{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:28:27Z","timestamp":1787030907235,"version":"build-2736575974"},"reference-count":30,"publisher":"National Athletic Trainers' Association","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Several studies have been conducted to better understand the effect of load on the Achilles tendon structure. However, the effect of a high cumulative load consisting of repetitive cyclic movements, such as those that occur during the running of a marathon, on Achilles tendon structure is not yet clear. Clinicians, coaches, and athletes will benefit from knowledge about the effects of a marathon on the structure of the Achilles tendon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the short-term response of the Achilles tendon structure to running a marathon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Case series (prospective).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Sports medicine centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients or Other Participants<\/jats:title>\n                    <jats:p>Ten male nonelite runners who ran in a marathon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes Measure(s)<\/jats:title>\n                    <jats:p>Tendon structure was assessed before and 2 and 7 days after a marathon using ultrasound tissue characterization (UTC), an imaging tool that quantifies tendon organization in 4 echo types (I\u2013IV). Echo type I represents the most stable echo pattern, and echo type IV, the least stable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At 7 days postmarathon, both the insertional and midportion structure changed significantly. At both sites, the percentage of echo type II increased (insertion P &amp;lt; .01; midportion P = .02) and the percentages of echo types III and IV decreased (type III: insertion P = .01; midportion P = .02; type IV: insertion P = .01; midportion P &amp;lt; .01). Additionally, at the insertion, the percentage of echo type I decreased (P &amp;lt; .01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We observed the effects of running a marathon on the Achilles tendon structure 7 days after the event. Running the marathon combined with the activity performed shortly thereafter might have caused the changes in tendon structure. This result emphasizes the importance of sufficient recovery time after running a marathon to prevent overuse injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4085\/1062-6050-49-19","type":"journal-article","created":{"date-parts":[[2020,1,14]],"date-time":"2020-01-14T16:31:33Z","timestamp":1579019493000},"page":"176-180","source":"Crossref","is-referenced-by-count":15,"title":["Running a Marathon\u2014Its Influence on Achilles Tendon Structure"],"prefix":"10.4085","volume":"55","author":[{"given":"Lucas Maciel","family":"Rabello","sequence":"first","affiliation":[{"name":"Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris Sophie","family":"Albers","sequence":"first","affiliation":[{"name":"Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathijs","family":"van Ark","sequence":"first","affiliation":[{"name":"Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, The Netherlands"},{"name":"Department of Physiotherapy, Hanze University of Applied Sciences, Groningen, The Netherlands"},{"name":"Centre of Expertise Primary Care Groningen (ECEZG), Peescentrum (Tendon Centre), The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron L.","family":"Diercks","sequence":"first","affiliation":[{"name":"Department of Orthopedics, University of Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge","family":"van den Akker-Scheek","sequence":"first","affiliation":[{"name":"Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Zwerver","sequence":"first","affiliation":[{"name":"Department of Sports and Exercise Medicine, University of Groningen, University Medical Center Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","reference":[{"key":"2020060414145209200_i1062-6050-55-2-176-b01","article-title":"Road Running Information Center annual marathon report","year":"2018","journal-title":"Running USA Web site"},{"issue":"4\u20135","key":"2020060414145209200_i1062-6050-55-2-176-b02","doi-asserted-by":"crossref","first-page":"437","DOI":"10.2165\/00007256-200737040-00043","article-title":"Epidemiology and aetiology of marathon running injuries","volume":"37","author":"Fredericson","year":"2007","journal-title":"Sport Med"},{"key":"2020060414145209200_i1062-6050-55-2-176-b03","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2147\/CLEP.S151613","article-title":"Replacing sedentary time with physical activity: a 15-year follow-up of mortality in a national cohort","volume":"10","author":"Dohrn","year":"2018","journal-title":"Clin Epidemiol"},{"issue":"3","key":"2020060414145209200_i1062-6050-55-2-176-b04","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1249\/MSS.0b013e31818c1752","article-title":"Lower prevalence of hypertension, hypercholesterolemia, and diabetes in marathoners","volume":"41","author":"Williams","year":"2009","journal-title":"Med Sci Sports Exerc"},{"issue":"8","key":"2020060414145209200_i1062-6050-55-2-176-b05","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1136\/bjsm.2006.033548","article-title":"Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review","volume":"41","author":"Van Gent","year":"2007","journal-title":"Br J Sports Med"},{"issue":"10","key":"2020060414145209200_i1062-6050-55-2-176-b06","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1007\/BF03262301","article-title":"What are the main running related musculoskeletal injuries? 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