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Achilles Tendon Load is Progressively Increased with Reductions in Walking Speed


Medicine & Science in Sports & Exercise: October 2017 - Volume 49 - Issue 10 - p 2001–2008
doi: 10.1249/MSS.0000000000001322
Clinical Sciences

Introduction Achilles tendon rehabilitation protocols commonly recommend a gradual increase in walking speed to progressively intensify tendon loading. This study used transmission-mode ultrasound to evaluate the influence of walking speed on loading of the human Achilles tendon in vivo.

Methods Axial transmission speed of ultrasound was measured in the right Achilles tendon of 33 adults (mean ± SD: age, 29 ± 3 yr; height, 1.725 ± 0.069 m; weight, 71.4 ± 19.9 kg) during unshod, steady-state treadmill walking at three speeds (slow, 0.85 ± 0.12 ms; preferred, 1.10 ± 0.13 m·s−1; fast, 1.35 ± 0.20 m·s−1). Ankle kinematics, spatiotemporal gait parameters and vertical ground reaction force were simultaneously recorded. Statistical comparisons were made using repeated-measures ANOVA models.

Results Increasing walking speed was associated with higher cadence, longer step length, shorter stance duration, greater ankle plantarflexion, higher vertical ground reaction force peaks, and a greater loading rate (P < 0.05). Maximum (F 1,38 = 7.38, P < 0.05) and minimum (F 1,46 = 8.95, P < 0.05) ultrasound transmission velocities in the Achilles tendon were significantly lower (16–23 m·s−1) during the stance but not swing phase of gait, with each increase in walking speed.

Conclusions Despite higher vertical ground reaction forces and greater ankle plantarflexion, increasing walking speed resulted in a reduction in the axial transmission velocity of ultrasound in the Achilles tendon; indicating a speed-dependent reduction in tensile load within the triceps surae muscle–tendon unit during walking. These findings question the rationale for current progressive loading protocols involving the Achilles tendon, in which reduced walking speeds are advocated early in the course of treatment to lower Achilles tendon loads.

1Faculty of Sports and Health Sciences, Technische Universität München, Munich, GERMANY; 2Unite 957, BPLC, INRA, Ecole Nationale Vétérinaire d’Alfort (National Veterinary School of Alfort), University Paris Est, Maisons-Alfort, FRANCE; and 3Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, AUSTRALIA

Address for correspondence: Scott C. Wearing, Ph.D., Institute of Health & Biomedical Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove Qld 4059, Australia; E-mail:

Submitted for publication December 2016.

Accepted for publication May 2017.

© 2017 American College of Sports Medicine