity. J Foot Ankle Res 2020; 13: 34-41
    CrossrefPubMedSearch in Google Scholar
  • 16 Redinger A, Allen SMF, Montgomery SA. et al. Seasonal Achilles Tendon Injury Risk and Musculoskeletal Adaptation in Division I Cross-Country and Track Athletes. Int J Exer Sci Conf Proc 2024; 11: 37
    PubMedSearch in Google Scholar
  • 17 Peter Magnusson S, Hansen M, Langberg H. et al. The adaptability of tendon to loading differs in men and women. Int J Exp Pathol 2007; 88: 237-240
    CrossrefPubMedSearch in Google Scholar
  • 18 Fouré A, Cornu C, McNair PJ. et al. Gender differences in both active and passive parts of the plantar flexors series elastic component stiffness and geometrical parameters of the muscle–tendon complex. J Orthop Res 2012; 30: 707-712
    CrossrefPubMedSearch in Google Scholar
  • 19 Westh E, Kongsgaard M, Bojsen-Moller J. et al. Effect of habitual exercise on the structural and mechanical properties of human tendon, in vivo, in men and women. Scand J Med Sci Sports 2008; 18: 23-30
    CrossrefPubMedSearch in Google Scholar
  • 20 Miller BF, Hansen M, Olesen JL. et al. Tendon collagen synthesis at rest and after exercise in women. J Appl Physiol (1985) 2007; 102: 541-546
    CrossrefPubMedSearch in Google Scholar
  • 21 Astill BD, Katsma MS, Cauthon DJ. et al. Sex-based difference in Achilles peritendinous levels of matrix metalloproteinases and growth factors after acute resistance exercise. J Appl Physiol (1985) 2017; 122: 361-367
    CrossrefPubMedSearch in Google Scholar
  • 22 Borg G, Hassmén P, Lagerström M. Perceived exertion related to heart rate and blood lactate during arm and leg exercise. Eur J Appl Physiol Occup Physiol 1987; 56: 679-685
    CrossrefPubMedSearch in Google Scholar
  • 23 van Melick N, Meddeler BM, Hoogeboom TJ. et al. How to determine leg dominance: The agreement between self-reported and observed performance in healthy adults. PLoS One 2017; 12: e0189876
    CrossrefPubMedSearch in Google Scholar
  • 24 Barfod KW, Riecke AF, Boesen A. et al. Validation of a novel ultrasound measurement of achilles tendon length. Knee Surg Sports Traumatol Arthrosc 2015; 23: 3398-3406
    CrossrefPubMedSearch in Google Scholar
  • 25 Kongsgaard M, Nielsen CH, Hegnsvad S. et al. Mechanical properties of the human Achilles tendon, in vivo. Clin Biomech (Bristol) 2011; 26: 772-77
    CrossrefPubMedSearch in Google Scholar
  • 26 Sarto F, Spörri J, Fitze DP. et al. Implementing Ultrasound Imaging for the Assessment of Muscle and Tendon Properties in Elite Sports: Practical Aspects, Methodological Considerations and Future Directions. Sports Med 2021; 51: 1151-1170
    CrossrefPubMedSearch in Google Scholar
  • 27 Silbernagel KG, Steele R, Manal K. Deficits in heel-rise height and Achilles tendon elongation occur in patients recovering from an Achilles tendon rupture. Am J Sports Med 2012; 40: 1564-1571
    CrossrefPubMedSearch in Google Scholar
  • 28 Lanferdini FJ, Manganelli BF, Lopez P. et al. Echo Intensity Reliability for the Analysis of Different Muscle Areas in Athletes. J Strength Cond Res 2019; 33: 3353-3360
    CrossrefPubMedSearch in Google Scholar
  • 29 Caresio C, Molinari F, Emanuel G. et al. Muscle echo intensity: reliability and conditioning factors. Clin Physiol Funct Imaging 2015; 35: 393-403
    CrossrefPubMedSearch in Google Scholar
  • 30 McLean BD, Coutts AJ, Kelly V. et al. Neuromuscular, Endocrine, and Perceptual Fatigue Responses During Different Length Between-Match Microcycles in Professional Rugby League Players. Int J Sports Physiol Perform 2010; 5: 367-383
    CrossrefPubMedSearch in Google Scholar
  • 31 Bakeman R. Recommended effect size statistics for repeated measures designs. Behav Res Methods 2005; 37: 379-384
    CrossrefPubMedSearch in Google Scholar
  • 32 Hopkins WG, Marshall SW, Batterham AM. et al. Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 2009; 41: 3-13
    CrossrefPubMedSearch in Google Scholar
  • 33 Fritz CO, Morris PE, Richler JJ. Effect size estimates: Current use, calculations, and interpretation. J Exp Psychol Gen 2012; 141: 2-18
    CrossrefPubMedSearch in Google Scholar
  • 34 Merza E, Pearson S, Lichtwark G. et al. Immediate and long-term effects of mechanical loading on Achilles tendon volume: A systematic review and meta-analysis. J Biomech 2021; 118: 110289
    CrossrefPubMedSearch in Google Scholar
  • 35 Edwards WB. Modeling Overuse Injuries in Sport as a Mechanical Fatigue Phenomenon. Exerc Sport Sci Rev 2018; 46: 224-231
    CrossrefPubMedSearch in Google Scholar
  • 36 Obst SJ, Barrett RS, Newsham-West R. Immediate effect of exercise on achilles tendon properties: Systematic review. Med Sci Sports Exerc 2013; 45: 1534-1544
    CrossrefPubMedSearch in Google Scholar
  • 37 Egger A, Berkowitz MJ. Achilles tendon injuries. Curr Rev Musculoskelet Med 2017; 10: 72-80
    CrossrefPubMedSearch in Google Scholar
  • 38 Burgess KE, Graham-Smith P, Pearson SJ. Effect of acute tensile loading on gender-specific tendon structural and mechanical properties. J Orthop Res 2009; 27: 510-516
    CrossrefPubMedSearch in Google Scholar
  • 39 Intziegianni K, Cassel M, Hain G, Mayer F. Gender Differences of Achilles tendon Cross-sectional Area during Loading. Int J Sports Med 2017; 1: E135-E140
    Thieme ConnectPubMedSearch in Google Scholar