Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy – a randomized trial with 1-year follow-up

22-07-2018
Achilles tendinopathy is common, especially in physically active people. The incidence increases with age. Proposed etiological factors are extrinsic factors such as training load and inappropriate footwear and intrinsic factors such as flexibility, weakness and poor alignment of the ankle joints.

Treatment with eccentric muscle strength exercises seems promising for patients with Achilles tendinopathy. A prospective randomized clinical study has looked at this hypothesis with regard to eccentric exercises of calf muscles on reduction of pain and improvement of function. Forty-four patients were recruited from the first line (average age: 45 years, 23 women, 65% active in sport) and randomized to three treatment groups for 12 weeks: the first group received eccentric exercises, the second group a night splint; the third group a combination of both interventions. The outcome measures were pain and function, and were evaluated at 6, 12, 26 and 52 weeks by the score for foot and ankle outcome. After 6 weeks, the eccentric group reported a significant pain reduction (27% compared to the baseline, P50.007) that lasted 1 year (42%, P50.001).

The two groups treated with a night splint also reported significant but less pain relief than the eccentric group. The differences between all three groups were not significant. After 12 weeks, the eccentric group reported significantly less pain than the only-splint group (P50.04). More patients in the eccentric group than in the splint group returned to sport after 12 weeks.

In conclusion, eccentric exercises reduce pain and improve function in patients with Achilles tendinopathy. The results are in line with previous studies and reinforce the recommendation that patients should undergo an eccentric exercise program before considering other treatments, such as surgery.

Scand J Med Sci Sports 2004. Ewa M. Roos et al.

• 24-07-2018 Physical Therapy Referral Rates Alongside Rising Opioid Prescription Rates in Patients With Low Back Pain
• 22-07-2018 Corticosteroid or placebo injection in combination with deep transverse friction, manipulation of Mills, stretching and eccentric exercises for acute lateral epicondylitis