BIOKINETICS IN ACHILLES TENDINOPATHY: ESSENTIAL FINDINGS AND CLINICAL APPLICATIONS

Metsavaht, Leonardo; Gonzalez, Felipe F.; Generoso, Talissa Oliveira; Pallone, Lucas Valério; Guadagnin, Eliane Celina; Godoy-Santos, Alexandre Leme; Leporace, Gustavo

doi:10.1590/1413-785220253306e291432

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Review Article/Sports Medicine • Acta Ortop Bras 33 (06) • 2025 • https://doi.org/10.1590/1413-785220253306e291432 linkcopy

BIOKINETICS IN ACHILLES TENDINOPATHY: ESSENTIAL FINDINGS AND CLINICAL APPLICATIONS

BIOCINÉTICA NA TENDINOPATIA DO AQUILES: PRINCIPAIS ACHADOS E APLICAÇÕES CLÍNICAS

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The Achilles tendon, though the strongest in the human body, is the most commonly ruptured and frequently affected by tendinopathy, particularly in athletes. Achilles tendinopathy (AT) impacts approximately 8% of sports participants, with a lifetime incidence of over 50% in runners. Characterized by pain and tenderness, AT significantly compromises quality of life and functional performance. This narrative review explores biomechanical factors contributing to AT, focusing on both kinematic and kinetic parameters and their clinical relevance, providing a review of AT biomechanics literature, nonoperative interventions, and exercises targeting specific biomechanical risks. Studies have linked abnormal motion to AT. Key biomechanical factors include decreased plantar flexion strength, reduced gluteus medius and maximus activity, decreased peak ankle dorsiflexion, altered peak knee flexion, and decreased forward progression of the center of force, which may increase mechanical load and microtrauma, ultimately resulting in tendon damage. The effectiveness of various interventions was examined, emphasizing the integration of specific exercises aimed at addressing distinct biomechanical deficits. Effective management of AT requires addressing strength deficits and biomechanical abnormalities. Traditional rehabilitation protocols focus on strengthening but often neglect critical biomechanical issues. This review highlights the importance of incorporating specific exercises targeting kinematic and kinetic deficiencies. Level of Evidence V; Expert Opinion.

Keywords:
Tendinopathy; Biomechanics; Kinematics; Motion Analysis; Rehabilitation

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Rearfoot Kinematics	– Greater rearfoot inversion at heel strike – Increased peak eversion – Shorter time to maximum eversion – Greater peak eversion velocity during midstance – Controversy in studies, but shod conditions often show increased rearfoot eversion in AT subjects. Some studies find no differences in eversion in barefoot conditions. – Longer duration of rearfoot eversion in some AT patients.
Knee Kinematics	– Conflicting evidence on knee flexion ROM during running – Reduced maximal knee flexion observed in some studies, while others report greater knee flexion during stance. – AT patients often demonstrate altered knee mechanics, potentially linked to pain avoidance or compensatory strategies.
Ankle Kinematics	– Prospective studies report lower peak ankle dorsiflexion in AT patients compared to controls. – Conflicting evidence on whether limited ankle dorsiflexion ROM is associated with AT. – Complex association between passive and active dorsiflexion ROM and AT, suggesting the presence of distinct subgroups.
Hip Kinematics	– Greater contralateral pelvic drop and forward trunk lean in AT patients. – Some studies found no differences in hip kinematics between AT patients and controls.
Kinetic Parameters	– Reduced plantar flexion and dorsiflexion moments at the ankle in AT patients, leading to difficulty in push-off during gait. – Increased knee internal extensor moments during stance. – Altered force distribution across joints as compensatory mechanisms. – Conflicting evidence on ground reaction forces (GRF).
Muscle Strength	– Weaker plantar flexors in AT patients compared to healthy controls. – Reduced maximal, reactive, and explosive strength in the plantar flexors. – Some studies find no significant strength deficits in AT patients. – Reduced knee flexor strength in AT patients, possibly influencing lower limb biomechanics and increasing Achilles tendon stress.
Muscle Activity	– Delayed and reduced gluteus medius and maximus activation during running in AT patients. – Reduced activity of the gastrocnemius and peroneal muscles during running. – Altered triceps surae neuromotor control, with earlier activation of the soleus. – Differences in force-sharing strategies within the triceps surae in AT patients compared to controls.
Foot Strike Patterns	– Midfoot/forefoot strike pattern during running in non-rearfoot strikers is associated with higher Achilles tendon loading. – Barefoot runners (who often use a midfoot strike) experience more Achilles tendon injuries.
Ankle Flexibility	– Limited ankle dorsiflexion passive ROM is associated with AT in some studies. – Other studies report no significant differences in ankle dorsiflexion in AT patients.