Is heavy eccentric calf training the best treatment for Achilles tendinopathy?

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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.

To learn more about tendinopathies and their management complete the ‘Tendinopathy’ module in the FIFA Diploma in Football Medicine.

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Bangoura
27 March 2019 11:48

La tendinopathies achillienne ou tendinite de l achille est une blessure de surcharge mécanique ou surmenage la traitement doit être adopté au stade de la lésion.le traitement est à la fois MÉDICAL.PHYSYQUE.CHIRURGICAL en fonction de la severite de la lésion. Le tendon calcaneen ou tendon d achille traitement 1Alimentation Viande rouge et charcuterie 1 à 2fois /semaine maxi Fromage Les légumes fruits anti acide. 2Soins Repos sportif obligatoire Séance de kinesi avec étirements MUSCULO résineux et massage MTP(massage transverse profond).AINS per os locale quelques infiltrations locales NB trop d infiltration locale entraîne une fragilisation du tendon pouvant terminer par une… Read more »

Zeke
29 May 2019 13:30

Achilles tendinopathy is problem with connective tissue around tenders fiber cells . Cells of connective tissue needs to be regenerated by removing element of swelling and start normal cells production of essential amino acids that is main element in there degradation to prevent swelling. If you topically apply free amino acids an effected area problems is resolve in a hours. After that apply heat to the area for fife minutes before start exercise and training for week .

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Physiotherapy Auckland
11 March 2020 9:39

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pedro
pedro
20 October 2020 6:10

his 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.

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Last edited 1 month ago by pedro