BACKGROUND & OBJECTIVE
Achilles tendinopathy (AT) is a common condition that affects both athletes and sedentary individuals. While there is a growing evidence-base in progressive loading, there are very few studies examining the effectiveness of massage which is commonly used in clinical practice. This study looked to address this and compare the effectiveness of pressure massage and eccentric exercise for improving pain and calf muscle function.
This prospective, single-blinded RCT recruited 60 patients with AT and randomised them into 3 groups:
- Eccentric exercises only – 1 session with a physiotherapist where exercises where provided using the protocol developed by Alfredson et al. 1998 (1), alongside access to an instructional video.
- Pressure massage only – twice weekly sessions for 6 weeks then once per week for 6 weeks. The therapist’s knee was used to apply pressure to the soleus at 3 pre-defined points. They also looked for tender points in the medial and lateral soleus and applied pressure using their thumbs.
- Combined eccentric exercise and massage (as above)
Pressure pain threshold and an Icelandic version of the Victorian Institute of Sports Assessment–Achilles questionnaire (VISA-A-IS) were assessed alongside ankle ROM at 0, 4, 8, 12 and 24 weeks. Real-time ultrasonographic scanning (US) was used at 0, 12 and 24 weeks to determine tendon thickness and degree of vascularization.
VISA-A-IS improved in all groups. The pressure massage group improved significantly more than eccentric exercise at week 4, but this was the only significant between group difference. Combining the treatments did not result in a better outcome. ROM (dorsiflexion with