PICO
Patient/Population
Chronic (>= 6 month) recalcitrant insertional Achilles tendinopathy (n=68)
Intervention
- Radial low-energy shock wave therapy + Eccentric loading
Comparison
Eccentric loading
Outcomes
- VISA-A, Likert scale
- Pain
- Analgesics and all consultations with family doctors, physiotherapists, and other health care providers
Translatability: (3/3) Easy
Comments: “The likelihood of recovery after 4 months was higher after a combined approach of both eccentric loading and SWT compared to eccentric loading alone. “
Limitations: “All patients were fully aware of the active treatment they received. However, as the assistant was not directly involved in the management of patients, it is unlikely that this would have biased the results. The independent observer may have become aware of the treatment being received by patients in some instances. Another potential weakness is the relatively small number of patients included. Nevertheless, power was even higher in the post hoc analysis than estimated before the study began, and the results are univocal. Of 68 patients enrolled for this study, only 21 (9 in group 1, 12 in group 2) performed some sort of sports activity on a regular schedule, at least once a week. So the results from our study cannot be necessarily extrapolated to an athletic community.”
Appraisals:
PEDro Scale – (8/10) Blind therapists: No; Blind subjects: No. (by PEDro – confirmed)
Evidence – Level I (by the authors)
BTB
Intervention – 1
- RSWT
Dose
- 2000 pulses, 3 bar (energy flux density of 0.1 mJ/mm²), 8Hz
Periodicity
- 1 weekly session for 3 weeks. After 4 weeks, additionally to the ongoing eccentric loading exercises.
Local/Technic:
15-mm-diameter header; standard, commercially ultrasound gel; at the area of maximal tenderness in a circumferential pattern, starting at the point of maximum pain
Intervention – 2
- Excentric loading
Dose
Patients started with one set of 10 repetitions on the first day of exercises and gradually progressed to 3 sets of 15 repetitions by the seventh day, aiming to complete 3 sets of 15 repetitions twice a day by the second week of treatment. Patients were advised to continue the exercises through mild or moderate pain, stopping only if the pain became unbearable.
Periodicity
- 7 days per week for 12 weeks.
Local/Technic:
- Following the suggestions from Alfredson and his colleagues
Citation: Rompe, J. D., Furia, J., & Maffulli, N. (2009). Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine,37(3), 463–470. https://doi.org/10.1177/0363546508326983