Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of Achilles tendinopathy, but whether they have any additive clinical effect on physical rehabilitation in the early phase of tendinopathy remains unknown. Purpose/Hypothesis: To investigate whether an initial short-term NSAID treatment added to a physical rehabilitation program in the early phase of Achilles tendinopathy would have an additive effect. We hypothesized that the combination of NSAID and rehabilitation would be superior to rehabilitation alone. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 69 patients with early phase Achilles tendinopathy (lasting <3 months) were randomly assigned to either a naproxen group (7 days of treatment; 500 mg twice daily; n = 34) or a placebo group (7 days of placebo treatment; n = 35). Both groups received an identical 12-week physical rehabilitation program. The clinical outcome of the study was evaluated using the Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire and a numerical rating scale (NRS), and the physiological outcome was evaluated using ultrasonography, magnetic resonance imaging (MRI), and ultra-short time to echo T2* mapping MRI (UTE T2* MRI). Follow-up was performed at 1 week, 3 months, and 1 year. Time effects are presented as mean difference ± SEM. Results: No significant differences were found between the 2 treatment groups for any of the outcome measures at any time point ( P > .05). For the VISA-A score, a significant time effect was observed between baseline and 3-month follow-up (14.9 ± 2.3; P < .0001), and at 1-year follow-up, additional improvements were observed (6.1 ± 2.3; P < .01). Furthermore, the change in VISA-A score between baseline and 3-month follow-up was greater in patients with very short symptom duration (<1 month) at baseline compared with patients who had longer symptom duration (>2 months) (interaction between groups, 11.7 ± 4.2; P < .01). Despite clinical improvements, total weekly physical activity remained lower compared with preinjury levels at 3 months (–2.7 ± 0.5 h/wk; P < .0001) and 1 year (–3.0 ± 0.5 h/wk; P < .0001). At baseline, ultrasonography showed increased thickness (0.12 ± 0.03 cm; P < .0001) and vascularity (0.3 ± 0.1 cm2; P < .005) on the tendinopathic side compared with the contralateral side, but no changes over time were observed for ultrasonography, MRI, or UTE T2* MRI results. Conclusion: Clinical symptoms in early tendinopathy improved with physical rehabilitation, but this improvement was not augmented with the addition of NSAID treatment. Furthermore, this clinical recovery occurred in the absence of any measurable structural alterations. Finally, clinical improvements after a physical rehabilitation program were greater in patients with very short symptom duration compared with patients who had longer symptom duration. Registration: NCT03401177 (ClinicalTrials.gov identifier) and BFH-2016-019 (Danish Data Protection Agency)

Achilles tendinopathy (AT) is associated with pain and altered ultrasound (US) and color Doppler (CD) findings. However, the relationship between them is equivocal, perhaps because previous studies have only used the VISA‐A scale as the measure of tendon pain. To determine the relationship between tendon US and CD findings and self‐reported pain using the VISA‐A, Short‐form McGill Pain Questionnaire (sf‐MPQ), and Short‐form Brief Pain Inventory (sf‐BPI). Recreational athletes with AT rated their tendon pain on the VISA‐A, sf‐MPQ, and sf‐BPI. The Achilles tendons of runners with (TEN, n = 127) and without tendinopathy (CON, n = 103) were examined using conventional grayscale ultrasound and CD settings. Participants with AT had thicker tendons (mm) (median [IQR]) [TEN‐ 6.2 (5.3‐7.9) vs CON 5.5 (4.8; 6.0)] (P < 0,001); abnormal tendon ultrasound appearances (P = .001); and more neovessels than healthy controls (P < .001). No differences were noted between tendon pain scores and US or CD abnormalities (P > .05). Tendinopathy is associated with US and CD changes that may be of some prognostic value. The mismatch between patient‐reported symptoms and US and CD findings could be indicative of the need to standardize US and CD protocols in order to enhance comparisons across the studies.