Achilles Subtendons Stiffness Differ in People with and without Achilles Tendinopathy

ABSTRACT Purpose Previous work showed altered mechanical properties of the Achilles tendon in the presence of tendinopathy, considering the Achilles tendon as a homogeneous structure with the gastrocnemius medialis (GM) subtendon representative of it. However, the Achilles tendon consists of three semi-independent structures: the GM, gastrocnemius lateralis (GL) and soleus (SOL) subtendons, each independently pulled by their respective muscle. The aim of this study was (i) to compare the mechanical properties of the different Achilles subtendons in humans in vivo by considering the force of each muscle within the triceps surae group and (ii) to determine whether the loss of stiffness in the presence of tendinopathy is specific to individual subtendons. We hypothesized that (i) stiffness would differ between subtendons in healthy participants and that (ii) the loss of stiffness in people with Achilles tendinopathy compared to healthy controls would not affect the three subtendons identically. Methods Fourteen participants with tendinopathy and 14 controls performed ramped isometric plantarflexions. Simultaneously, the elongation of the three subtendons was recorded, and an estimate of the force pulling on each was made (from muscle activation and volume). Stiffness was calculated from the individual muscle index of force-subtendon elongation relationships. Results Results showed that regardless of the group, SOL stiffness was significantly higher than stiffness of both gastrocnemii (muscle effect: p < 0.001). A muscle x group interaction showed specific loss of stiffness of GL in Achilles tendinopathy compared to controls (p = 0.029, d = 1.3), with no between-group difference for GM or SOL (both p > 0.925, d = 0.3). Conclusions This study supports the hypothesis that the biomechanical properties of the Achilles tendon differ between subtendons and further shows that the loss of stiffness in Achilles tendinopathy is specific to the GL subtendon.