Patellar and Achilles Tendon Stiffness in Elite Soccer Players Assessed Using Myotonometric Measurements

Iver Cristi-Sánchez, Claudia Danes-Daetz, Alejandro Neira, Wilson Ferrada, Roberto Yáñez Díaz, Rony Silvestre Aguirre, Iver Cristi-Sánchez, Claudia Danes-Daetz, Alejandro Neira, Wilson Ferrada, Roberto Yáñez Díaz, Rony Silvestre Aguirre

Abstract

Background:: Tendon overuse injuries are an issue in elite footballers (soccer players) and may affect tendon function. Achilles and patellar tendinopathy are the most frequent pathologies. Tendon stiffness, the relationship between the force applied to a tendon and the displacement exerted, may help represent tendon function. Stiffness is affected by training and pathology. Nevertheless, information regarding this mechanical property is lacking for elite soccer athletes.

Hypothesis:: Achilles and patellar tendon stiffness assessed using myotonometric measurements will be greater in elite soccer athletes than in control participants.

Study design:: Cross-sectional study.

Level of evidence:: Level 4.

Methods:: Forty-nine elite soccer athletes and 49 control participants were evaluated during the 2017 preseason. A handheld device was used to measure Achilles and patellar tendon stiffness. Dominant and nondominant limbs were assessed for both groups.

Results:: A significantly stiffer patellar tendon was found for both the dominant and the nondominant limb in the elite soccer athletes compared with the control group. Nevertheless, no differences were found in Achilles tendon stiffness between groups. When comparing between playing positions in soccer athletes, no significant differences were found for both tendons.

Conclusion:: Greater patellar tendon stiffness may be related to an improvement in force transmission during muscle contraction. On the other hand, it seems that after years of professional training, Achilles tendon stiffness does not change, conserving the storing-releasing function of elastic energy. The nonsignificant differences between positions may be attributable to the years of homogeneous training that the players underwent.

Clinical relevance:: The present study shows another technique for measuring mechanical properties of tendons in soccer athletes that could be used in clinical settings. In the future, this technique may help clinicians choose the best exercise protocol to address impairments in tendon stiffness.

Keywords: Achilles tendon; elite soccer athletes; myotonometric measurements; patellar tendon; soccer; tendon stiffness.

Conflict of interest statement

<?release-delay 12|0>The authors report no potential conflicts of interest in the development and publication of this article.

Figures

Figure 1.
Figure 1.
Obtained filtered acceleration curve. Displacement and velocity curves are obtained by double integrating the acceleration curve. (Reproduced with permission from MyotonPRO User Manual.)
Figure 2.
Figure 2.
Patellar tendon and Achilles tendon assessment. (a) Position of the participant during stiffness assessment of the patellar tendon. Players were relaxed and sat with their knees in 90° of flexion. (b) Position of the participant during stiffness assessment of the Achilles tendon. Players were relaxed and lay on a stretcher with their ankles in neutral position (approximately 90°).
Figure 3.
Figure 3.
Patellar tendon and Achilles tendon stiffness for both groups, football (soccer athlete) and control. Significant intergroup differences (*P < 0.05) can be observed.

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