Military Study Reveals Hidden Risks in Achilles Recovery

Achilles tendinopathy is a frequent issue among physically active populations, especially military personnel. Managing symptoms while preventing structural degeneration is a challenge in high-demand environments. A new study, published in BMJ Military Health, evaluated the effects of load modification on both symptoms and tendon structure in soldiers with midportion Achilles tendinopathy (mid-AT).

Over an eight-week period, 40 service members with symptomatic mid-AT replaced running with low-impact exercises such as stair climbing and cross-training. The aim was to assess whether this change in loading would result in structural remodeling of the tendon or simply symptom relief.

UTC Imaging Shows No Structural Improvement

Using Ultrasound Tissue Characterization (UTC), the researchers monitored the percentage of aligned and disorganized tendon tissue. Both the midportion and the area of maximum degeneration were assessed at baseline and follow-up.

The findings were clear: there were no statistically significant changes in tendon structure after eight weeks of low-impact exercise. The proportion of aligned tissue (echo-types I + II) remained stable, and there was no significant reduction in disorganized matrix (echo-types III + IV).

Symptoms Improve Despite Stable Tendon Matrix

In contrast to the UTC results, participants reported a significant reduction in symptoms. VISA-A scores improved notably, indicating less pain and improved function. However, these symptomatic gains did not correlate with structural changes in the tendon. This disconnect reinforces earlier clinical observations: pain and function can improve without actual tendon healing.

Clinical Relevance for Tendon Management in High-Load Populations

These results are particularly relevant for sports medicine professionals working with soldiers, athletes, or other high-performance populations. They support the use of load reduction strategies as a way to safely reduce symptoms, without risking tendon breakdown.

However, the lack of structural improvement highlights the importance of continued monitoring. UTC Imaging allows clinicians to detect whether symptoms are masking underlying degeneration, especially in chronic or recurring tendinopathy.

Conclusion: Use Imaging to Guide Return-to-Load Decisions

This study confirms that symptom relief does not equal structural recovery. In tendon care—especially in demanding environments—combining patient-reported outcomes with structural imaging leads to safer and more informed decisions. UTC enables objective tracking of tendon matrix integrity, helping clinicians guide rehabilitation and prevent relapse.

Citation

Paantjens MA, Helmhout PH, Martens MTAW, Lentjes GW, Bakker EWP. Achilles tendon structure and symptoms after low-impact loading: a UTC study. BMJ Mil Health. 2025 Feb 26. PMID: 40011020