RATE OF IMPROVEMENT OF PAIN AND FUNCTION IN MID-PORTION ACHILLES TENDINOPATHY WITH LOADING PROTOCOLS: A SYSTEMATIC REVIEW AND LONGITUDINAL META-ANALYSIS

BACKGROUND & OBJECTIVE

The purpose of this study was to determine the rate of improvement for mid-portion Achilles tendinopathy (AT) while completing a loading protocol intervention. In this case, improvement was defined as change in pain and function over time. The purpose of the study was to help clinicians answer one of the most common patient questions - "how long will it take to get better?".

In order to better understand the course of an injury, it is imperative that clinicians begin to appreciate the physiological methods by which improvements are made. A greater understanding of this may also help to guide clinical decision making. The study discusses potential adaptations and the proposed mechanism of the analgesia associated with loading protocols as well.

METHODS

The authors pooled the data from a total of 31 separate cohorts whom all met their inclusion criteria. All cohorts were required to undergo a loading protocol for mid-portion AT. Two authors independently gathered eligible studies, assessed risk bias, and measured treatment effects.

Loading protocols were organized into four categories: heavy eccentric calf training, modified heavy eccentric calf training, eccentric overload, and eccentric overload with active rest. Only studies that used validated and reliable pain and outcome measures were included. Studies with sample sizes less than 50 were considered to be at high risk of sample bias.

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RESULTS

The process of pain perception is largely controlled by higher level brain processing, and thus can change quickly. Pain has been shown to decrease significantly following a single bout of isometric loading. Unfortunately, with persistent or chronic pain the analgesic

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