January 2020

Myotonometry for the evaluation of Achilles tendon mechanical properties: a reliability and construct validity study

Authors: Alessandro Schneebeli, Deborah Falla, Ron Clijsen, Marco Barbero


  1. Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno/Landquart, Switzerland
  2. Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise Rehabilitation Sciences, College of Life Environmental Sciences, University of Birmingham, Birmingham, UK
  3. University College Physiotherapy, Thim van der Laan AG, Landquart, Switzerland

Journal: BMJ Open Sport & Exercise Medicine - January 2020, 6:e000726 (DOI: 10.1136/ bmjsem-2019-000726)

Objective: This study evaluates the intra-rater and inter- rater reliability of the MyotonPRO and its construct validity for the assessment of Achilles tendon stiffness.

Design: Reliability and construct validity study.

Methods: Forty healthy participants were assessed using the MyotonPRO by two raters on two different occasions. Tendon was evaluated in three different positions (relaxed, 0° plantarflexion and standing) and during different isometric contractions (range 0–3 kg). Reliability was calculated using intraclass correlation coefficient (ICC and 95% CI) standard error of measurement and minimal detectable change. Construct validity was evaluated between the different positions and the different contraction intensities using Friedman test.

Results: Intra-rater reliability was very high ICC2,k 0.87– 0.98. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.59. Inter-rater reliability ranged from high to very high with an ICC2,k of 0.76–0.86. The reliability of the 0.5 kg, 1 kg contraction and the standing position was moderate with an ICC2,k of 0.55, 0.54 and 0.56 respectively. Inter-session reliability ranged from high to very high with an ICC2,k of 0.70–0.89. The reliability of the 0.5 kg contraction was moderate with an ICC2,k of 0.54. Construct validity was demonstrated between different contraction levels and different positions.

Figure 1 – Schematic of the experimental setup.

MyotonPRO is a reliable tool for the evaluation of Achilles tendon stiffness during different contraction levels and in different positions. Construct validity was supported by changes of tendon stiffness during the explored conditions. MyotonPRO can be implemented, as a ready to use device, in the evaluation of tendon tissue mechanical properties.