Heavy eccentric calf training is a common treatment for mid-portion Achilles tendinopathy, however this systematic review and meta-analysis suggests the evidence supporting this is low and the true beneficial effect has not been well established. Strengthening programmes appear useful but other regimes may be at least as effective1.
Mid-portion Achilles tendinopathy is often seen in running sports (including football) and is clinically diagnosed with symptoms of pain, morning stiffness and impaired load-bearing capacity. This often comes on after a recent increase in activity. Heavy eccentric calf training (HECT) is commonly used in clinical practice for rehabilitation of mid-portion Achilles tendinopathy. This generally involves a player doing a large number of (painful) exercises daily for a period of several months. An ideal programme would be less time consuming and more integrative with training. This would reduce morbidity and may also increase treatment adherence.
A total of seven studies were included in this review. These included 241 active and non-active participants who had suffered from mid-portion Achilles tendinopathy for greater than three months. Comparisons were made between HECT and ‘natural history’, as well as between HECT and ‘traditional’ physiotherapy and various other exercise interventions. ‘Traditional physiotherapy’ included taping, manual therapy, ultrasound and/or friction massage.
The studies comparing HECT to both natural history and ‘traditional therapy’ suggested there was a small benefit associated with using HECT. The quality of the evidence was generally low however, so it was difficult to make a definite recommendation. The studies comparing HECT to other exercise interventions demonstrated a pooled mean difference in favour of other (non-HECT) exercise interventions. Again, the quality of the evidence supporting this recommendation was very low.
While HECT has been widely adopted as a treatment for Achilles tendinopathy the efficacy of this treatment remains largely unproven. In order to definitively establish the clinical usefulness of HECT for those suffering from mid-portion Achilles tendinopathy further large sized, high quality studies are required. Based on the available evidence, strengthening programmes appear to be superior to other both ‘time’ and ‘traditional physiotherapy’ and should be encouraged.
1Murphy MC, Travers MJ, Chivers P, et al. Efficacy of heavy eccentric calf training for treating mid-portion Achilles tendinopathy: a systematic review and meta-analysis. Br J Sports Med 2019;0:1-9.