Mid-portion Achilles Tendinopathy Research Articles

Poor association between tendon structure and self-reported symptoms following conservative management in active soldiers with mid-portion Achilles tendinopathy

IntroductionMid-portion Achilles tendinopathy (mid-AT) is currently the preferred term for persistent Achilles tendon pain, defined as located 2–7 cm proximal to the calcaneus, and with loss of function related to...

Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial.

To investigate if daily treatment with glyceryl trinitrate (GTN) ointment, over 24 weeks combined with a 12-week eccentric exercise programme is more effective for chronic mid-portion Achilles tendinopathy than placebo ointment and eccentric exercise. This was a single-site randomised double-blind placebo-controlled trial at an acute hospital, Dublin, Ireland. Patients with chronic mid-portion Achilles tendinopathy were randomised to either 24 weeks of daily GTN ointment or placebo ointment. Both groups received an identical 12-week eccentric exercise programme. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 24 weeks, which measures pain, function and activity. Secondary outcomes included pain severity, self-reported physical function, calf muscle function, pressure pain thresholds and ultrasound changes. Statistical analyses were performed according to intention-to-treat principles. 76 patients (30 women; 46 men, mean age±SD, 45.6±8.2 years) were recruited for the trial. Significant improvements in VISA-A scores occurred in both groups at 6-week, 12-week and 24-week follow-up. The increase was not significantly different between groups, adjusted mean between-group difference from baseline to week 6, -1.33 (95% CI -6.96 to 4.31); week 12, -1.25 (95% CI -8.0 to 5.49) and week 24, -3.8 (95% CI -10.6 to 3.0); negative values favour GTN. There was no significant between-group difference in any of the secondary outcome measures at 6, 12 and 24 weeks. Adding daily GTN ointment over 24 weeks to a 12-week eccentric exercise programme did not improve pain, function and activity level in patients with chronic mid-portion Achilles tendinopathy when compared with placebo ointment.

Effectiveness of Low-Level Laser Therapy Combined With Eccentric Exercise in Treating Midportion Achilles Tendinopathy: A Randomized Controlled Trial.

Background Achilles tendinopathy is a common overuse tendon injury, affecting athletes in running and similar sports. Repetitive overload of the Achilles tendon is the primary cause of inflammation, collagen degeneration, and tendon thickening. This study aims to investigate the efficacy of combining low-level laser therapy (LLLT) with eccentric exercises in treating midportion Achilles tendinopathy. Methods This prospective randomized controlled trial was conducted at the Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, from 2019 to 2022. Sixty clinically diagnosed patients with midportion Achilles tendinopathy, aged 18 to 60, were randomly assigned to two groups: Group A received eccentric exercises with LLLT, and Group B received eccentric exercises with placebo LLLT. The Victorian Institute of Sport Assessment-Achilles (VISA-A) score and the visual analogscale (VAS) score were used to measure treatment effectiveness at baseline and three, six, 12, and 24 weeks. Results The study included 60 participants, with no dropouts observed. The mean age was 33.9 ± 8.3 years in Group A and 33.40 ± 8.64 years in Group B, with no significant difference between the groups (p = 0.821). Both groups showed significant improvement in VISA-A and VAS scores over time (p < 0.001), but there was no statistically significant difference between the groups at any time point (p > 0.05). Conclusion Adding LLLT to eccentric exercises did not provide significant additional benefits compared to eccentric exercises alone in treating midportion Achilles tendinopathy. Practitioners should prioritize evidence-based interventions, such as eccentric exercises, as the primary treatment modality while considering alternative therapies for adjunctive purposes. Further research is needed to explore additional modalities or combination therapies that may enhance outcomes for patients with Achilles tendinopathy.

Efficacy of heel lifts for mid-portion Achilles tendinopathy (the LIFT trial): study protocol for a randomised controlled trial

BackgroundMid-portion Achilles tendinopathy is a common condition, characterised by localised Achilles tendon load-related pain and dysfunction. Numerous non-surgical treatments have been proposed for the treatment of this condition, but many of these treatments have a poor or non-existent evidence base. Heel lifts have also been advocated as a treatment for Achilles tendinopathy, but the efficacy and mechanism of action of this intervention is unclear. This proposal describes a randomised controlled trial comparing the effectiveness of heel lifts versus sham heel lifts for reducing pain associated with mid-portion Achilles tendinopathy, with an embedded biomechanical analysis.MethodsOne hundred and eight men and women aged 18 to 65 years with mid-portion Achilles tendinopathy (who satisfy the inclusion and exclusion criteria) will be recruited. Participants will be randomised, using the website Sealed Envelope, to either a control group (sham heel lifts) or an experimental group (heel lifts). Both groups will be provided with education regarding acceptable pain levels to ensure all participants receive some form of treatment. The participants will be instructed to use their allocated intervention for at least 8 h every day for 12 weeks. The primary outcome measure will be pain intensity (numerical rating scale) at its worst over the previous week. The secondary outcome measures will be additional measures of Achilles tendon pain and disability, participant-perceived global ratings of change, function, level of physical activity and health-related quality of life. Data will be collected at baseline and the primary endpoint (week 12). Data will be analysed using the intention-to-treat principle. In addition, the acute kinetic and kinematic effects of the interventions will be examined at baseline in a subpopulation of the participants (n = 40) while walking and running using three-dimensional motion analysis.DiscussionThe LIFT trial (efficacy of heeL lIfts For mid-portion Achilles Tendinopathy) will be the first randomised trial to compare the efficacy of heel lifts to a sham intervention in reducing pain and disability in people with Achilles tendinopathy. The biomechanical analysis will provide useful insights into the mechanism of action of heel lifts.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12623000627651. Registered 7 June 2023.

Prognostic value of ultrasound tissue characterisation for a recurrence of mid-portion Achilles tendinopathy in military service members: a prospective cohort study

IntroductionTendon structure in mid-portion Achilles tendinopathy (mid-AT) appears poorly associated with symptoms. Yet, degenerative tendon changes on imaging have been associated with an increased risk of mid-AT. We aimed to...

Do physical tests have a prognostic value in chronic midportion Achilles tendinopathy?

To determine whether baseline physical tests have a prognostic value on patient-reported outcomes in Achilles tendinopathy. Prospective cohort study, secondary analysis of data from a randomized trial. Patients with chronic midportion Achilles tendinopathy performed a progressive calf muscle exercise program. At baseline and after 2, 6, 12 and 24 weeks, patients completed the Victorian Institute of Sports Assessment-Achilles questionnaire and performed the following physical tests: ankle dorsiflexion range of motion with a bent knee or an extended knee, calf muscle strength, jumping height and pain on palpation (Visual Analogue Scale; 0-100) and after 10 hops (Visual Analogue Scale-10-hops). Associations between baseline test results and improvement (Victorian Institute of Sports Assessment-Achilles scores) were determined using a Mixed Linear Model. 80 patients were included. The mean Victorian Institute of Sports Assessment-Achilles score improved 20 points (95 % confidence interval, 16-25, P < .001) after 24 weeks. There were significant associations between the baseline ankle dorsiflexion range of motion with a bent knee (β 0.2, 95 % confidence interval 0.001 to 0.3, P = .049), the baseline pain provocation tests (Visual Analogue Scale palpation: β -0.2; 95 % confidence interval: -0.4 to -0.1; P < .001, Visual Analogue Scale-10-hops: β -0.3; 95 % confidence interval: -0.4 to -0.2; P < .001) and the change in the Victorian Institute of Sports Assessment-Achilles score. In patients with chronic midportion Achilles tendinopathy, easy-to-perform pain provocation tests have a clinically relevant prognostic value on patient-reported improvement. Patients with less pain during pain provocation tests at baseline have a better improvement in pain, function and activities after 24 weeks than patients with high baseline pain scores.

Effects of exercise treatment on functional outcome parameters in mid-portion achilles tendinopathy: a systematic review.

Exercise interventions are evident in the treatment of mid-portion Achilles tendinopathy (AT). However, there is still a lack of knowledge concerning the effect of different exercise treatments on improving a specific function (e.g., strength) in this population. Thus, this study aimed to systematically review the effect of exercise treatments on different functional outcomes in mid-portion AT. An electronic database of Pubmed, Web of Science, and Cochrane Central Register of Controlled Trials were searched from inception to 21 February 2023. Studies that investigated changes in plantar flexor function with exercise treatments were considered in mid-portion AT. Only randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Functional outcomes were classified by kinetic (e.g., strength), kinematic [e.g., ankle range of motion (ROM)], and sensorimotor (e.g., balance index) parameters. The types of exercise treatments were classified into eccentric, concentric, and combined (eccentric plus concentric) training modes. Quality assessment was appraised using the Physiotherapy Evidence Database scale for RCTs, and the Joanna Briggs Institute scale for CCTs. The search yielded 2,260 records, and a total of ten studies were included. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Eccentric training led to improvements in power outcomes (e.g., height of countermovement jump), and in strength outcomes (e.g., peak torque). Concentric training regimens showed moderate enhanced power outcomes. Moreover, one high-quality study showed an improvement in the balance index by eccentric training, whereas the application of concentric training did not. Combined training modalities did not lead to improvements in strength and power outcomes. Plantarflexion and dorsiflexion ROM measures did not show relevant changes by the exercise treatments. In conclusion, eccentric training is evident in improving strength outcomes in AT patients. Moreover, it shows moderate evidence improvements in power and the sensorimotor parameter "balance index". Concentric training presents moderate evidence in the power outcomes and can therefore be considered as an alternative to improve this function. Kinematic analysis of plantarflexion and dorsiflexion ROM might not be useful in AT people. This study expands the knowledge what types of exercise regimes should be considered to improve the functional outcomes in AT.

Systematic Review and Meta-analyses of Randomized Controlled Trials Comparing Exercise Loading Protocols With Passive Treatment Modalities or Other Loading Protocols for the Management of Midportion Achilles Tendinopathy.

There is no clear consensus as to which intervention to prioritize for midportion Achilles tendinopathy (AT), although recent clinical practice guidelines have recommended eccentric exercises. The purpose of this study was to (1) compare exercise loading protocols with passive treatment modalities for the management of midportion AT and (2) compare different exercise loading protocols. We hypothesized that loading exercises would be associated with a greater decrease in pain and symptoms compared with passive treatment modalities but that no loading protocols would be associated with improved results. Systematic review; Level of evidence, 1. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the MEDLINE, EMBASE, CINHAL, and Web of Science databases for randomized controlled trials (RCTs) and compared eccentric loading protocols with passive treatment modalities or different eccentric loading protocols as an intervention for midportion AT. A total of 5126 articles were identified after the initial search. After selection, the risk of bias (RoB) and the Grading of Recommendations, Assessment, Development and Evaluation approach were applied to pooled studies for quantitative analysis. The outcomes of interest were pain and function, which were measured using the visual analog scale and the Victorian Institute of Sport Assessment-Achilles scale. Mean differences (MDs) and 95% CIs were calculated using random effects (significant heterogeneity) or fixed effects (nonsignificant heterogeneity) inverse variance models. In this study, 12 RCTs (N = 543 participants) were included, of which 2 had a high RoB and 10 showed some concerns of bias. Passive interventions resulted in greater pain reduction in the short term compared with eccentric loading protocols (n = 4 studies; n = 212 participants; pooled MD, 10.22 [95% CI, 2.18 to 18.25]; P = .01). For function, there was a nonsignificant trend in favor of eccentric loading in the short- (n = 3 studies; n = 144 participants; pooled MD, -7.91 [95% CI, -16 to 0.19]; P = .06) and midterm follow-up (n = 5 studies; n = 258 participants; pooled MD, -6.78 [95% CI, -14.23 to 0.68]; P = .07). Meta-analyses of RCTs comparing different types of exercise loading protocols showed no significant differences in the short, mid-, and long term with regard to pain and function. Our meta-analyses did not highlight the superiority of one treatment over another for midportion AT.

Return to Sports and Functional Outcomes after Autologous Platelet-Rich Fibrin Matrix (PRFM) and Debridement in Midportion Achilles Tendinopathy: A Case Series with 24-Month Follow-Up

(1) Background: Achilles tendinopathy (AT) is characterized by load-induced tendon pain, stiffness, and functional impairment that may affect the tendon midportion or insertion. Platelet-rich fibrin matrix (PRFM) is a promising adjunctive therapy for AT. We analyzed 24-month pain and functional outcomes in a cohort of patients managed by tendon debridement and autologous PRFM application to determine whether the combined treatment ensured an early return to sports/work and satisfactory clinical outcomes and functional scores. (2) Methods: The 24-month outcomes of 32 sport-practicing patients with chronic midportion AT treated with debridement and autologous PRFM were evaluated in terms of time to return to sports/work. The AOFAS and VISA-A were computed preoperatively and at 6 and 24 months. Blazina scores were evaluated preoperatively and at 6 months; ankle range of motion was assessed at 1, 6, 12, 24 months; and patient satisfaction was assessed at 24 months. (3) Results: Altogether, all patients had resumed their sport(s) activity, at the same or higher level, after 25.41 days (±5.37). Regarding work, all patients were able to return to their jobs after 16.41 days (±2.43). Ankle dorsiflexion and plantarflexion increased significantly: the AOFAS rose from 54.56 (±6.47) to 97.06 (±4.06) and 98.88 (±2.21) at 6 and 12 months, respectively, and the mean VISA-A score rose from 69.16 (±7.35) preoperatively to 95.03 (±4.67) and 97.28 (±2.43) at 6 and 12 months, respectively, after treatment. There were no complications. Most (90.62%) patients were very satisfied. (4) Conclusions: In symptomatic midportion AT, surgical debridement and autologous PRFM ensured a fast return to sports/work (4 weeks), significantly improving AOFAS and VISA-A and Blazina scores already at 6 months and providing excellent clinical outcomes at 24 months.

Epidemiology of insertional and midportion Achilles tendinopathy in runners: A prospective cohort study

BackgroundAchilles tendinopathy (AT) is a common problem among runners. There is only limited evidence for risk factors for AT, and most studies have not defined the AT subcategories. No study has compared the incidence and risk factors between insertional AT and midportion AT, though they are considered distinct. This study aimed to assess incidence and risk factors of AT based on data from a large prospective cohort. The secondary aim was to explore differences in risk factors between insertional and midportion AT. MethodsParticipants were recruited from among registered runners at registration for running events. Questionnaires were completed at baseline, 1 month before the event, 1 week before the event, and 1 month after the event. Information concerning demographics, training load, registered events, and running-related injuries were collected at baseline. The follow-up questionnaires collected information about new injuries. A pain map was used to diagnose midportion and insertional AT. The primary outcome was the incidence of AT. Multivariable logistic regression analysis was applied to identify risk factors for the onset. ResultsWe included 3379 participants with a mean follow-up of 20.4 weeks. The incidence of AT was 4.2%. The proportion of insertional AT was 27.7% and of midportion AT was 63.8%; the remaining proportion was a combined type of insertional and midportion AT. Men had a significantly higher incidence (5%, 95% confidence interval (95%CI): 4.1%–6.0%) than women (2.8%, 95%CI: 2.0%–3.8%). AT in the past 12 months was the most predominant risk factor for new-onset AT (odds ratio (OR) = 6.47, 95%CI: 4.27 –9.81). This was similar for both subcategories of AT (insertional: OR = 5.45, 95%CI: 2.51–11.81; midportion: OR = 6.96, 95%CI: 4.24–11.40). Participants registering for an event with a distance of 10/10.55 km were less likely to develop a new-onset AT (OR = 0.59, 95%CI: 0.36–0.97) or midportion AT (OR = 0.47, 95%CI: 0.23 –0.93). Higher age had a significant negative association with insertional AT (OR = 0.97, 95%CI: 0.94–1.00). ConclusionThe incidence of new-onset AT among recreational runners was 4.2%. The proportion of insertional and midportion AT was 27.7% and 63.8%, respectively. AT in the past 12 months was the predominant risk factor for the onset of AT. Risk factors varied between insertional and midportion AT, but we could not identify clinically relevant differences between the 2 subtypes.

Victorian Institute of Sport Assessment—Achilles thresholds for minimal important change and return to presymptom activity level in active soldiers with mid-portion Achilles tendinopathy

IntroductionMid-portion Achilles tendinopathy (mid-AT) is common in soldiers, significantly impacting activity levels and operational readiness. Currently, Victorian Institute of Sport Assessment—Achilles (VISA-A) represents the gold standard to evaluate pain and...

Combined Midportion Achilles and Plantaris Tendinopathy: A 1-Year Follow-Up Study after Ultrasound and Color-Doppler-Guided WALANT Surgery in a Private Setting in Southern Sweden.

Background and Objectives: Chronic painful midportion Achilles combined with plantaris tendinopathy can be a troublesome condition to treat. The objective was to prospectively follow patients subjected to ultrasound (US)- and color doppler (CD)-guided wide awake, local anesthetic, no-tourniquet (WALANT) surgery in a private setting. Material and Methods: Twenty-six Swedish patients (17 men and 9 women, mean age 50 years (range 29-62)) and eight international male patients (mean age of 38 years (range 25-71)) with combined midportion Achilles and plantaris tendinopathy in 45 tendons altogether were included. All patients had had >6 months of pain and had tried non-surgical treatment with eccentric training, without effect. US + CD-guided surgical scraping of the ventral Achilles tendon and plantaris removal under local anesthesia was performed on all patients. A 4-6-week rehabilitation protocol with an immediate full-weight-bearing tendon loading regime was used. The VISA-A score and a study-specific questionnaire evaluating physical activity level and subjective satisfaction with the treatment were used for evaluation. Results: At the 1-year follow-up, 32/34 patients (43 tendons) were satisfied with the treatment result and had returned to their pre-injury Achilles tendon loading activity. There were two dropouts (two tendons). For the Swedish patients, the mean VISA-A score increased from 34 (0-64) before surgery to 93 (61-100) after surgery (p < 0.001). There were two complications, one wound rupture and one superficial skin infection. Conclusions: For patients suffering from painful midportion Achilles tendinopathy and plantaris tendinopathy, US + CD-guided surgical Achilles tendon scraping and plantaris tendon removal showed a high satisfaction rate and good functional results 1 year after surgery.

Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis

Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented “some concerns”, and 37.5% (five and three articles, respectively) presenting “high risk” of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was − 1.21 (− 2.72 to − 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.

Differences in Recovery of Tendon Health Explained by Midportion Achilles Tendinopathy Subgroups: A 6-Month Follow-up.

OBJECTIVES: To (1) evaluate whether the defining characteristics of previously reported Achilles tendinopathy subgroups were reproducible in a cohort with midportion Achilles tendinopathy and (2) compare recovery trajectories and outcomes. DESIGN: Prospective single cohort study. METHODS: Participants (n = 114; 57 women; age [mean ± standard deviation]: 47 ± 12 years) received the Silbernagel protocol and were evaluated at baseline, and at 8, 16, and 24 weeks. Subgroups were identified using mixture modeling. Main effects of group and time, and interaction effects were evaluated using linear mixed models for 23 outcome measures representing symptoms, lower extremity function, tendon structure, psychological factors, and patient-related factors. Recovery trajectories were reported descriptively to reflect clinically meaningful change for outcomes. RESULTS: Activity-Dominant (n = 34), Function-Dominant (n = 38), Psychosocial-Dominant (n = 27), and Structure-Dominant (n = 15) subgroups were identified. There were significant effects of group and time for all primary outcome measures, except heel-rise and viscosity limb symmetry indexes. The Activity- and Function-Dominant subgroups achieved functional recovery despite persisting symptoms. The Psychosocial-Dominant subgroup reported the greatest impairments in symptom and foot- and ankle-related quality of life at all time points. The Structure-Dominant subgroup experienced delayed improvement in symptoms and was the only subgroup to not achieve structural recovery. No subgroup met our criteria for complete recovery. CONCLUSION: The defining characteristics of Achilles tendinopathy subgroups were reproduced in a cohort with midportion Achilles tendinopathy. The Activity- and Function-Dominant subgroups had superior outcomes compared to the Psychosocial- and Structure-Dominant subgroups for symptomatic, functional, and structural recovery. J Orthop Sports Phys Ther 2023;53(4):1-18. Epub: 23 January 2023. doi:10.2519/jospt.2023.11330.

“I’ve got a spring in my step” participants experience of action observation therapy and eccentric exercises, a telehealth study for mid-portion Achilles Tendinopathy: a qualitative study

BackgroundQuantitative research has dominated the field of Achilles Tendinopathy. The use of qualitative research allows in-depth exploration of participants’ perspectives, offering great insight in the evaluation of a trial’s processes, particularly when exploring a novel intervention such as Action Observation Therapy combined with eccentric exercises which has not been previously researched. This study aimed to qualitatively explore participants’ experiences of partaking in a telehealth study including the acceptability of the intervention, motivators for participation, and perspectives on the trial processes.MethodA thematic analysis as guided by Braun and Clarke was used to analyse the semi-structured interviews conducted on a purposive sample of participants with mid-portion Achilles Tendinopathy who recently completed a pilot feasibility study. The study adhered to the criteria for reporting qualitative research guidelines (COREQ).Results/DiscussionSixteen participants were interviewed. The five themes identified were: (i) The impact of Achilles Tendinopathy is commonly not prioritised with ‘The acceptance and minimisation of pain’ as a sub-theme (ii) Therapeutic alliance has the greatest impact on support (iii) Factors which influenced adherence (iv) Action Observation Therapy is valued and recommended (v) Recommendations for future interventions.ConclusionThis study provides insightful recommendations around; exploring the use of Action Observation Therapy in Achilles Tendinopathy, the relative importance of therapeutic alliance rather than mode of therapy delivery, and that sufferers of Achilles Tendinopathy may not prioritise health seeking for this condition.

Sonographic Appearance of a Midportion Achilles Tendinopathy in an Adult Who Underwent Achilles Tenotomy for Clubfoot.

Sonographic Appearance of a Midportion Achilles Tendinopathy in an Adult Who Underwent Achilles Tenotomy for Clubfoot.

The effect of combined Action Observation Therapy with eccentric exercises in the treatment of mid-portion Achilles-tendinopathy: a feasibility pilot randomised controlled trial

BackgroundMid-portion Achilles Tendinopathy (AT) is a common musculoskeletal condition with varying rehabilitation success rates. Despite the prevalence of this condition, a considerable proportion of individuals experience persisting pain and functional deficits. Current treatment approaches bias the biomedical model which emphasises physically treating and loading the tendon. Overall, there is a lack of consideration for the central nervous system that is commonly implicated in chronic injuries. The aim of this pilot study was to explore the feasibility of combining Action Observation Therapy (AOT), a treatment technique which targets central changes and influences motor learning, with eccentric exercises in the treatment of mid-portion AT. AOT involves the observation of movements and is commonly followed by the physical performance of these same movements.MethodologyThis was a double-blinded randomised controlled pilot feasibility study. All participants underwent the 12-week Alfredson eccentric training protocol. The intervention group watched videos of the exercises prior to performing these exercises, whilst the control group watched nature videos before performing the same exercises. Study feasibility was the primary outcome measure, with the Victorian Institute of Sports Assessment- Achilles (VISA-A) selected as the primary clinical outcome measure.ResultsThirty participants were recruited, reflecting a 75% eligibility rate and 100% of eligible participants enrolled in the study. The retention rate at week 12 was 80%. At week six the mean VISA-A score improved by 18.1 (95% CI 10.2–26.0) in the intervention group and 7.7 (95% CI 0.3–14.9) in the control group, and 75% and 33% of participants in the intervention and control group respectively exceeded the minimal clinically important difference (MCID). At week 12 the mean VISA-A score from baseline improved by 22.25 (95% CI 12.52–31.98) in the intervention group and 16.5-(95% CI 8.47–24.53) in the control group, equating to 75% and 58% in each group respectively exceeding the MCID.ConclusionThe positive feasibility outcomes and exploratory data from the clinical outcome measures suggest that a larger scaled RCT is warranted to further investigate the impact of AOT in the rehabilitation of mid-portion AT.Trial registration ISRCTN58161116, first registered on the 23/12/2020.

The Outcomes of Conservative Nonpharmacological Treatments for Achilles Tendinopathy: An Umbrella Review

Achilles tendinopathy (AT) is the most common injury of the Achilles tendon and represents 55–65% of all Achilles tendon clinical diagnoses. AT is characterized by pain, swelling, and impaired performance. ATs can be divided into two types, according to anatomical location—midportion AT (MAT) and insertional AT (IAT). MAT more often occurs in older, less active, and overweight populations, while IAT usually occurs in the more physically active population. Both types of AT can be treated by different treatments, such as surgery, conservative pharmacological treatments, and conservative nonpharmacological treatments. This umbrella review aims to assemble the evidence from all available systematic reviews and/or meta-analyses to determine which conservative nonpharmacological treatments are most commonly used and have the greatest effects. Three major electronic scientific databases (PubMed, Scopus, and Web of Science) were screened. The reference lists of several recent articles on AT were also searched. We found 50 articles that met the inclusion criteria. The methodological quality of the included articles was assessed using the AMSTAR 2 tool. Eccentric (ECC) exercise, isotonic (ISOT) exercise, and acupuncture treatment showed the greatest effects for treating MAT as a standalone therapy. Meanwhile, extracorporeal shockwave therapy and ECC exercise provided the best outcomes for treating IAT as individual treatments. However, an even greater pain decrease, greater function improvement, and greater patient satisfaction for treating either MAT or IAT were achieved with combined protocols of ECC exercise with extracorporeal shockwave therapy (in both cases), ECC exercise with cold air and high-energy laser therapy (in the case of IAT), or ECC exercise with ASTYM therapy (in the case of IAT).

Exercise rehabilitation for mid-portion Achilles tendinopathy: a critique of evidence and assumptions (PhD Academy Award)

Exercise rehabilitation for mid-portion Achilles tendinopathy: a critique of evidence and assumptions (PhD Academy Award)

Lower motor unit discharge rates in gastrocnemius lateralis, but not in gastrocnemius medialis or soleus, in runners with Achilles tendinopathy: a pilot study.

Deficits in muscle performance could be a consequence of a reduced ability of a motor neuron to increase the rate in which it discharges. This study aimed to investigate motor unit (MU) discharge properties of each triceps surae muscle (TS) and TS torque steadiness during submaximal intensities in runners with Achilles tendinopathy (AT). We recruited runners with (n = 12) and without (n = 13) mid-portion AT. MU discharge rate was analysed for each of the TS muscles, using high-density surface electromyography during 10 and 20% isometric plantar flexor contractions. MU mean discharge rate was lower in the gastrocnemius lateralis (GL) in AT compared to controls. In AT, GL MU mean discharge rate did not increase as torque increased from 10% peak torque, 8.24 pps (95% CI 7.08 to 9.41) to 20%, 8.52 pps (7.41 to 9.63, p = 0.540); however, in controls, MU discharge rate increased as torque increased from 10%, 8.39 pps (7.25-9.53) to 20%, 10.07pps (8.89-11.25, p < 0.001). There were no between-group difference in gastrocnemius medialis (GM) or soleus (SOL) MU discharge rates. We found no between-group differences in coefficient of variation of MU discharge rate in any of the TS muscles nor in TS torque steadiness. Our data demonstrate that runners with AT may have a lower neural drive to GL, failing to increase MU discharge rate to adjust for the increase in torque demand. Further research is needed to understand how interventions focussing on increasing neural drive to GL would affect muscle function in runners with AT.