Achilles tendon Doppler flow may be associated with mechanical loading among active athletes

Peter Malliaras, Paula J. Richards, Giorgio Garau, Nicola Maffulli

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42 Citations (Scopus)


Background: Tendon Doppler flow may be associated with tendon pain in symptomatic patients, but the relationship between Doppler flow and pain among athletes who are still competing is unclear. Hypothesis: Among active athletes, Doppler flow may partly reflect tendon adaptation to increased mechanical load and/or asymptomatic tendinopathy. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The Achilles tendons of 61 badminton players (24 elite, 37 recreational) were examined with gray-scale and color Doppler ultrasound. Achilles tendon pain and activity level (badminton training, badminton playing, badminton years) were measured. Results: Doppler flow was not associated with current Achilles tendon pain but was associated with an increased anteroposterior tendon diameter (an indicator of tendinopathy) (P =.02). Athletes who had been playing badminton for longer were more likely to have Doppler flow (P <.01), and there was a trend toward an association between a greater number of badminton playing hours per week and Doppler flow (P =.07). Conclusion: Achilles tendon Doppler flow appears to be a sign of asymptomatic tendinopathy rather than pain among active athletes. The association between weekly badminton hours and badminton years and Doppler flow suggests that Doppler flow may be a response to mechanical load in this cohort.

Original languageEnglish
Pages (from-to)2210-2215
Number of pages6
JournalThe American Journal of Sports Medicine
Issue number11
Publication statusPublished - 1 Nov 2008
Externally publishedYes


  • Achilles tendinopathy
  • Doppler flow
  • Tendon pain
  • Ultrasound

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