A $3.2 million, five-year R01 grant from the National Institutes of Health will support the work. Cone's laboratory in the Department of Biomedical Engineering is partnering with researchers at UD’s College of Health Sciences and the University of North Carolina at Chapel Hill.

“This is a truly interdisciplinary effort, bringing together engineers, clinicians, imaging experts and computational modelers,” said Cone.

Understanding responses to exercise treatment

The Achilles tendon comprises three bundled subtendons, each linked to one of three calf muscles: two gastrocnemius and one soleus. “Basically, you’ve got three motors—the muscles—that are pulling on three cords wrapped around each other—the subtendons,” explained Cone.

Past work with healthy volunteers revealed that this anatomy varies from person to person. Some people have a larger soleus subtendon, while others have a gastrocnemius subtendon that dominates. The new study will explore how these anatomic variations affect Achilles tendinopathy injuries and recovery.

The researchers suspect that the standard exercises benefit some patients because they happen to engage the subtendon most affected by injury. Others may see less benefit because the exercises do not directly target the right region.

Part of the work will be performed in collaboration with Karin Grävare Silbernagel’s team at the Delaware Tendon Research Group in UD’s Department of Physical Therapy. Study volunteers will receive standard 12-week treatment for Achilles tendinopathy provided by a physical therapist. They will complete movement tests and MRI scans before and after to track improvements in muscle strength and tendon structure and function. 

In general, most patients with Achilles tendinopathy experience noticeable improvement after 12 weeks of physical therapy, although recovery is not complete and progress often continues at home. Physical therapists typically recommend continuing the exercises even after pain subsides.