Force-sharing within the Triceps Surae: An Achilles Heel in Achilles Tendinopathy

Purpose The primary aim of this study was to determine whether the distribution of force between the three heads of the triceps surae differs between people with Achilles tendinopathy and controls. We also aimed to determine the effect of this force distribution on subtendon strain. Methods Data were collected for 21 participants with Achilles tendinopathy and 21, case-wise paired, asymptomatic controls. Ultrasonography was used to measure muscle volume, fascicle length, pennation angle and subtendon length at rest. Muscle activation was estimated using surface electromyography during maximal and submaximal isometric plantarflexion tasks. The product of normalized activation, physiological cross-sectional area, and the cosine of the pennation angle was considered as an index of individual muscle force. Displacement of the distal myotendinous junction of each muscle was measured during the submaximal contractions. Results The contribution of the gastrocnemius lateralis to the overall triceps surae physiological cross-sectional area and activation was 8.5% (P = 0.047, d = 0.75) and 24.7% lower (main effect group P = 0.009, d = 0.67) in people with Achilles tendinopathy than in the controls, respectively. Consequently, gastrocnemius lateralis contributed approximately 28% less (main effect group P = 0.025, d = 0.62) of the triceps surae force in people with Achilles tendinopathy. The contribution of gastrocnemius medialis and soleus was not different between groups. Subtendon strain was not different between groups (P = 0.835). Conclusions These results provide evidence for a difference in force-sharing strategy within the triceps surae in people with Achilles tendinopathy compared with the controls. Whether this altered strategy is a cause or a consequence of Achilles tendinopathy should be explored further.