Current Clinical Concepts: Conservative Management of Achilles Tendinopathy

Silbernagel, Karin Grävare; Hanlon, Shawn; Sprague, Andrew L

doi:10.4085/1062-6050-356-19

Cited by 121 publications

(156 citation statements)

References 52 publications

(122 reference statements)

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“…Other investigators have proposed extended interventions to aid patients in return to sports. 27 Such interventions potentially could have optimized return to sports but were not implemented in the current study. However, we did encourage patients to gradually return to their usual level of physical activity.…”

Section: Discussionmentioning

confidence: 99%

No Additive Clinical or Physiological Effects of Short-term Anti-inflammatory Treatment to Physical Rehabilitation in the Early Phase of Human Achilles Tendinopathy: A Randomized Controlled Trial

et al. 2021

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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)

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Section: Discussionmentioning

confidence: 99%

No Additive Clinical or Physiological Effects of Short-term Anti-inflammatory Treatment to Physical Rehabilitation in the Early Phase of Human Achilles Tendinopathy: A Randomized Controlled Trial

et al. 2021

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“…Furthermore, exercise is likely to have many other, general positive impacts for the patient that will not occur with medication use [29]. Finally, if patients had strategies to independently manage their pain, it may improve adherence with any further rehabilitation [30]. This study differs from a previous case series study [9] investigating the efficacy of isometric exercise in Achilles tendinopathy in several respects.…”

Section: Interventionmentioning

confidence: 99%

Immediate Effects of two Isometric Calf Muscle Exercises on Mid-portion Achilles Tendon Pain

et al. 2021

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The objectives of this randomized, cross-over pilot study were to determine whether isometric plantarflexion exercises resulted in an immediate change in Achilles tendon pain during a loading task, and whether this differed in knee extension or flexion. Eleven participants with mid-portion Achilles tendinopathy were recruited from NHS community physiotherapy services and local running clubs. Participants were then randomized to complete an isometric calf muscle exercise with the knee fully extended or flexed to 80°. Participants switched to the alternate exercise after a minimum seven-day period. Achilles tendon pain during a specific, functional load test was measured on a 11-point numeric pain rating scale (NPRS) pre- and post-intervention. There was a small, immediate, mean reduction in pain following isometric plantar flexion performed in both knee extension (1.6, 95%CI 0.83 to 2.45, p=0.001) and knee flexion (1.3, 95%CI 0.31 to 2.19, p=0.015). There were no significant differences between the two positions. A non-significant, potentially clinically relevant finding was a 20% larger reduction in symptoms in knee extension versus flexion (p=0.110). In conclusion, isometric plantarflexion holds gave an approximately 50% immediate reduction in Achilles tendon pain with a functional load test. There were no significant differences between the two positions and both were well tolerated.

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“…Tendinopathy has been classified pathologically as either (1) reactive, (2) dysrepair or (3) degenerative tendinopathy; the former two equivalent to an ‘acute’ state, and the latter to a persistent state (Cook & Purdam, 2009). The purpose of pathological classification is to guide management choices, by matching treatment to the stage of pathology in attempt to optimise clinical outcomes (Silbernagel, Hanlon, & Sprague, 2020). Acute management of any musculoskeletal injury is important as it influences both short and long‐term recovery (Bleakley et al, 2010; Lagas et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Conservative management of acute lower limb tendinopathies: A systematic review

Mitham¹,

Mallows

Debenham

et al. 2020

Musculoskeletal Care

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Background Most knowledge regarding conservative management for lower limb tendinopathy (LLT) is for persistent symptoms, with less known about conservative management of acute LLT. Sub‐optimal management of acute LLT is detrimental in many regards, not least the likely conversion to persistent symptoms. Objectives To synthesise existing literature on conservative management of acute LLTs. Design Systematic review of relevant literature (PROSPERO [ID: CRD42018117882]). Method A search was made of multiple databases (MEDLINE, CINAHL and EMBASE) using relevant search terms. Titles, abstracts and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction and quality assessment, using the Grading of Recommendations Assessment, Development and Evaluation, were done independently by two authors. To understand how the interventions impacted the duration of reported symptoms, results were split into three time points: short‐term (<4 weeks), medium‐term (4–12 weeks) and long‐term (>12 weeks). Results Thirteen studies (n = 534) met the criteria for inclusion. There was very low level of certainty for the effectiveness of interventions at short‐term, medium‐term and long‐term follow ups. However, there were large effects seen across a number of different treatments on pain intensity and disability in LLTs. Conclusions This review demonstrates that limited evidence currently exists to guide the management of acute LLT, and the quality of the existing evidence is collectively low. These findings inform the discussion of different treatment options with patients in a shared decision‐making process to empower and enable the patient.

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Current Clinical Concepts: Conservative Management of Achilles Tendinopathy

Cited by 121 publications

References 52 publications

No Additive Clinical or Physiological Effects of Short-term Anti-inflammatory Treatment to Physical Rehabilitation in the Early Phase of Human Achilles Tendinopathy: A Randomized Controlled Trial

No Additive Clinical or Physiological Effects of Short-term Anti-inflammatory Treatment to Physical Rehabilitation in the Early Phase of Human Achilles Tendinopathy: A Randomized Controlled Trial

Immediate Effects of two Isometric Calf Muscle Exercises on Mid-portion Achilles Tendon Pain

Conservative management of acute lower limb tendinopathies: A systematic review

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