Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomized clinical trial

Review written by Shruti Nambiar info

Key Points

  1. Insertional Achilles tendinopathy (IAT) often responds poorly to traditional eccentric loading, which is most effective for mid-portion Achilles tendinopathy.
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BACKGROUND AND OBJECTIVE

Insertional Achilles tendinopathy (IAT) is a prevalent and challenging condition, particularly among active individuals. Achilles tendinopathy affects approximately 6% of the general population, with patients often experiencing pain, stiffness, and functional limitations, impacting daily activities and athletic performance.

Despite various non-operative treatments, there remains no consensus on the most effective approach. Emerging evidence suggests that tendon compression may play a significant role in IAT pathogenesis, prompting investigations into rehabilitation protocols that modulate compressive loads. Conservative management, including eccentric exercises and extracorporeal shockwave therapy (ESWT), has been the mainstay of treatment. However, outcomes are variable, and some patients do not achieve satisfactory relief.

Interventions that limit dorsiflexion, avoid stretching and incorporate heel lifts aim to decrease tendon compression. Despite theoretical support, there is a paucity of high-quality randomized controlled trials comparing low-compression and high-compression rehabilitation strategies for IAT.

The study aimed to address this gap by conducting a randomized controlled trial comparing low tendon compression rehabilitation (LTCR) to high tendon compression rehabilitation (HTCR) over a 24-week period in active adults with chronic IAT.

Achilles tendinopathy affects approximately 6% of the general population, with patients often experiencing pain, stiffness, and functional limitations, impacting daily activities and athletic performance.
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These findings underscore the need to customize rehabilitation programs on the specific characteristics of the underlying pathology.

METHODS

  • This investigator-blinded, block-randomized controlled trial assessed LTCR versus HTCR in 42 active adults (18–60 yrs.) with chronic IAT.
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