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PubMed2005

Isokinetic strength and endurance after percutaneous and open surgical repair of Achilles tendon ruptures.

BACKGROUND: Reports on complete spontaneous Achilles tendon ruptures and associated treatment have become more frequent in the literature in the past two decades, as has the request for treatments that enable the finest possible functional recovery. The best available treatment is a matter of considerable controversy in the literature. The purpose of this study was to compare the isokinetic strength and endurance of the plantarflexor muscle-tendon unit in subjects who sustained rupture of the Achilles tendon and underwent either open surgery or closed percutaneous repair of the Achilles tendon. METHODS: Twenty patients (18 males, 2 females) with spontaneous ruptures of the Achilles tendon were included in this study. Ten patients were treated by open surgery, and 10 patients were treated percutaneously. All patients had ruptured their Achilles tendon more than 6 months before the study, and all of the ruptures occurred 3.5 years or less before the day of the testing. All patients underwent an oriented physical examination. An isokinetic Biodex dynamometer (Biodex Medical System, Shirley, NY) was used to measure ankle joint angle, and in plantarflexion to calculate the torque at the ankle joint (Newton/meter), and the average work (jouls) for both maximal power and endurance. Each measurement was compared to the normal ankle. RESULTS: Biodex dynamometer evaluations at 90 deg/sec demonstrated a significant difference of maximal voluntary plantarflexor torque, endurance performance and range of motion at the ankle joint between the involved and uninvolved sides in patients treated by either mode of treatment. Yet, no statistically significant differences were revealed for the parameters mentioned above between the subjects that were treated either percutaneously or by an open surgery. CONCLUSIONS: In functional terms, the biomechanical outcomes of open surgery and percutaneous repair for acute ruptures of the Achilles tendon are both effective.

Achilles Tendon↗
PubMed2005

Effects of a partially supervised training program in subjects over 75 years of age.

BACKGROUND AND AIMS: Partially supervised training programs may be preferable than class-based ones in older subjects because the adherence rate is more likely to be good and they cost less. The main purpose of this investigation was to provide some evidence of the effectiveness of a 4-month partially supervised training program. We compared it with a class-based program focusing on the knee extensor (KE) and ankle plantar flexor (APF) muscles. METHODS: We selected for the study 14 subjects over 75 years of age (75+), age range 75 to 83 years with a mean age of 77.8, and 14 subjects over 65 years of age (65+), age range 65 to 72 years, mean age 66.3 years. They were moderately physically active subjects, free from neurological, cardiovascular, metabolic or inflammatory diseases. The two groups underwent two 4-month training sessions 3 days a week, including: warm-up, aerobics, strength training, cool-down exercises. 65+ subjects underwent a class-based program three times a week. 75+ subjects underwent a partially supervised program consisting of two supervised sessions and one session at home. Strength training was carried out bilaterally with the "Leg Press" and "Sitting Calf" variable-resistance machines (Technogym, Italy). The subjects performed one set of 10 repetitions with a 2-min rest in between. At home, 75+ subjects were instructed to carry out the strength exercises with graded elastic bands (Theraband). Subjects were tested immediately before and after the 4-month training. In addition to weight-lifting ability (1RM), we measured the isometric maximum strength values of KE and APF with a Cybex Norm dynamometer at various angles. RESULTS: Significant baseline differences between 75+ and 65+ were found at all KE angles except 30 degrees and -20 degrees APF. A significantly increased maximum load (1RM) was observed over the 4-month period. The baseline and post-training torque-angle relationships for APF and KE in the two groups showed higher post-training gains in 75+ at all angles except at -20 degrees APF, although a statistically significant difference (p < 0.005) between the groups was only found at 30 degrees KE. CONCLUSION: Our baseline data confirm the decay in torque capacity in subjects aged 75+ compared with 65+. The partially supervised training for 75+ subjects showed better responses in terms of relative strength gain than for 65+ subjects, and it appears effective in counteracting the age-related physiological and functional decay which appears to be particularly evident around that age.

Age Factors↗
PubMed2002

Adapted physical activity in old age: effects of a low-intensity training program on isokinetic power and fatigability.

BACKGROUND AND AIMS: This pilot study measured the effects of an original low-intensity training program, called "posture-balancing-mobility" (PBM), on muscular function. METHODS: Nine non-disabled, elderly (74.3 +/- 6 years) subjects were trained with the PBM technique for 11 weeks (2 sessions per week). Mean power and fatigue index parameters were measured using an isokinetic dynamometer before and after training and compared with those recorded in another group of 9 elderly (71.1 +/- 4.3 years) subjects, who had performed aquatic exercises during the same period and with the same frequency. RESULTS: The mean power of the knee extension muscles increased slightly but significantly on the dominant (15.6%, p<0.05) and non-dominant sides (13.4%, p<0.05) in the PBM group, with no significant fatigue index variation. None of the parameters changed significantly for the aquatic group, and comparison of variations obtained in the two groups showed no significant difference between their respective effects. CONCLUSIONS: Although the results showed slightly enhanced strength production in the PBM group, the low statistical power does not allow conclusions about the impact of this type of training intervention in its current form. Nevertheless, this pilot study provides some indication of the benefits that can be obtained from such an individualized approach. Its efficiency would most likely be improved by further exploration of the minimal threshold of intensity required for strength exercises and by measurement of its effect on functions involving neuromuscular parameters, such as balance or gait.

Aged↗
PubMed2006

[Fatigability evaluation on multiple sclerosis patients by using a hand held dynamometer].

Fatigue is one of the most common disabling symptoms in multiple sclerosis (MS). The aim of this study was to evaluate the fatigability on patients with MS by the application of hand grip isotonic and isometric exercises with dynamometer. As results the fatigability, the isometric strength and time were statistically similar in the control group and in MS. We conclude that although fatigue is a frequent subjective complaint on MS, the fatigability and the recover after exercises seems to be normal.

Adult↗
PubMed2005

The immediate effects of manual massage on power-grip performance after maximal exercise in healthy adults.

OBJECTIVE: Research into the effects of manual massage on physical performance has proved inconclusive, with studies primarily examining the major muscle groups of the lower extremities. Grip performance is essential for object manipulation, as well as for many grip-dependent activities and sports; but there have been no studies to determine the effects of manual massage on immediate grip performance in healthy subjects. The purpose of this study was to assess the effects of using manual massage to improve power-grip performance immediately after maximal exercise in healthy adults. STUDY DESIGN: This was a pretest/post-test study. SETTING: The study took place in a suburban allied health school. SUBJECTS: Fifty-two (52) volunteer massage-school clients, staff, faculty, and students participated. INTERVENTIONS: Subjects randomly received either a 5-minute forearm/hand massage of effleurage and friction (to either the dominant hand or nondominant hand side), 5 minutes of passive shoulder and elbow range of motion, or 5 minutes of nonintervention rest. OUTCOME MEASURES: Power-grip measurements (baseline, postexercise, and postintervention) were performed on both hands using a commercial hand dynamometer. These measurements preceded and followed 3 minutes of maximal exercise using a commercial isometric hand exerciser that produced fatigue to 60% of baseline strength. RESULTS: After 3 minutes of isometric exercise, power grip was consistently fatigued to at least 60% of baseline, with recovery occurring over the next 5 minutes. Statistical analyses involving single-factor repeated-measures analyses of variance (p = 0.05) with Bonferroni a priori tests (p = 0.0083) demonstrated that massage had a greater effect than no massage or than placebo on grip performance after fatigue, especially in the nondominant-hand group. CONCLUSIONS: Manual massage to the forearm and hand after maximal exercise was associated with greater effects than nonmassage on postexercise grip performance. The present data do support the use of a 5-minute manual massage to assist immediate grip performance after fatigue in healthy subjects.

Adult↗
PubMedDate not supplied

Genetic influences and grip strength norms in the NHLBI twin study males aged 59-69.

Maximal grip strength was measured in kilograms using a hand dynamometer on 344 unrelated males between the ages of 59 and 70 participating in the third examination of the NHLBI Twin Study. There was a significant linear decline in mean grip strength over this age range. Mean grip strength and grip strength per kilogram weight are presented for age 59, ages 60-64 and 65-69. Genetic analysis using 127 pairs of identical (MZ) twins and 130 pairs of fraternal (DZ) twins indicated significant genetic effects for absolute grip strength and grip strength per kilogram weight. The largest estimate of heritability (65%) was obtained for grip strength adjusted for significant effects of weight, height, age, and various anthropometric measures of fatness, muscle mass, and frame size.

Age Factors↗
PubMed2004

Acute effects of static stretching on peak torque in women.

The purpose of this study was to examine the effects of static stretching on concentric, isokinetic leg extension peak torque (PT) at 60 and 240 degrees.s(-1) in the stretched and unstretched limbs. The PT of the dominant (stretched) and nondominant (unstretched) leg extensors were measured on a calibrated Cybex 6000 dynamometer. Following the prestretching PT assessments, the dominant leg extensors were stretched using 1 active and 3 passive stretching exercises. After the stretching, PT was reassessed. The results of the statistical analyses indicated that PT decreased following the static stretching in both limbs and at both velocities (60 and 240 degrees.s(-1)). The present findings suggested that the stretching-induced decreases in PT may be related to changes in the mechanical properties of the muscle, such as an altered length-tension relationship, or a central nervous system inhibitory mechanism. Overall, these findings, in conjunction with previous studies, indicated that static stretching impairs maximal force production. Strength and conditioning professionals should consider this before incorporating static stretching in preperformance activities. Future studies are needed to identify the underlying mechanisms that influence the time course of stretching-induced decreases in maximal force production for athletes and nonathletes across the age span.

Adult↗
PubMed1990

Falls in the elderly: Part II, Balance, strength, and flexibility.

The purpose of this study was to determine and compare the balance, muscular strength, and flexibility of two groups of elderly adults: one with a history of falls (HF) and one with no history of falls (NHF). Subjects were 19 men and 36 women. Static and dynamic balance was determined by a one-foot stance balance test and a backwards walking test. Hip, knee, and ankle joint muscular strength were assessed on a Cybex Leg Press Dynamometer. A goniometer was used to determine hip, knee, and ankle joint range of motion (flexibility), ANOVA indicated a significant difference between the two groups for static balance (p less than .001), leg strength (p less than .01), and hip and ankle flexibility (p less than .01). The results suggest that balance, leg strength, and flexibility may be factors contributing to falls in the elderly.

Accidental Falls↗
PubMed2001

Power output of legs during high intensity cycle ergometry: influence of hand grip.

Traditionally, leg cycle ergometry is used to assess the power output of the lower limbs. However, it is suspected that the upper body makes a significant, albeit as yet unknown, contribution to the measured power output, and as such, the lean mass of the whole body should be considered during ergometric assessment. To test this idea, indices of mechanical power output were obtained from 11 subjects during high intensity leg cycle ergometry tests (20 second duration; 75 grams per kilogram total body mass) using two protocols: one with a standard handle-bar grip (with grip) and one with supinated wrists (without-grip). Peak mechanical power, mean mechanical power, fatigue index and total mechanical work values were calculated for each subject during each test and the sample mean differences associated with the two protocols were compared using paired Student t-tests. The with-grip protocol yielded significantly greater peak mechanical power output than the without-grip protocol (886+/-124 W and 815+/-151 W, respectively), suggesting a significant upper body contribution to the maximum power output measured for the legs. As a first step towards quantifying the upper body involvement during leg cycle ergometry, surface electromyography of the forearm musculature was measured in a twelfth subject whilst performing each of the test protocols. During the with-grip ergometer tests, the intensity of electrical activity in the forearm musculature was similar, if not greater than, the intensity of electrical activity recorded for the forearm musculature during 100% maximum voluntary hand grip-dynamometer contractions, suggesting maximum isometric-type forearm muscle contraction during the with-grip leg ergometry tests. These findings suggest that the performance of traditional-style leg cycle ergometry requires a muscular contribution from the whole body. As such, researchers should be mindful of this, both in terms of the allocation of ergometer loads, and in the analysis of blood-borne metabolites.

Adult↗
PubMed1998

Isokinetic eccentric exercise as a model to induce and reproduce pathophysiological alterations related to delayed onset muscle soreness.

Physiological alterations following unaccustomed eccentric exercise in an isokinetic dynamometer of the right m. quadriceps until exhaustion were studied, in order to create a model in which the physiological responses to physiotherapy could be measured. In experiment I (exp. I), seven selected parameters were measured bilaterally in 7 healthy subjects at day 0 as a control value. Then after a standardized bout of eccentric exercise the same parameters were measured daily for the following 7 d (test values). The measured parameters were: the ratio of phosphocreatine to inorganic phosphate (PCr/Pi), the ratio of inorganic phosphate to adenosintriphosphate (Pi/ATP), the ratio of phosphocreatine to adenosintriphosphate (PCr/ATP) (all three ratios measured with 31P-nuclear magnetic resonance spectroscopy), dynamic muscle strength, plasma creatine kinase (CK), degree of pain and "muscle" blood flow rate (133Xenon washout technique). This was repeated in experiment II (exp. II) 6-12 months later in order to study reproducibility. In experiment III (exp. III), the normal fluctuations over 8 d of the seven parameters were measured, without intervention with eccentric exercise in 6 other subjects. All subjects experienced pain, reaching a maximum 48 h after eccentric exercise in both exp. I and II. A systematic effect over time for CK (increasing 278% resp. 308%), muscle strength (decreasing more than 10%), PCr/Pi (decreasing 31% resp. 43%) and Pi/ATP (increasing 55% resp. 99%) was found in both exp. I and II (P < 0.05), but not in exp. III. No significant difference was observed between exp. I and II for CK, blood-flow rate, concentric muscle strength, PCr/Pi, Pi/ATP and PCr/ATP. It is concluded that pathophysiological alterations in m. quadriceps following eccentric exercise can be induced and can be reproduced after an interval of 6 months. Thus, this model can be used to study the effects of physiotherapy.

Adenosine Triphosphate↗
PubMed1997

Relationships between measures of function, strength and walking speed in patients with diabetes and transmetatarsal amputation.

OBJECTIVE: To determine the correlation between strength and functional measures, and the intercorrelation between the functional measures themselves, in a group of subjects with diabetes mellitus (DM) and transmetatarsal amputation (TMA). DESIGN: Correlational study. SETTING: The subjects were tested in the Applied Kinesiology Laboratory of the Program in Physical Therapy at Washington University School of Medicine, St Louis, MO, USA. SUBJECTS: Thirty subjects with DM and TMA (mean age 61.7 +/- 11.3 years) were studied. MAIN OUTCOME MEASURES: Function was measured using the Functional Reach Test (FR), the Physical Performance Test (PPT), the Sickness Impact Profile (SIP), and walking speed (WS) for 15.24 m. Strength measurements were taken using a hand-held dynamometer. RESULTS: Highest correlations were found between hip extension strength and PPT: r = 0.69, FR: r = 0.45, and WS: r = 0.76, between knee extension strength and PPT: r = 0.48, and WS: r = 0.51, between hip flexion strength and PPT: r = 0.51, FR: r = 0.47, and WS: r = 0.59, between knee flexion strength and PPT: r = 0.57, and WS: r = 0.63, and between dorsiflexion strength and PPT: r = 0.49, and WS: r = 0.63. The following intercorrelations between functional measures were significant; PPT and FR: r = 0.66, PPT and SIP: r = -0.54, PPT and WS: r = 0.77, FR and WS: r = 0.54, SIP and WS: r = -0.47. CONCLUSIONS: The relationship between measures of hip and knee muscle strength and function provides some evidence that rehabilitation should focus on strengthening hip and knee extensors and flexors to improve function. The relationships between walking speed and strength, PPT, FR and SIP suggest that the simple measure of walking speed is a useful functional test in the clinic.

Aged↗
PubMedDate not supplied

Shoulder strength, power, and endurance in college tennis players.

Twenty-four college tennis players were tested for bilateral shoulder internal/external rotation strength on a Cybex 340 isokinetic dynamometer; they were positioned supine with the glenohumeral joint abducted to 90 degrees. Subjects produced significantly (P less than 0.01) more torque in internal rotation at 60 and 300 deg/sec in the dominant arm compared to the nondominant arm. Subjects also produced significantly more power in internal rotation at 60 deg/sec in the dominant arm. No significant differences between the dominant and nondominant arms were seen in internal rotation power at 300 deg/sec or in the internal rotation endurance ratio. No significant differences were seen in external rotation on any measurement. By significantly increasing the strength of the dominant shoulder in internal rotation without subsequent strengthening of the external rotators, muscle imbalances may be created in the dominant arm that could possibly affect the tennis player's predisposition to injuries caused by overloading of the shoulder joint. This study suggests that external rotation strengthening exercises should be implemented in tennis conditioning programs to maintain muscle strength balance, and possibly reduce the chance of overload injury.

Adult↗
PubMed1992

The effects of heavy eccentric contractions on serum creatine kinase levels.

Post-exercise serum creatine kinase (CK) has been frequently used to evaluate muscle damage. The purpose of present study was to examine the effects of 45 eccentric contraction on serum creatine kinase levels during laboratory tests. Using a Lido isokinetic dynamometer, thirteen subjects (five distance runners and eight PE students), average age = 24.0 (yrs), height = 172.5 (cm), weight = 66.5 (kg), and percent body fat = 15.3 (%), completed 5 and 40 eccentric contractions at speed of 60 degrees C/s and 120 degrees/s, respectively. Blood sample was drawn before and 18, 42, 66, 90 hours after exercise protocol. Result indicated that PE students have a significant increase in serum CK levels post-exercise 18 hours (p less than 0.05) only. Both groups in absolute muscular strength or corrected strength have found non-significant difference (p greater than 0.05). Resulting findings showed that training effect may be an important factor for CK leakage rather than lean body mass. In the light of results, it is seem safe to say that the exercise protocol for distance runners using by this study would not contribute to severe CK elevations in blood. This testing protocol can be recommended as an appropriate test for students and distance runners with similar fitness level. Due to large variations occurred during CK testing, follow-up study should try to establish baseline serum CK level by repeated enzyme tests.

Adult↗
PubMedDate not supplied

The effect of selenium supplementation on skeletal and cardiac muscle in selenium-depleted patients.

BACKGROUND: The purpose of the present study was to evaluate the effect of sodium selenite on skeletal and cardiac muscular function in patients with severe Se deficiency. METHODS: Skeletal and cardiac muscular function was investigated in 10 selenium depleted patients on long-term home parenteral nutrition because of short bowel syndrome. The following examinations were applied: Skeletal muscle biopsy, muscular force test (Kin-Com dynamometer test), electromyography (EMG) and radionuclide ventriculography. The patients were blindly randomized to intravenous supplementation with selenium 200 micrograms 5 to 7 times per week or placebo for 4 months. Hereafter the examinations were repeated. The patients randomized to placebo received selenium in an open study for a further 4 months and hereafter their skeletal and cardiac function was reevaluated. RESULTS: Plasma selenium increased to normal levels from median .21 mumol/l (range 0-.69) to 1.25 mumol/l (range .9-2.27) following selenium repletion. The muscle biopsies showed only minor abnormalities. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of fiber type 1. The muscle strength of the quadriceps muscle was unchanged after selenium substitution. EMG did not reveal signs of myopathy. The cardiac function was normal and remained unchanged. CONCLUSION: Despite severe selenium depletion ten patients on long term home parenteral nutrition had normal cardiac function, and no clinically significant signs of skeletal myopathy. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of muscle fiber type 1.

Adult↗
PubMed1993

The effect of isometric quadriceps strength training in mid-range for osteoarthritis of the knee.

This case report describes the effect of strengthening the quadriceps of an effused osteoarthritic knee joint of a 53-year-old man isometrically in mid-range. The instruments included an isokinetic dynamometer, a knee scoring inventory, and a visual analog scale. The outcome measures of isometric quadriceps torque and work, clinical status, and pain were recorded before and after the exercise intervention. The exercises were carried out three times per week for a 6-week period with the subject seated on an exercise chair. Following training, quadriceps torque increased, clinical status improved, and pain with walking decreased. Subject to further investigation, isometric training of the quadriceps in mid-range could prove useful for improving the function of persons with painful or effused knees who might otherwise experience muscle inhibition by exercising in the more traditional inner ranges of knee extension.

Exercise Therapy↗
PubMed2003

A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis.

OBJECTIVE: To investigate the therapeutic effects of different muscle-strengthening exercises on the functional status of patients with knee osteoarthritis (OA). METHODS: One hundred thirty-two patients with bilateral knee OA (Altman Grade II) were sequentially divided into 4 random groups (GI to GIV). The patients in group I received isokinetic muscle-strengthening exercise, group II received isotonic muscle-strengthening exercise, group III received isometric muscle-strengthening exercise, and group IV acted as controls. The changes of muscle power of leg flexion and extension were measured with a Kinetic Communicator dynamometer, and patients' functional status was evaluated by visual analogue scale, ambulation speed, and Lequesne index before and after treatment, and at the follow-up 1 year later. RESULTS: The results showed that the patients with OA in each treated group had significant improvement in pain reduction, disability reduction, and in walking speed after treatment and at follow-up when compared with their initial status. Isotonic exercise had the greatest effect on pain reduction after treatment, and fewer participants discontinued the treatment because of exercise knee pain. Isokinetic exercise caused the greatest increase of walking speed and decrease of disability after treatment and at follow-up. The greatest muscle-strength gain in 60 degrees /second angular velocity peak torques was found in the isokinetic and isotonic exercise groups. A significant muscle-strength gain in 180 degrees /second angular velocity peak torques was found only in the isokinetic group after treatment. CONCLUSION AND RELEVANCE: Isotonic exercise is suggested for initial strengthening in patients with OA with exercise knee pain, and isokinetic exercise is suggested for improving joint stability or walking endurance at a later time.

Activities of Daily Living↗
PubMed1993

Changes in torque and electromyographic activity of the quadriceps femoris muscles following isometric training.

BACKGROUND AND PURPOSE: The purpose of this study was to examine the effect of isometric training of the quadriceps femoris muscles, at different joint angles, on torque production and electromyographic (EMG) activity. SUBJECTS: One hundred seven women were randomly assigned to one of four groups. Three groups trained with isometric contractions three times per week at a knee flexion angle of 30, 60, or 90 degrees. The fourth group, which served as a control, did not exercise. METHODS: Isometric torque was measured using a dynamometer, and EMG activity was measured using a multichannel EMG system. Measurements were obtained during maximal isometric contraction of the quadriceps femoris muscles at 15-degree increments from 15 to 105 degrees of knee flexion. Measurements were taken before and after 8 weeks of training. RESULTS: Following isometric exercise, increased torque and EMG activity occurred not only at the angle at which subjects exercised, but also at angles in the range of motion at which exercise did occur. Further analyses indicated that exercising in the lengthened position for the quadriceps femoris muscles (90 degrees of knee flexion) produced increased torque across all angles measured and appeared to be the more effective position for transferring strength and EMG activity to adjacent angles following isometric training as compared with the shorter positions of the muscle (30 degrees and 60 degrees of knee flexion). CONCLUSION AND DISCUSSION: These findings suggest that an efficient method for increasing isometric knee extension torque and EMG activity throughout the entire range of motion is to exercise with the quadriceps femoris muscles in the lengthened position.

Adult↗
PubMed2003

Reliability of isokinetic dynamometry in assessing plantarflexion torque following Achilles tendon rupture.

BACKGROUND: Research investigating the most effective management of Achilles tendon injury has been limited by a lack of reliable outcome measurements. Calf strength may be a valid outcome measure, not only in terms of identifying possible risk factors for reoccurrence of rupture, but also as an indicator of recovery. Isokinetic dynamometry has been suggested as an effective tool for measuring the torque of the calf muscles. Such measurements have demonstrated high reliability for the assessment of calf muscle torque in healthy subjects. However, there are no published data to demonstrate the reliability of isokinetic dynamometry in subjects with pathology in the Achilles tendon. The purpose of this study was to assess the inter- and intraobserver reliability of isokinetic dynamometry for assessing plantarflexion torque following Achilles tendon rupture. METHODS: Two independent observers used the Kin-com Dynamometer to measure the torque of the plantarflexors in 22 subjects 6 months after unilateral rupture of the Achilles tendon. Twelve subjects had been managed operatively and 10 nonoperatively. Subjects were placed in the prone position with the knee extended. Measurements of peak torque, average torque, and total work were made for both concentric and eccentric plantarflexion movements at 60 degrees per second. RESULTS: Intraclass correlation coefficients were used to calculate reliability of measurements both within and between observers. Reliability was slightly greater on the healthy side (0.74-0.92 ICC) in comparison with the injured side (0.74-0.89 ICC). CONCLUSION: The results of this study suggest that isokinetic dynamometry provides a reliable method of measuring the torque of the plantarflexors following rupture of the Achilles tendon, with levels of reliability comparable with those from healthy subjects. The study concludes that this would be a valuable and reliable outcome measure for use in clinical trials.

Achilles Tendon↗