Properties Of Achilles Tendon Research Articles

Paper 259: The Mechanical Behavior of the Human Achilles Tendon In Vivo is Altered by Estrogen Levels

IntroductionWhilst estrogen fluctuations have been implicated in the soft tissue injury gender-bias due to the hormones effect on the viscoelastic properties of the musculotendinous unit (Eiling et al., 2007), the isolated effect of estrogen on the mechanical behaviour of human tendon in vivo is unknown. Therefore, the purpose of this study was to elucidate the effect of circulating levels of estrogen on the strain properties of the human Achilles tendon in vivo.

Achilles Tendon Mechanical Properties After Both Prolonged Continuous Running and Prolonged Intermittent Shuttle Running in Cricket Batting

Effects of prolonged running on Achilles tendon properties were assessed after a 60 min treadmill run and 140 min intermittent shuttle running (simulated cricket batting innings). Before and after exercise, 11 participants performed ramp-up plantar flexions to maximum-voluntary-contraction before gradual relaxation. Muscle-tendon-junction displacement was measured with ultrasonography. Tendon force was estimated using dynamometry and a musculoskeletal model. Gradients of the ramp-up force-displacement curves fitted between 0-40% and 50-90% of the preexercise maximal force determined stiffness in the low- and high-force-range, respectively. Hysteresis was determined using the ramp-up and relaxation force-displacement curves and elastic energy storage from the area under the ramp-up curve. In simulated batting, correlations between tendon properties and shuttle times were also assessed. After both protocols, Achilles tendon force decreased (4% to 5%, P < .050), but there were no changes in stiffness, hysteresis, or elastic energy. In simulated batting, Achilles tendon force and stiffness were both correlated to mean turn and mean sprint times (r = -0.719 to -0.830, P < .050). Neither protocol resulted in fatigue-related changes in tendon properties, but higher tendon stiffness and plantar flexion force were related to faster turn and sprint times, possibly by improving force transmission and control of movement when decelerating and accelerating.

Medial gastrocnemius muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic cerebral palsy

Individuals with spastic cerebral palsy (CP) typically experience muscle weakness. The mechanisms responsible for muscle weakness in spastic CP are complex and may be influenced by the intrinsic mechanical properties of the muscle and tendon. The purpose of this study was to investigate the medial gastrocnemius (MG) muscle fascicle active torque-length and Achilles tendon properties in young adults with spastic CP. Nine relatively high functioning young adults with spastic CP (GMFCS I, 17±2 years) and 10 typically developing individuals (18±2 years) participated in the study. Active MG torque-length and Achilles tendon properties were assessed under controlled conditions on a dynamometer. EMG was recorded from leg muscles and ultrasound was used to measure MG fascicle length and Achilles tendon length during maximal isometric contractions at five ankle angles throughout the available range of motion and during passive rotations imposed by the dynamometer. Compared to the typically developing group, the spastic CP group had 33% lower active ankle plantarflexion torque across the available range of ankle joint motion, partially explained by 37% smaller MG muscle and 4% greater antagonistic co-contraction. The Achilles tendon slack length was also 10% longer in the spastic CP group. This study confirms young adults with mild spastic CP have altered muscle–tendon mechanical properties. The adaptation of a longer Achilles tendon may facilitate a greater storage and recovery of elastic energy and partially compensate for decreased force and work production by the small muscles of the triceps surae during activities such as locomotion.

Effects of tendon viscoelasticity in Achilles tendinosis on explosive performance and clinical severity in athletes

The aim was to compare viscoelastic properties of Achilles tendons between legs in elite athletes with unilateral tendinosis, and to investigate relationships between the properties and explosive performance and clinical severity. Seventeen male athletes (mean ± standard deviation age, 27.3 ± 2.0 years) who had unilateral, chronic middle-portion tendinopathy of the Achilles tendon were assessed by the Victorian Institute of Sport Assessment questionnaire, measurements of tendon viscoelastic properties, voluntary electromechanical delay (EMD), normalized rate of force development (RFD), and one-leg hopping distance. Compared with the non-injured leg, the tendinopathic leg showed reduced tendon stiffness (-19.2%. P < 0.001), greater mechanical hysteresis (+21.2%, P = 0.004), lower elastic energy storage and release (-14.2%, P = 0.002 and -19.1%, P < 0.001), lower normalized RFD at one-fourth (-16.3%, P = 0.02), 2/4 (-17.3%, P = 0.006), and three-fourths maximal voluntary contraction (-13.7%, P = 0.02), longer soleus and medial gastrocnemius voluntary EMD (+26.9%, P = 0.009 and +24.0%, P = 0.004), and shorter hopping distances (-34.1%, P < 0.001). Tendon stiffness was correlated with normalized RFD, voluntary EMD in the medial gastrocnemius, and hopping distances (r ranged from -0.35 to 0.64, P < 0.05). Hysteresis was correlated to the soleus voluntary EMD and hopping distances (r = 0.42 and -0.39, P < 0.05). We concluded that altered tendon viscoelastic properties in Achilles tendinosis affect explosive performance in athletes.

Low‐level laser therapy in collagenase‐induced Achilles tendinitis in rats: Analyses of biochemical and biomechanical aspects

NSAIDs are widely prescribed and used over the years to treat tendon injuries despite its well-known long-term side effects. In the last years several animal and human trials have shown that low-level laser therapy (LLLT) presents modulatory effects on inflammatory markers, however the mechanisms involved are not fully understood. The aim of this study was to evaluate the short-term effects of LLLT or sodium diclofenac treatments on biochemical markers and biomechanical properties of inflamed Achilles tendons. Wistar rats Achilles tendons (n = 6/group) were injected with saline (control) or collagenase at peritendinous area of Achilles tendons. After 1 h animals were treated with two different doses of LLLT (810 nm, 1 and 3 J) at the sites of the injections, or with intramuscular sodium diclofenac. Regarding biochemical analyses, LLLT significantly decreased (p < 0.05) COX-2, TNF-α, MMP-3, MMP-9, and MMP-13 gene expression, as well as prostaglandin E(2) (PGE(2) ) production when compared to collagenase group. Interestingly, diclofenac treatment only decreased PGE(2) levels. Biomechanical properties were preserved in the laser-treated groups when compared to collagenase and diclofenac groups. We conclude that LLLT was able to reduce tendon inflammation and to preserve tendon resistance and elasticity.

Tendons from Non-diabetic Humans and Rats Harbor a Population of Insulin-producing, Pancreatic Beta Cell-like Cells

Diabetes mellitus is a risk factor for various types of tendon disorders. The mechanisms underlying diabetes associated tendinopathies remain unclear, but typically, systemic factors related to high blood glucose levels are thought to be causally involved. We hypothesize that tendon immanent cells might be directly involved in diabetic tendinopathy. We therefore analyzed human and rat tendons by immunohistochemistry, laser capture microdissection, and single cell PCR for pancreatic β-cell associated markers. Moreover, we examined the short term effects of a single injection of streptozotocin, a toxin for GLUT2 expressing cells, in rats on insulin expression of tendon cells, and on the biomechanical properties of Achilles tendons. Tendon cells, both in the perivascular area and in the dense collagenous tissue express insulin and Glut2 on both protein and mRNA levels. In addition, glucagon and PDX-1 are present in tendon cells. Intraperitoneal injection of streptozotocin caused a loss of insulin and insulin mRNA in rat Achilles tendons after only 5 days, accompanied by a 40% reduction of mechanical strength. In summary, a so far unrecognized, extrapancreatic, insulin-producing cell type, possibly playing a major role in the pathophysiology of diabetic tendinopathy is described. In view of these data, novel strategies in tendon repair may be considered. The potential of the described cells as a tool for treating diabetes needs to be addressed by further studies.

Aerobic physical training restores biomechanical properties of Achilles tendon in rats chemically induced to diabetes mellitus

The aim of this study is to evaluate if the application of a moderate aerobic exercise protocol reverses the damage caused by diabetes on the mechanical properties of the Achilles tendon. MethodsForty-four rats were divided randomly into four groups as follows: Sedentary Control Group-SCG, Sedentary Diabetic Group-SDG, Trained Control Group-TCG and Trained Diabetic Group-TDG, the trained groups were submitted to a protocol of moderate physical training on a continuous treadmill. For mechanical testing the tendons were fixed in a conventional mechanical testing machine and pulled to the point of failure of the specimen, the cell load of 500N. The parameters were: Elastic Modulus (MPa), Stress Maximum Strength (MPa), Strain Specific Maximum Force (mm), Energy / Tendon Area (N.mm/mm2) and Cross-sectional Area (mm2). ResultsThe evaluation of the biomechanical properties of the Achilles tendon of the SDG indicated that the elastic modulus (MPa) is decreased when compared to the TDG and the other groups (p<0.01). However, the specific deformation (%), the deformation at maximum force (mm), and energy / tendon area (N.mm/mm2) of the SDG were significantly higher than in the other groups (p<0.01). Moreover, moderate aerobic training on a treadmill caused the biomechanical property values to move closer to the values shown by the control groups (p>0.01). ConclusionIn summary, our study indicates that moderate-intensity aerobic training restored the normal mechanical properties of tendons in diabetic animals, since the elastic modulus (MPa), the specific deformation (%), the deformation of the maximum force (mm) and energy / tendon area (N.mm/mm2) approached the values shown by the control groups.

Ultrasonic assessment of extracellular matrix content in healing achilles tendon

Although several imaging modalities have been utilized to observe tendons, assessing injured tendons by tracking the healing response over time with ultrasound is a desirable method which is yet to be realized. This study examines the use of ultrasound for non-invasive monitoring of the healing process of Achilles tendons after surgical transection. The overall extracellular matrix content of the transection site is monitored and quantified as a function of time. B-mode images (built from successive A-scan signatures) of the injury site were obtained and compared to biomechanical properties. A quantitative measure of tendon healing using the extracellular matrix (ECM) content of the injury site was analyzed using linear regression with all biomechanical measures. Contralateral tendons were used as controls. The trend in the degree of ECM regrowth in the 4 weeks following complete transection of excised tendons was found to be most closely paralleled with that of linear stiffness (R(2) = 0.987, p < .05) obtained with post-ultrasound biomechanical tests. Results suggest that ultrasound can be an effective imaging technique in assessing the degree of tendon healing, and can be used to correlate structural properties of Achilles tendons.

Age‐related changes in mechanical properties of the Achilles tendon

The stiffness of a tendon, which influences muscular force transfer to the skeleton and increases during childhood, is dependent on its material properties and dimensions, both of which are influenced by chronic loading. The aims of this study were to: (i) determine the independent contributions of body mass, force production capabilities and tendon dimensions to tendon stiffness during childhood; and (ii) descriptively document age-related changes in tendon mechanical properties and dimensions. Achilles tendon mechanical and material properties were determined in 52 children (5-12 years) and 19 adults. Tendon stiffness and Young's modulus (YM) were calculated as the slopes of the force-elongation and stress-strain curves, respectively. Relationships between stiffness vs. age, mass and force, and between YM vs. age, mass and stress were determined by means of polynomial fits and multiple regression analyses. Mass was found to be the best predictor of stiffness, whilst stress was best related to YM (< 75 and 51% explained variance, respectively). Combined, mass and force accounted for up to 78% of stiffness variation. Up to 61% of YM variability could be explained using a combination of mass, stress and age. These results demonstrate that age-related increases in tendon stiffness are largely attributable to increased tendon loading from weight-bearing tasks and increased plantarflexor force production, as well as tendon growth. Moreover, our results suggest that chronic increases in tendon loading during childhood result in microstructural changes which increase the tendon's YM. Regarding the second aim, peak stress increased from childhood to adulthood due to greater increases in strength than tendon cross-sectional area. Peak strain remained constant as a result of parallel increases in tendon length and peak elongation. The differences in Achilles tendon properties found between adults and children are likely to influence force production, and ultimately movement characteristics, which should be explicitly examined in future research.

Dextrose prolotherapy and corticosteroid injection into rat Achilles tendon

To assess the mechanical behavior and the histology of collagen fibers after prolotherapy with 12.5% dextrose into rat Achilles tendons and to compare with those of corticosteroid treatment. Out of 60 adult female Wistar rats (70 tendons), 15 received 12.5% dextrose (group I); 15 were treated with corticosteroid injection (group II); and 15 were given 0.9% saline injection (group III), all into the right Achilles tendon, whereas 13 animals received no injections (group IV). Three doses of each substance (groups I, II, and III) were given at a 5-day interval. Collagen fiber color was quantitatively assessed in three samples from each group and in five samples from the control group using picrosirius red staining under polarized and nonpolarized light. Twelve tendons from each group treated with the test substance and 20 tendons from the control group were submitted to the tensile strength test. There was no statistical difference across the groups with respect to maximum load at failure (n.s.) and absorbed energy (n.s.). With respect to tendon rupture, there was no difference between the myotendinous and the tendinous regions (n.s.). However, hematoxylin-eosin staining revealed statistical significance in lymphocytic inflammatory infiltrate (P = 0.008) and in parallel fiber orientation (P = 0.003) when comparing groups to the control group, without significance for either neovascularization (n.s.) or the presence of fibroblasts (n.s.). Likewise, there was no significant difference between the percentage of mature (n.s.) and immature (n.s.) fibers. Dextrose was not deleterious to the tendinous tissue, as it did not change the mechanical and histological properties of Achilles tendons in rats. The data obtained in this study may help clinicians in their daily work as they suggest that injections of 12.5% dextrose caused no harm to the tendons, although the clinical importance in humans still needs to be defined.

Time course of changes in the human Achilles tendon properties and metabolism during training and detraining in vivo

The purpose of this study was to investigate the time course of changes in human tendon properties and metabolism during resistance training and detraining. Nine men (21-27 years) completed 3 months of isometric plantar flexion training and another 3 months of detraining. At the beginning and on every 1 month of training and detraining periods, the stiffness, blood circulation (blood volume and oxygen saturation), serum procollagen type 1 C-peptide (P1P; reflects synthesis of type 1 collagen), echointensity (reflects collagen content), and MRI signal intensity (reflects collagen structure) of the Achilles tendon were measured. Tendon stiffness did not change until 2 months of training, and the increase (50.3%) reached statistical significance at the end of the training period. After 1 month of detraining, tendon stiffness had already decreased to pre-training level. Blood circulation in the tendon did not change during the experimental period. P1P increased significantly after 2 months of training. Echointensity increased significantly by 9.1% after 2 months of training, and remained high throughout the experiment. MRI signal intensity increased by 24.2% after 2 months and by 21.4% after 3 months of training, but decreased to the pre-training level during the detraining period. These results suggested that the collagen synthesis, content, and structure of human tendons changed at the 2-month point of training period. During detraining, the sudden decrease in tendon stiffness might be related to changes in the structure of collagen fibers within the tendon.

Murine tendon function is adversely affected by aggrecan accumulation due to the knockout of ADAMTS5

The present study examined the effect of ADAMTS5 (TS5) knockout on the properties of murine flexor digitorum longus (FDL) and Achilles tendons. FDL and Achilles tendons were analyzed using biomechanical testing, histology, and immunohistochemistry; further characterization of FDL tendons was conducted using transmission electron microscopy (collagen fibril ultrastructure), SDS-PAGE (collagen content and type), fluorescence-assisted carbohydrate electrophoresis for chondroitin sulfate and hyaluronan, and Western blotting for aggrecan, versican, and decorin abundance and distribution. FDL tendons of TS5(-/-) mice showed a 33% larger cross-sectional area, increased collagen fibril area fraction, and decreased material properties relative to those of wild type mice. In TS5(-/-) mice, aggrecan accumulated in the pericellular matrix of tendon fibroblasts. In Achilles tendons, cross-sectional area, stress relaxation, and structural properties were similar in TS5(-/-) and wild type mice; however, the TS5(-/-) tendons exhibited a higher tensile modulus and a weakened enthesis. These results demonstrate that TS5 deficiency disturbs normal tendon collagen organization and alters biomechanical properties. Hence, the role of ADAMTS5 in tendon is to remove pericellular and interfibrillar aggrecan to maintain the molecular architecture responsible for normal tissue function.

Changes of calf muscle-tendon biomechanical properties induced by passive-stretching and active-movement training in children with cerebral palsy

Biomechanical properties of calf muscles and Achilles tendon may be altered considerably in children with cerebral palsy (CP), contributing to childhood disability. It is unclear how muscle fascicles and tendon respond to rehabilitation and contribute to improvement of ankle-joint properties. Biomechanical properties of the calf muscle fascicles of both gastrocnemius medialis (GM) and soleus (SOL), including the fascicle length and pennation angle in seven children with CP, were evaluated using ultrasonography combined with biomechanical measurements before and after a 6-wk treatment of passive-stretching and active-movement training. The passive force contributions from the GM and SOL muscles were separated using flexed and extended knee positions, and fascicular stiffness was calculated based on the fascicular force-length relation. Biomechanical properties of the Achilles tendon, including resting length, cross-sectional area, and stiffness, were also evaluated. The 6-wk training induced elongation of muscle fascicles (SOL: 8%, P = 0.018; GM: 3%, P = 0.018), reduced pennation angle (SOL: 10%, P = 0.028; GM: 5%, P = 0.028), reduced fascicular stiffness (SOL: 17%, P = 0.128; GM: 21%, P = 0.018), decreased tendon length (6%, P = 0.018), increased Achilles tendon stiffness (32%, P = 0.018), and increased Young's modulus (20%, P = 0.018). In vivo characterizations of calf muscles and Achilles tendon mechanical properties help us better understand treatment-induced changes of calf muscle-tendon and facilitate development of more effective treatments.

In Vivo Evaluations of Morphologic Changes of Gastrocnemius Muscle Fascicles and Achilles Tendon in Children with Cerebral Palsy

The Achilles tendon plays an important role in soleus and gastrocnemius muscle functions, including proper muscle force transmission and movement generation. However, few studies have examined concurrent changes of tendon and muscle properties in neurologic disorders. The objective of this study was to investigate the morphologic characteristics of both the calf muscle fascicles and the Achilles tendon in children with cerebral palsy (CP). A cross-sectional study was planned, and 12 children with CP and 11 typically developing children participated in this study. For both groups, B-mode ultrasonography was used to evaluate the architecture of the medial gastrocnemius muscle, including fascicle length and pennation angle at various ankle (20, 10, and 0 degrees plantar flexion and 10 degrees dorsiflexion) and knee (full extension and 90 degrees flexion) positions. The length and cross-sectional area of the Achilles tendon were also evaluated using ultrasonography. For both CP and control groups, muscle fascicle length, pennation angle, and Achilles tendon length and cross-sectional area varied with ankle and knee positions systematically. Compared with controls, children with CP had shorter muscle fascicles across the tested ankle range of motion (P ≤ 0.003), longer Achilles tendon (P = 0.001), and smaller cross-sectional area of the Achilles tendon (P = 0.003). The changes in Achilles tendon properties could be a result of adaptation to calf muscle fascicle shortening and stiffening, which may affect performance of the muscles. A better understanding of the interactions between calf muscle fascicles and Achilles tendon in children with CP may help treat the pathologic changes more effectively.

The influence of acetaminophen and exercise on rat Achilles tendon structural properties

The purpose of this study was to evaluate the influence of acetaminophen (APAP) and exercise on the structural properties of rat Achilles tendon. Ten-week-old male Wistar rats were divided into placebo or APAP groups and further divided into sedentary or treadmill exercised groups. APAP (200 mg•kg−1) or placebo (saline) was administered once daily via oral gavage for 8 weeks. Tendon collagen content was determined by detection of the collagen specific amino acid hydroxyproline using high performance liquid chromatrography. Rats in the exercise group ran on a treadmill five days per week for 8 weeks with progression to 60 minutes per day, 20 m•min−1, and 8° incline. Exercise did not influence tendon collagen content and data were collapsed into placebo (n=24) and APAP (n=26) groups. Achilles tendon collagen content was greater (p<0.065) in the rats given APAP (placebo: 598±22; APAP: 652±18 μg collagen•mg tendon wet weight). When expressed relative to tendon dry mass collagen content was not influenced by APAP (placebo: 1346±60; APAP: 1345±57 μg collagen•mg tendon dry weight). Evaluation of tendon water content revealed a 7% (p<0.01) decrease in tendon water content in the APAP group when compared to placebo. Our data suggests that chronic consumption of APAP results in a loss of tissue water from tendon and this effect may be independent of exercise. Midwestern University College of Health Science and Office of Research and Sponsored Programs

Mechanical, Compositional, and Structural Properties of the Post-natal Mouse Achilles Tendon

During post-natal development, tendons undergo a well orchestrated process whereby extensive structural and compositional changes occur in synchrony to produce a normal tissue. Conversely, during the repair response to injury, structural and compositional changes occur, but in this case, a mechanically inferior tendon is produced. As a result, the process of development has been postulated as a potential paradigm through which improved adult tissue healing may occur. In this study we measured the mechanical, compositional, and structural properties in the post-natal mouse Achilles tendon at 4, 7, 10, 14, 21, and 28 days old. Throughout post-natal development, the mechanical properties, collagen content, fibril diameter mean, and fibril diameter standard deviation increased. Biglycan expression decreased and decorin expression and fiber organization were unchanged. This study provides a new mouse model that can be used to quantitatively examine mechanical development, as well as compositional and structural changes and biological mechanisms, during post-natal tendon development. This model is advantageous due to the large number of genetically modified mice and commercially available assays that are not available in other animal models. A mouse model therefore allows future mechanistic studies to build on this work.

Mechanical properties of the human Achilles tendon, in vivo

Background Ultrasonography has been widely applied for in vivo measurements of tendon mechanical properties. Assessments of human Achilles tendon mechanical properties have received great interest. Achilles tendon injuries predominantly occur in the tendon region between the Achilles-soleus myotendinous junction and Achilles-calcaneus osteotendinous junction i.e. in the free Achilles tendon. However, there has been no adequate ultrasound based method for quantifying the mechanical properties of the free human Achilles tendon. This study aimed to: 1) examine the mechanical properties of the free human Achilles tendon in vivo by the use of ultrasonography and 2) assess the between-day reproducibility of these measurements. Methods Ten male subjects had the Achilles tendon moment arm length, Achilles tendon cross sectional area and free Achilles tendon length determined. All subjects performed isometric plantarflexion ramp contractions to assess between-day reproducibility on two separate days. Simultaneous ultrasonography based measurements of Achilles-soleus myotendinous junction and Achilles-calcaneus osteotendinous junction displacement together with Achilles tendon force estimates yielded free Achilles tendon mechanical properties. Findings Free Achilles tendon maximal force, deformation and stiffness were 1924 (SD 229) N, 2.2 (SD 0.6) mm and 2622 (SD 534) N/mm on day 1. For between-day reproducibility there were no significant differences between days for free Achilles tendon mechanical properties. The between-day correlation coefficient and typical error percent were 0.81 and 5.3% for maximal Achilles tendon force, 0.85 and 11.8% for maximal Achilles tendon deformation and 0.84 and 8.8% for Achilles tendon stiffness respectively. Last, osteotendinous junction proximal displacement on average contributed with 71 (SD 12) % of proximal myotendinous junction displacement. Interpretation This study, for the first time, presents an ultrasonography based in vivo method for measurement of free AT mechanical properties. The method is applicable for evaluation of free human Achilles tendon mechanical properties in relation to training, injury and rehabilitation.

Mechanical Properties of Achilles Tendon in Rats Induced to Experimental Diabetes

The aim of this study was to quantify the effect of chemically induced diabetes mellitus (DM) on the mechanical properties of the Achilles tendon of rats and correlate it with metabolic and biomechanical findings. Adult rats were selected randomly and assigned to two groups, the diabetic group consisted of animals receiving a dose of streptozotocin to induce type I diabetes and the control group. The animals were placed in metabolic cages for analysis of metabolism. Ten weeks after diabetes induction, the Achilles tendon of both groups were collected and submitted to a traction test in a conventional testing machine. The measurements of mechanical properties indicated that the elastic modulus (MPa) was significantly higher in the control group (p < 0.01). In Maximum tension (MPa), the groups did not have differences (p > 0.01). Energy/tendon area (N mm/mm²), specific strain (%) and maximum specific strain (mm) were higher in tendon tests of the diabetic group (p < 0.01). We observed that the mechanical properties of tendons have correlations with metabolic properties of the diabetic animals. These results showed that induced DM in rats have an important negative effect on the mechanical properties of the Achilles tendon.

Influence of leg muscle activity and mechanical Achilles tendon properties in hopping musculoskeletal stiffness

Influence of leg muscle activity and mechanical Achilles tendon properties in hopping musculoskeletal stiffness

Tendinopathy alters mechanical and material properties of the Achilles tendon

The purpose of this study was to investigate the in vivo material and mechanical properties of the human Achilles tendon in the presence of tendinopathy. Real-time ultrasound imaging and dynamometry were used to assess Achilles tendon stiffness, Young's modulus, stress, strain, and cross-sectional area (CSA) in 12 individuals with Achilles tendinopathy and 12 age- and gender-matched controls. The results of this study suggest that tendinopathy weakens the mechanical and material properties of the tendon. Tendinopathic tendons had greater CSA, lower tendon stiffness, and lower Young's modulus. These alterations in mechanical characteristics may put the Achilles tendon at a higher risk to sustain further injury and prolong the time to recovery. Results from this study may be used to design treatment strategies that specifically target these deficits, leading to faster and permanent recovery from tendinopathy.