Abstract
BackgroundMid-portion Achilles tendinopathy (AT) is prevalent amongst athletic and non-athletic populations with pain, stiffness and impaired function typically reported. While different management options exist, loading protocols remain the best available intervention and have been shown to be effective in the management of AT. Trials investigating loading in AT have used a variety of different protocols, and recent narrative reviews suggest that no protocol is superior to another when comparing outcomes in pain and function. However, there has been no systematic review or meta-analysis completed to determine this. Furthermore, the narrative review did not consider wait-and-see or sham interventions, thus a systematic review and met-analysis which includes wait-and-see or sham interventions is warranted.MethodsA systematic review and meta-analyses will be conducted as per the PRISMA guidelines. The databases PUBMED, CINAHL (Ovid) and CINAHL (EBSCO) will be searched for articles published from inception to 31 December 2017. Our search focuses on studies examining the improvement of pain and function when completing a loading program for mid-portion AT. Only randomised/ quasi-randomised trials will be included while case reports and case series will be excluded. The primary outcome assessing pain and function will be the Victorian Institute Sports Assessment - Achilles (VISA-A). Two reviewers will screen articles, extract data and assess the risk of bias independently with a third reviewer resolving any disagreements between the two reviewers. A meta-analysis will then be performed on the data (if appropriate) to determine if the traditional heavy load calf training protocol described by Alfredson is superior to wait-and-see, sham intervention, traditional physiotherapy, and other forms of exercise rehabilitation.DiscussionThis systematic review and meta-analysis will allow us to investigate if there are difference in pain and function when comparing wait-and-see, sham interventions, traditional physiotherapy and different exercise interventions to the traditional heavy eccentric calf training protocol for mid-portion Achilles tendon pain.Systematic review registrationPROSPERO registration number CRD42018084493.
Highlights
Mid-portion Achilles tendinopathy (AT) is prevalent amongst athletic and non-athletic populations with pain, stiffness and impaired function typically reported
The collagen disruption/ tearing models suggests that tendon pain is caused from a catabolic response of the tendon cells due to a lack of loading caused secondary to microscopic collagen damage [3]
To determine if heavy eccentric calf training is more effective than wait-and-see, sham interventions, traditional physiotherapy and other exercise rehabilitation protocols for improvements in pain and function in mid-portion Achilles tendinopathy
Summary
Mid-portion Achilles tendinopathy (AT) is prevalent amongst athletic and non-athletic populations with pain, stiffness and impaired function typically reported. Trials investigating loading in AT have used a variety of different protocols, and recent narrative reviews suggest that no protocol is superior to another when comparing outcomes in pain and function. Many different models have been presented to attempt to explain the link between tendon pain, function and structure. Three different models are used to describe tendinopathy; collagen disruption/tearing, tendon cell response and inflammation. The collagen disruption/ tearing models suggests that tendon pain is caused from a catabolic response of the tendon cells due to a lack of loading caused secondary to microscopic collagen damage [3]. The inflammatory model suggests that, in response to loading, an inflammatory response occurs which may relate to tendon degradation and disorganisation [5,6,7]. The continuum of tendinopathy presents a continuum of change from an acute reactive tendon to a chronic degenerative tendon [1, 2]
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