The Majority of Patients With Achilles Tendinopathy Recover Fully When Treated With Exercise Alone

Silbernagel, Karin Grävare; Brorsson, Annelie; Lundberg, Mari

doi:10.1177/0363546510384789

Cited by 146 publications

(147 citation statements)

References 33 publications

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“…A recent case series found that a majority of patients showed improved symptoms with up to ve years of treatment -too long a time frame for many patients [35]. Eccentric exercises may provide adequate relief of symptoms if there is constant supervision by a healthcare professional; however, it is not e ective for patients to use as a treatment otherwise.…”

Section: Discussionmentioning

confidence: 99%

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

Ram

Meeuwisse²,

Patel³

et al. 2013

CIM

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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.

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Section: Discussionmentioning

confidence: 99%

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

Ram

Meeuwisse²,

Patel³

et al. 2013

CIM

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“…59 Some athletes may develop fear-avoidance behavior, which has been associated with poorer functional outcomes in individuals with lower-limb tendinopathy. 82 Education about pain and realistic time frames for rehabilitation are important. This includes education regarding the potential link between psychosocial factors and pain.…”

Section: Inaccurate Beliefs and Expectations About Painmentioning

confidence: 99%

Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations

Malliaras¹,

Cook²,

Purdam³

et al. 2015

J Orthop Sports Phys Ther

225

204

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® T t SYNOPSIS:The hallmark features of patellar tendinopathy are (1) pain localized to the inferior pole of the patella and (2) load-related pain that increases with the demand on the knee extensors, notably in activities that store and release energy in the patellar tendon. While imaging may assist in differential diagnosis, the diagnosis of patellar tendinopathy remains clinical, as asymptomatic tendon pathology may exist in people who have pain from other anterior knee sources. A thorough examination is required to diagnose patellar tendinopathy and contributing factors. Management of patellar tendinopathy should focus on progressively developing load tolerance of the tendon, the musculoskeletal unit, and the kinetic chain, as well as addressing key biomechanical and other risk factors. Rehabilitation can be slow and sometimes frustrating. This review aims to assist clinicians with key concepts related to examination, diagnosis, and management of patellar tendinopathy. Difficult clinical presentations (eg, highly irritable tendon, systemic comorbidities) as well as common pitfalls, such as unrealistic rehabilitation time frames and overreliance on passive treatments, are also discussed. J Orthop Sports Phys Ther 2015;45(11):887-898. Epub 21 Sep 2015. doi:10.2519/jospt.2015 can induce pathology and a change in the tendon's mechanical properties, which is a risk factor for developing symptoms. 17,61 Energy-storage load is defined in this article as high tendon load, because it is associated with tendon injury.Although the relationship between pain and tendon pathology is unclear, the presence of pathology appears to be a risk factor for an individual becoming symptomatic.17,61 Thus, it is important for clinicians to have an appreciation of tendon pathology. Briefly, tendon pathology includes increases in tenocyte numbers and rounding, and in ground substance expression, causing swelling, matrix degradation, and neovascular ingrowth. 53,58 These changes have been extensively reviewed elsewhere.

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“…The total exercise volume would be much higher over a longer period (eg, 1-5 years) and may be associated with clinical improvements. 29,35 It would be of interest for future research to investigate the long-term influence of repetition volume on clinical progress. Between-Group Results In the present study, with both ITT and PP analyses there was a statistically significant between-group difference in VISA-A [ research report ] scores at week 3.…”

Section: Visa-a and Pain Scoresmentioning

confidence: 99%

“…This potential clinical predictor could simply be based on the aggravation of symptoms or a heuristic process used by patients who have shown optimal clinical improvements. For example, Silbernagel et al 29 used a pain-monitoring model to help with exercise adherence and to prevent overloading and underloading of the tissue. Such a strategy may allow patients to take a more active role in the management of their condition.…”

Section: Eccentric-exercise Loadmentioning

confidence: 99%

Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial

Stevens

Tan²

2014

J Orthop Sports Phys Ther

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The Majority of Patients With Achilles Tendinopathy Recover Fully When Treated With Exercise Alone

Cited by 146 publications

References 33 publications

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

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

Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations

Effectiveness of the Alfredson Protocol Compared With a Lower Repetition-Volume Protocol for Midportion Achilles Tendinopathy: A Randomized Controlled Trial

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