The Limited Effectiveness of a Home-Based Eccentric Training for Treatment of Achilles Tendinopathy

Abstract

Purpose: Objective was to evaluate the outcome of a standardized heavy load eccentric training program in adults with chronic painful Achilles tendinopathy, and the presence of increased Colour Doppler activity in diseased and non-diseased adults. e hypothesis was that patient satisfaction would fall within the range of average satisfaction present in the literature (60 to 90%).Methods: Twenty patients were instructed on a training program based on the Alfredson protocol of straight leg followed by bent knee heel drops and raises. Patient satisfaction was recorded as the primary outcome. Secondary outcomes included the VISA-A and Tegner scales. Twenty one subjects without present or history of lower extremity pain and seven patients presenting at the clinic but without Achilles tendinopathy were included as controls.Results: Patient satisfaction was signi cantly lower when compared to the literature as two patients reported that they were satis ed with the treatment while the remaining 15 reported that they were unsatis ed. ree patients were excluded from the analysis as they were unable to complete the exercises. Increased Colour Doppler activity was present in only one participant without the disease and in all patients with the disease at the end of the study (increased Colour Doppler activity was present in 40% of patients with the disease at the beginning of the study). Conclusion:Although some patients' symptoms improved over time, eccentric training did not satisfy patient expectations of improvement following treatment despite compliance with the home based program. Although it is a mainstay of treatment, other options, which are both e cacious and e ective, need to be provided for patients who prefer a conservative and relatively non-invasive treatment option from the start.

Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid injections in a clinical setting

“…However, we do not think that a more aggressive training program would have increased the success rate, as many of the patients could not increase the training according to the protocol because of pain. In another clinical study, only 10% had satisfactory effect of home‐based training alone (Ram et al., ). In many efficacy studies, patients are required to complete a minimum of 75% of the exercises.…”

“…In every day life in a normal clinical setting, ideal circumstances are not likely, and we expect that a larger proportion than 10–40% will not benefit from these treatments. In a recent study on the effectiveness of a home exercise program consisting of eccentric training, only 10% of AT patients improved (Ram et al., ). No studies describe the differences between the ideal circumstances in efficacy studies and the circumstances in a usual clinical setting, but the cost of physiotherapy to either the patient or the society, convenience of training at home rather than going frequently to a physiotherapy clinic, compromised compliance in the case of improvement or deterioration of symptoms are among the possible reasons.…”

Altered Strength Profile in Achilles Tendinopathy: A Systematic Review and Meta-Analysis

“…A total of 11 studies were removed after screening of the full texts. 3,[29][30][31][32][33][34][35][36][37][38] Searching the reference lists of these full-text studies led to the addition of 1 study. 39 The final number of studies reviewed was 19.…”

Fortalecimiento excéntrico en tendinopatías del manguito de los rotadores asociadas a pinzamiento subacromial. Evidencia actual

“…El tratamiento con entrenamiento muscular excéntrico es definido por algunos autores como doloroso, e incluso se utiliza el término «painful eccentric muscle training» o entrenamiento muscular excéntrico doloroso; dicho programa ha dado resultados clínicos positivos en pacientes con tendinopatía aquílea crónica, en los cuales se han enconestructurales favorables del tendón 21,22 , aunque existen reportes recientes con resultados contrarios, que muestran limitada efectividad del tratamiento 23,24 , por lo que su utilidad aún es controversial. Algunos ejemplos de ejercicios por contracción excéntrica para deltoides, supraespinoso y Fortalecimiento excéntrico en lesiones de manguito rotador y pinzamiento subacromial Con el objetivo de evaluar la evidencia existente sobre tías del manguito rotador, se realizó una búsqueda en la base de datos electrónica de Pubmed en la que se incluyeron los términos «tendon», «tendinopathy», «tendinitis», «eccentric», «rotator cuff» y «resistance training», combinando uno de los 3 primeros con cada uno de los 3 restantes.…”