SLR - November 2014 - Troy Fowler

The Effects of Conventional Physical Therapy and Eccentric Strengthening for Insertional Achilles Tendinopathy

Reference: Margaret Kedia, DPT, PhD; Michael Williams, PT, OCS; Lisa Jain, DPT, OCS; Marie Barron, PT, OCS; Nick Bird, MPT; Brian Blackwell, PT, OCS; David R. Richardson, MD; Susan Ishikawa, MD; G. Andrew Murphy, MD. The Effects of Conventional Physical Therapy and Eccentric Strengthening for Insertional Achilles Tendinopathy. The International Journal of Sports Physical Therapy. 2014; 9(4):488-497.

Scientific Literature Review

Reviewed By: Troy Fowler, DPM
Residency Program: North Colorado Podiatric Medicine and Surgery Residency, Greeley, CO

Podiatric Relevance: Achilles tendinopathy is a common podiatric pathology. The effect of eccentric training for mid-portion Achilles tendinopathy is well documented; however its effect on insertional Achilles tendinopathy is inconclusive. There are physical therapy modalities and treatments that have been successful for insertional Achilles tendinopathy. Will the addition of eccentric strengthening to the treatment protocol for insertional Achilles tendinopathy improve the results on pain and function is the question addressed in this article.  

Methods: Thirty-six patients were randomly assigned in a single-blinded study to either a control group or the experimental group.  All patients were diagnosed with insertional Achilles tendinopathy. The control group consisted of gastrocnemius, soleus and hamstring stretches, ice massage on Achilles tendon twice a day for 5-10 minutes, use of bilateral heel lifts, and a resting night splint. Patients were instructed to perform each stretch for three repetitions (30 seconds) twice daily. The experimental group consisted of the same and included two eccentric strengthening exercises. Patients were evaluated initially and then at 6 and 12 weeks. Pain and function were evaluated using the SF-36 and SF-36 Bodily pain surveys and the visual analog scale (VAS).

Results: Patients from both the control and experimental groups significantly improved in both pain and function.  Significant improvements in ankle joint dorsiflexion were seen in both groups as well. There were no statistical differences found between the two groups in these areas though.

Conclusion: Conventional physical therapy consisting of gastrocnemius, soleus, and hamstring stretches, ice massage on the Achilles tendon, and use of heel lifts and night splints with or without eccentric training is effective for treating insertional Achilles tendinopathy.

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