Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis

Key Points

1. Eccentric exercise exhibited higher effectiveness in treating mid-portion Achilles tendinopathy compared to other exercise modalities.
2. Clinicians can confidently opt for eccentric exercise interventions as a primary approach, potentially leading to reduced pain and improved functionality.
3. The study offers a robust evidence base, empowering healthcare professionals to develop more targeted and efficient treatment plans, promoting quicker recovery and enhancing patient care.

BACKGROUND & OBJECTIVE

Achilles Tendinopathy is one of the most frequent overuse injuries in the ankle and foot (1-3). Most individuals who suffer from Achilles tendinopathy are active individuals who are involved in either recreational or competitive sports (4,5).

This research article investigated the efficacy of eccentric exercise for treating mid-portion Achilles tendinopathy. It compared eccentric exercise against other treatments and exercises. Achilles tendinopathy often requires effective interventions (6-8). The authors examined existing literature to determine whether eccentric exercise stands out as a superior treatment option.

The study aimed to provide a comprehensive analysis of the available evidence regarding the effectiveness of eccentric exercise in addressing mid-portion Achilles tendinopathy, contributing valuable insights for clinical practice and further research.

Achilles Tendinopathy is one of the most frequent overuse injuries in the ankle and foot.

Eccentric exercises in rehabilitation protocols for patients with mid-portion Achilles tendinopathy could potentially lead to reduced pain and improved functionality.

METHODS

• The authors conducted a comprehensive search across various electronic databases to identify relevant studies.

• The search strategy involved specific keywords and inclusion criteria to ensure the selection of high-quality studies.

• Included studies underwent thorough quality assessment and data extraction to collect relevant information such as study design, participant characteristics, intervention details, outcome measures, and results.

• The meta-analysis utilized statistical methods to combine data from selected studies, generating pooled effect sizes and confidence intervals.

• Heterogeneity among studies was assessed, and sensitivity analyses were conducted to ensure robustness of the findings.

RESULTS

• The investigation compared the efficacy of eccentric exercise with alternative interventions for mid-portion Achilles tendinopathy.

• Through a systematic review and meta-analysis, it was observed that eccentric exercise yielded superior outcomes in managing the condition compared to other exercise approaches.

• The analysis of various studies showed a notable reduction in symptoms (e.g. pain, as seen in Figure 1) and improved treatment results associated with eccentric exercise.

• These findings underscore the potential of eccentric exercise as a more effective therapeutic strategy for mid-portion Achilles tendinopathy, offering valuable guidance for clinical decision-making in its treatment.

LIMITATIONS

• Heterogeneity among the selected studies in terms of participant characteristics, exercise protocols, and outcome measures might influence the pooled results.

• The quality and methodological variations among the included studies can introduce potential bias. While efforts were made to minimize biases and address limitations, these factors should be considered when interpreting the results and their implications for clinical practice.

CLINICAL IMPLICATIONS

The findings of this research article are important in the management of mid-portion Achilles tendinopathy. The demonstrated superiority of eccentric exercise over other exercise modalities provides clinicians with valuable guidance in designing effective treatment strategies (6,7). Incorporating eccentric exercises into rehabilitation protocols for patients with mid-portion Achilles tendinopathy could potentially lead to better outcomes, including reduced pain and improved functionality.

Clinicians can confidently consider eccentric exercises as a first-line therapeutic option for this condition. This knowledge empowers us to make informed decisions when tailoring individualized treatment plans, enhancing patient care, and optimizing recovery. By focusing on eccentric exercise interventions, healthcare professionals can potentially expedite the healing process, leading to quicker return to regular activities for patients (6,7).

Furthermore, the study emphasizes the importance of evidence-based practice. Clinicians can now rely on this comprehensive systematic review and meta-analysis to guide their clinical decisions, minimizing the need for trial and error when selecting appropriate interventions. This is especially relevant given the potential variations in treatment responses among individuals.

Additionally, the research encourages future investigation into the specific protocols and parameters of eccentric exercises that yield the best results. Understanding the optimal dosage and progression of eccentric exercises can further refine clinical approaches and improve patient outcomes.

In summary, the study's findings place eccentric exercises at the forefront of mid-portion Achilles tendinopathy treatment, offering clinicians a well-supported, effective intervention to alleviate symptoms and enhance patients' quality of life.

+STUDY REFERENCE

Prudêncio D, Maffulli N, Migliorini F, Serafim T, Nunes L, Sanada S, Okubo R (2023) Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation, 15(9).

SUPPORTING REFERENCE

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3. Loppini M, Mafulli N. Conservative management of tendinopathy: an evidence-based approach. Muscles Ligaments Tendons J. 2011;1:134–7.
4. Kujala UM, Sarna S, Kaprio J. Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005;15:133–5.
5. Janssen I, van der Worp H, Hensing S, Zwerver J. Investigating Achilles and patellar tendinopathy prevalence in elite athletics. Res Sports Med. 2018;26:1–12.
6. Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport. 2007;10:52–8.
7. Verrall G, Schofield S, Brustad T, Physio D. Chronic Achilles tendinopathy treated with eccentric stretching program. Foot Ankle Int. 2011.
8. Beyer R, Kongsgaard M, Kjær BH, et al. Heavy slow resistance versus eccentric training as treatment for achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015.