Eccentric exercise and shock-wave therapy benefit patients with chronic Achilles tendinopathy

Abstract

Is eccentric exercise or shock-wave therapy more effective than wait-and-see in the management of chronic Achilles tendinopathy? Pragmatic randomised controlled trial. Primary health care clinics in Germany. Seventy-five patients with a diagnosis of chronic midportion Achilles tendinopathy (duration > 6 months), aged 18 to 70 years. All patients had received previous treatment for at least 3 months, without success. Subjects were randomly allocated to one of 3 groups: eccentric loading, shock-wave therapy, or wait-and-see. The eccentric loading group performed twicedaily, eccentric, calf muscle exercises, gradually progressed over 12 weeks. The shock-wave wave therapy intervention consisted of 3 sessions at weekly intervals of repetitive, low-energy shock-wave therapy. Patients in the wait-and-see group visited their physician once and were encouraged to await spontaneous improvement. Outcomes were assessed at 4 months from baseline. The Victorian Institute of Sport Assessment (VISA-A) questionnaire was used to measure pain, function and activity (0–100 scale, 100 = asymptomatic). Recovery was measured on a 6-point Likert scale (1 = completely recovered, 6 = much worse). Pain was assessed on an 11-point Numeric Rating Scale. Compared with the wait-and-see group, both eccentric exercise and shock-wave therapy resulted in improved VISA-A scores (21, 95% CI 12 to 29; and 15, 95% CI 8 to 23 respectively). Sixty percent of patients in the eccentric loading group reported complete recovery or much improved (scores of 1 or 2 on the Likert scale), compared with 53% in the shock-wave therapy group and 24% in the wait-and-see group. Between-group differences in pain were 2.4 (95% CI 1.3 to 3.5) for eccentric loading and 2.0 (95% CI 1.0 to 3.0) for shock-wave therapy, compared with wait-and-see. No serious complications were reported. This study provides evidence that both eccentric exercise and shock-wave therapy produce worthwhile improvements for patients with chronic Achilles tendinopathy.