Autoregulated Combined Resistance Training for Plantar Heel Pain in Athletes: Protocol for a Feasibility Prospective Cohort Study

Abstract

Background: Musculoskeletal disorders such as tendinopathy are having an increasing burden on society and health systems. Plantar heel pain (PHP) is considered a tendinopathy and it affects up to 10% of the population, having a high incidence in running athletes. Although resistance training has shown short-term effectiveness for treating PHP, more comprehensive exercise protocols and progression methods are needed due to poor long-term outcomes. Combining heavy slow resistance training with other types of exercise, such as plyometric exercise could lead to superior outcomes. It is recommended that PHP not be treated by one exercise type in isolation. However, studies often use only one type of exercise, with there being a need to investigate feasibility and effectiveness of comprehensive exercise programs in PHP. Resistance training programs in PHP are currently not achieving required intensity and dosage, leading to high recurrence rates. Therefore, better methods for progressing resistance training are required to improve outcomes. One potential method is autoregulation, which allows individuals to progress at their own rate, taking individual factors into account. Despite being found effective in increasing strength in healthy athletes, autoregulation methods have not been investigated in tendinopathy. Methods: A feasibility cohort study investigating a comprehensive exercise program for PHP could test feasibility and acceptability, prior to conducting a larger-scale study. A feasibility study would also help to determine if specific autoregulation progression methods for resistance training is feasible and acceptable for use with PHP patients. Patients expectations, and views on feasibility and acceptability of different types of exercise as well as autoregulation progression methods for PHP are unknown. Therefore, the addition of qualitative interviews in a mixed methods format would help ascertain acceptability of these methods and exercise interventions for the first time and help explain the intervention outcomes, allowing for design of a larger-scale study to determine effectiveness.