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

Abstract

Background Mid-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. Methodology This 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. Results Thirty 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. Conclusion The 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.

“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

“…This was a qualitative follow-up study undertaken on a group of participants from a previous pilot feasibility randomised controlled trial which explored the effect of Action Observation Therapy with Eccentric loading in the treatment of mid-portion AT over the course of 12- weeks [ 19 ]. Two groups of participants with mid-portion Achilles Tendinopathy were compared; the intervention group watched videos of the eccentric exercises to be performed prior to performing the same exercises, while the control group watched videos of landscapes before performing the two same eccentric exercises.…”

Cortical activation of neuromuscular electrical stimulation synchronized mirror neuron rehabilitation strategies: an fNIRS study

“…Therefore, it is possible to improve the brain activation area and amplitude by combing NMES with other top-down and active rehabilitation strategies or methods, thus making full use of the rehabilitation time window to achieve better treatment effects, especially for early rehabilitation phases. The mirror neuron system (MNS) plays a key role in the neural mechanism underlying motor learning-related neural plasticity, and a series of rehabilitation strategies and treatment techniques based on MNS theory have been widely applied in patients with neurological conditions and musculoskeletal disease (13,14). Mirror Neuron (MN) is a special type of neuron that is activated not only when a primate performs a movement, but also when the same or comparable action is seen (15).…”

“…In physical therapy practice, the above MNS-based rehabilitation strategies are usually used in combination. For example, observation and following the performance of target movements are commonly used in therapeutic exercise practice (14). In addition, a published article showed that brain regions activated by NMES and FES overlap with the cortical areas that participate in AE and MI processes (9,25).…”

Comparison of Adaptations in the Gastrocnemius Muscle from an Exercise Program with and without Low-Intensity Blood Flow Restriction Banding in 18 Male Amateur Basketball Players Aged 16-45 Years

“…This was a double-blind, randomized controlled trial focused on the effectiveness or differences between the eccentric exercise protocol and low-intensity flow-restricted training. The CONSORT 2016 guideline for randomized clinical trials was used [25].…”