An Isometric and Functionally Based 4-Stage Progressive Loading Program in Achilles Tendinopathy: A 12-Month Pilot Study

Abstract

Background. Achilles tendinopathy (AT) is a common musculoskeletal disorder, and its management remains challenging. Hypothesis/Purpose. By conducting a pilot study, we aimed to assess the feasibility, safety, and clinical improvement of a new home-based 4-stage rehabilitation program with progressive loading including isometric exercises on a small scale prior to setting up a randomized controlled trial. Methods. Ten recreational athletes with chronic midportion AT were included. The primary outcome was change in VISA-A score after 1, 2, 3, 6, and 12 months. Secondary outcomes included tenderness on palpation of the tendon and ultrasonographic changes after 6 months. Results. Average VISA-A improvements of 26.9 points ( P = 0.004 ) and 35.4 points ( P = 0.006 ) were observed at 6- and 12-month follow-up, respectively. Tenderness on palpation of the tendon (0–10) was reduced from 5.5 to 2.5 ( P < 0.001 ). Color Doppler ultrasound activity (0–4) was reduced by 50%, from an average of grade 2 to grade 1 ( P = 0.023 ). The hypoechoic cross-sectional area of the Achilles tendon was reduced from an average of 29.1% to 8.5% ( P = 0.001 ). Tendon thickness showed no statistically significant change ( P = 0.415 ). Conclusion. Following the 4-stage rehabilitation program for AT based on isometric training and progressive loading, we observed improvement in both VISA-A score and ultrasonography in a group of athletes who had previously failed to benefit from standard AT rehabilitation. The study was feasible in terms of high adherence to the program and with no observed safety issues. The results of this pilot study support a further assessment of this specific approach for rehabilitation in a future randomized controlled trial.

In Achilles Tendinopathy the Symptomatic Tendon Differs from the Asymptomatic Tendon While Exercise Therapy Has Little Effect on Asymmetries—An Ancillary Analysis of Data from a Controlled Clinical Trial

“…A common exercise therapy approach in Achilles tendinopathy is the eccentric exercise protocol developed by Alfredson [35,36]. As the adaptational response may be higher when higher tendon strains are applied [37][38][39], exercise protocols with higher load intensities, such as heavy slow resistance training [40] or the progressive loading program [41] have been applied in Achilles tendinopathy. Indeed, a high-loading exercise protocol, in which high tendon strain was induced, led to improved mechanical, and morphological tendon properties, and a greater strength of the tendinopathic side in Achilles tendinopathy patients [42].…”