Conservative management of midportion achilles tendinopathy: A mixed methods study, integrating systematic review and clinical reasoning

Sports Medicine

Volumn 42, Issue 11, 2012, Pages 941-967

  Rowe, Victoria ^a   Hemmings, Stephanie ^a   Barton, Christian ^a   Malliaras, Peter ^a   Maffulli, Nicola ^a   Morrissey, Dylan ^a  

^a ROYAL LONDON HOSPITAL   (United Kingdom)

Author keywords

Ankle injuries; exercise performance; inflammation; sports; sports injuries; sports medicine

Indexed keywords

ACHILLES TENDON; ANALGESIA; FEMALE; FOOT ORTHOSIS; HEALTH CARE SURVEY; HUMAN; INJURY; KINESIOTHERAPY; LOW LEVEL LASER THERAPY; MALE; METHODOLOGY; REVIEW; TENDINITIS; TREATMENT OUTCOME;

ACHILLES TENDON; EXERCISE THERAPY; FEMALE; FOOT ORTHOSES; HEALTH CARE SURVEYS; HUMANS; LASER THERAPY, LOW-LEVEL; MALE; PAIN MANAGEMENT; TENDINOPATHY; TREATMENT OUTCOME;

EID: 84867292117     PISSN: 01121642     EISSN: 11792035     Source Type: Journal    
DOI: 10.2165/11635410-000000000-00000     Document Type: Review

References (73)

1. Longo UG, Ronga M, Maffulli N, et al. Achilles tendinopathy. Sports Med Arthrosc 2009; 17 (2): 112-26
2. Kingma JJ, de Knikker R, Wittink HM. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med 2001; 41(6): e3 [online]. Available from URL: http://bjsm.bmj.com/content/ 41/6/e3.full [Accessed 2011 Feb 21]
3. Munteanu SE, Barton CJ. Lower limb biomechanics during running in individuals with Achilles tendinopathy: a systematic review. J Foot Ank Res 2011; 4: 15
4. Ames PR, Longo UG, Denaro V, et al. Achilles tendon problems: not just an orthopaedic issue. Disabil Rehabil 2008; 30 (20-22): 1646-50
5. Gaida JE, Alfredson L, Kiss ZS, et al. Dyslipidemia in Achilles tendinopathy is characteristic of insulin resistance. Med Sci Sports Exerc 2009; 41 (6): 1194-7
6. Maffulli N, Longo UG, Denaro V. Novel approaches for the management of tendinopathy. J Bone Joint Surg Am 2010; 92: 2604-13
7. Chan O, O'Dowd D, Padhiar N, et al. High volume image guided injections in chronic Achilles tendinopathy. Disabil Rehabil 2008; 30 (20-22): 1697-708
8. Alfredson H. Where to now with Achilles tendon treatment? Br J Sports Med 2011; 45 (5): 386
9. Bohu Y, Lefèvre N, Bauer T, et al. Surgical treatment of Achilles tendinopathies in athletes: multicenter retrospective series of open surgery and endoscopic techniques. Orthop Traumatol Surg Res 2009; 95 (8): 172-7
10. Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med 2009; 19 (1): 54-64
11. Atkinson K, Ajjawi R, Cooling N. Promoting clinical reasoning in general practice trainees: role of the clinical teacher. Clin Teach 2011; 8 (3): 176-80
12. Ryu YU, Park J. Medical and narrative use of physical therapy knowledge in clinical reasoning by Korean physical therapists. J Phy Ther Sci 2011; 23 (2): 251-4
13. Physiotherapy Evidence Database. PEDro Scale [online]. Available from URL: http://www.pedro.org.au/english/downloads/pedro-scale/[Accessed 2011 Feb 22]
14. Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomised controlled trials. Phys Ther 2008; 88 (8): 718-21
15. van Tulder M, Furlan A, Bombardier C, et al. Updated method guidelines for systematic reviews in the Cochrane back review group. Spine 2003; 28 (12): 1290-9 (Pubitemid 36734620)
16. Lewis J, Ritchie J, editors. Qualitative research practice: a guide for social science students and researchers. London: SAGE Publications Ltd, 2003
17. Mays N, Pope C. Qualitative research in healthcare: analysing qualitative data. 2nd ed. London: BMJ Books, 1999
18. Mays N, Pope C. Qualitative research in healthcare: assessing quality in qualitative research. BMJ 2000; 320: 50-2 (Pubitemid 30173021)
19. Rompe JD, Nafe B, Furia J, et al. Eccentric loading, shockwave treatment, or a wait-and-see policy for tendinopathy of the main body of the tendo achilles: a randomised control trial. Am J Sports Med 2007; 35 (3): 374-83 (Pubitemid 46280497)
20. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomised control trial. Am J Sports Med 2009; 37 (3): 463-70
21. Rasmussen S, Christensen M, Mathiesen I, et al. Shockwave therapy for chronic achilles tendinopathy: a double-blind, randomised clinical trial of efficacy. Acta Orthop Scand 2008; 79 (2): 249-56 (Pubitemid 351878357)
22. Tumilty S, Munn J, Abbott JH, et al. Laser therapy in the treatment of achilles tendinopathy: a pilot study. Photomed Laser Surg 2008; 26 (1): 25-30 (Pubitemid 351206153)
23. Silbernagel KG, Thomee R, Eriksson BI, et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with achilles tendinopathy. Am J Sports Med 2007; 35 (6): 897-906 (Pubitemid 46956302)
24. Yelland MJ, Sweeting KR, Lyftogt JA, et al. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. Br J Sports Med 2011; 45 (5): 421-8
25. Langberg H, Ellingsgaard H, Madsen T, et al. Eccentric rehabilitation exercise increases peritendinous type I collagen synthesis in humans with Achilles tendinosis. Scand J Med Sci Sports 2007; 17 (1): 61-6
26. Silbernagel KG, Thomeé R, Thomeé P, et al. Eccentric overload training for patients with chronic Achilles tendon pain: a randomised control study with reliability testing of the evaluation methods. Scand J Med Sci Sports 2001; 11 (4): 197-206 (Pubitemid 33643506)
27. Knobloch K, Schreibmueller L, Kraemer R, et al. Eccentric training and an Achilles wrap reduce Achilles tendon capillary blood flow and capillary venous filling pressures and increase tendon oxygen saturation in insertional and midportion tendinopathy: a randomized trial.AmJ Sports Med 2006; doi: 10.1177/0363546506295700 [online]. Available from URL: http://ajs.sagepub.com/ content/early/2006/12/27/0363546506295700.full.pdf [Accessed 2012 Aug 29]
28. Knobloch K, Kraemer R, Jagodzinski M, et al. Eccentric training decreases paratendon capillary blood flow and preserves paratendon oxygen saturation in chronic Achilles tendinopathy. J Orthop Sports Phys Ther 2007; 37 (5): 269-76
29. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for chronic non-insertional Achilles tendinopathy. Am J Sports Med 2008; 36 (3): 502-8 (Pubitemid 351253394)
30. Stergioulas A, Stergioula M, Aarskog R, et al. Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic Achilles tendinopathy. Am J Sports Med 2008; 36 (5): 881-7 (Pubitemid 351551243)
31. Chester R, Costa ML, Shepstone L, et al. Eccentric calf muscle training compared with therapeutic ultrasound for chronic Achilles tendon pain: a pilot study.Man Ther 2008; 13: 484-91
32. Costa M, Shepstone L, Donell S, et al. Shock wave therapy for chronic Achilles tendon pain. Clin Orthop Relat Res 2005; 440: 199-204
33. Kane TPC, Ismail M, Calder JDF. Topical glyceryl trinitrate and non-insertional achilles tendinopathy. Am J Sports Med 2008; 36 (6): 1160-3
34. Paoloni JA, Appleyard RC, Nelson J, et al. Topical glyceryl trinitrate treatment of chronic non-insertional Achilles tendinopathy. J Bone Joint Surg Am 2004; 86: 916-22
35. Paoloni JA, Murrell GAC. Three year follow-up study of topical glyceryl trinitrate treatment of chronic non-insertional Achilles tendinopathy. Foot Ankle Int 2007; 28 (10): 1064-8 (Pubitemid 47536047)
36. de Vos RJ, Weir A, Visser RJA, et al. The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: a randomised control trial. Br J Sports Med 2007: 41; e5 [online]. Available from URL: http://bjsm.bmj.com/content/41/7/e5.long?ath-user=qmw. 18685900b6960100&ath-ttok=%3CTY3HrKNHg8ed9r%2 Bm1Q%3E [Accessed 2011 Mar 26]
37. de Jonge S, de Vos RJ, Van Schie HTM, et al. One-year follow-up of a randomised controlled trial on added splinting to eccentric exercises in chronic mid-portion Achilles tendinopathy. Br J Sports Med 2010; 44: 673-7
38. Roos E, Engström M, Largerquist A, et al. Clinical improvement after 6 weeks of eccentric exercises in patients with mid-portion Achilles tendinopathy: a randomised trial with 1-year follow-up. Scand J Med Sci Sports 2004; 14: 286-95 (Pubitemid 39360653)
39. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf-muscle training compared to concentric training in a randomised prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc 2001; 9: 42-7 (Pubitemid 33684587)
40. van der Plas A, de Jonge S, de Vos RJ, et al. A 5-year followup study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med 2012; 46 (3): 214-8
41. Croisier J, Forthomme B, Foidart-Dessalle M, et al. Treatment of recurrent tendinitis by isokinetic eccentric exercises. Isokinet Exerc Sci 2001; 9: 133-41 (Pubitemid 34155590)
42. Alfredson H, Lorentzon R. Intra-tendinous glutamate levels and eccentric training in chronic Achilles tendinosis: a prospective study using microdialysis technique. Knee Surg Sports Traumatol Arthrosc 2003; 11 (3): 196-9 (Pubitemid 38249647)
43. Knobloch K, Schreibmueller L,Kraemer R, et al. Gender and eccentric training in Achilles mid-portion tendinopathy. Knee Surg Sports Traumatol Arthrosc 2010; 18 (5): 648-55
44. Knobloch K. Eccentric training in Achilles tendinopathy: is it harmful to tendon micro-circulation [abstract]. Br J Sports Med 2007; 41: e2
45. Gardin A, Movin T, Svensson L, et al. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis. Skeletal Radiol 2010; 39 (5): 435-42
46. Maffulli N, Walley G, Sayana MK, et al. Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disabil Rehabil 2008; 30 (20-22): 1677-84
47. Herrington L, McCulloch R. The role of eccentric training in the management of Achilles tendinopathy: a pilot study. Phys Ther Sport 2007: 8; 191-6 (Pubitemid 47611593)
48. Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with achilles tendinopathy. J Sci Med Sport 2007; 10: 52-8 (Pubitemid 44909046)
49. Ohberg L, Lorentzon R, Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. Br J Sports Med 2004; 38 (1): 8-11 (Pubitemid 38183592)
50. Nørregaard J, Larsen C, Bieler H, et al. Eccentric exercise in treatment of Achilles tendinopathy. Scand J Med Sci Sports 2007; 17: 133-8
51. Shalabi A, Kristoffersen-Wilberg M, Svensson L, et al. Eccentric training of the gastrocnemius-soleus complex ion chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med 2004; 32 (5): 1286-96 (Pubitemid 38970385)
52. Fahlström M, Jonsson P, Lorentzon R, et al. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc 2003; 11 (5): 327-33 (Pubitemid 38251123)
53. Alfredson H, Pietilä T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med 1998; 26 (3): 360-6 (Pubitemid 28248723)
54. Saxena A. Extra-corporeal pulsed-activated therapy ("EPAT" Sound Wave) for Achilles tendinopathy: a prospective study. J Foot Ankle Surg 2011; 50 (3): 315-9
55. Vulpiani MC, Trischitta D, Trovato P, et al. Extracorporeal shockwave therapy (ESWT) in Achilles tendinopathy: a long-term follow-up observational study. J Sports Med Phys Fitness 2009; 49 (2): 171-6
56. Lakshmanan P, O'Doherty DP. Chronic Achilles tendinopathy: treatment with extracorporeal shock waves. Foot Ankle Surg 2004; 10 (3): 125-30 (Pubitemid 39149690)
57. Knobloch K, Schreibmueller L, Longo UG, et al. Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without the Airheel brace: a randomised control trial; effects on pain and microcirculation. Disabil Rehabil 2008; 30 (20-22): 1685-91
58. Peterson W, Welp R, Rosenbaum D. Chronic Achilles tendinopathy: a prospective randomised study comparing the therapeutic effect of eccentric training, the Airheel brace and a combination of both. Am J Sports Med 2007; 35 (10): 1659-67 (Pubitemid 47476054)
59. Silbernagel KG, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone. Am J Sports Med 2011; 39 (3): 607-13
60. Mayer F, Hirschmü ller A, Müller S et al. Effects of shortterm treatment strategies over 4 weeks in Achilles tendinopathy. Br J Sports Med 2007; 41(7): e6 [online]. Available from URL: http://bjsm.bmj.com/content/41/7/ e6.full.pdf [Accessed 2011 Jan 2]
61. Niesen-Vertommen SL, Taunton JE, Clement DB, et al. The effect of eccentric versus concentric exercise in the management of Achilles tendonitis. Clin J Sport Med 1992; 2 (2): 109-13
62. Smith M, Brooker S, Vicenzino B, et al. Use of antipronation taping to assess suitability of orthotic prescription: case report. Aust J Physiother 2004; 50 (2): 111-3 (Pubitemid 38811970)
63. Firth BL, Dingley P, Davies ER, et al. The effect of kinesiotape on function, pain and motoneuronal excitability in healthy people and people with Achilles tendinopathy. Clin J Sport Med 2010; 20 (6): 416-21
64. Christenson RE. Effectiveness of specific soft tissue mobilizations for the management of Achilles tendinosis: single case study-experimental design. Man Ther 2007; 12 (1): 63-71 (Pubitemid 46201920)
65. Verrall G, Schofield S, Brustad T. Chronic Achilles tendinopathy treated with eccentric stretching programme. Foot Ankle Int 2011; 32 (9): 843-9
66. Niesen-Vertommen SL, Taunton JE, Clement DB, et al. The effect of eccentric versus concentric exercise in the management of Achilles tendonitis. Clin J Sport Med. 1992; 2: 109-13
67. Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res. 1986 Jul; (208): 65-8 (Pubitemid 16049770)
68. Roles NC. Radial tunnel syndrome: resistant tennis elbow as nerve entrapment. J Bone Joint Surg Br 1972; 54 (3): 499-508
69. Robinson JM, Cook JL, Purdam C, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 2001; 35: 335-41 (Pubitemid 32929821)
70. Schulz KF, Altman DG, Moher D, for the CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ 2010; 340: c332
71. Eliasson P, Andersson T, Aspenberg P. Achilles tendon healing in rats is improved by intermittent mechanical loading during the inflammatory phase. J Orthop Res 2012; 30 (2): 274-9
72. Hunter G. The conservative management of Achilles tendinopathy. Phys Ther Sport 2000; 1: 6-14
73. Mays N, Pope C. Qualitative research: rigor and qualitative research. BMJ 1995; 311: 109