Autoregulated heavy slow resistance training combined with radial shockwave therapy for plantar heel pain: Protocol for a mixed‐methods pilot randomised controlled trial

Abstract

Background: Plantar heel pain (PHP) is considered a tendinopathy and it affects up to 10% of the population. Both heavy slow resistance training (HSRT) and extracorporeal shockwave therapy (ESWT) have shown effectiveness for treating PHP in isolation. However, more comprehensive exercise protocols and progression methods are needed due to poor long-term outcomes, and better standardisation of ESWT protocols are required. Autoregulation of resistance training involves selfselecting exercise dosage based on individual factors. Although autoregulation has proven effective for strength gains in athletes, it has not been investigated in tendinopathy. Recent studies recommend that PHP should not be treated by one treatment intervention in isolation. However, there is a dearth of research investigating the feasibility and effectiveness of combined treatment interventions for PHP. Currently, no studies have investigated autoregulated HSRT combined withESWT, despite their individual efficacy. The optimal treatment protocol for PHP is unknown, and there is a need to ascertain whether the addition of ESWT to autoregulated HSRT leads to better outcomes compared to either alone.Methods: A three-arm randomised controlled trial (RCT) comparing these groups would be the ideal way to investigate this question, with a pilot RCT testing trial procedures and process evaluation required prior to a definitive RCT. Patients expectations, feasibility and acceptability of combined ESWT and exercise for PHP also remain unknown. Therefore, the addition of qualitative interviews in a mixedmethods pilot RCT would help ascertain acceptability and help explain the intervention outcomes. K E Y W O R D S extracorporeal shockwave therapy, fasciitis, plantar, resistance training, tendinopathy 1 | BACKGROUND Musculoskeletal disorders have recently been identified as a leading global cause of disability and pain, comprising 6.7% of the total global disability-adjusted life years and the second highest (21.3%) global volume of years lived with disability (Sebbag et al., 2019).Musculoskeletal disorders can have a high morbidity for individuals and represent a vast burden to society and healthcare systems, with effective clinical treatments and recommendations lacking (March et al., 2014). In the United Kingdom, musculoskeletal disorders are responsible for 30% of all years lived with disability, and account for 25% of all General Practitioner (GP) consultations

Blood Flow Restriction Training for Tendinopathy Rehabilitation: A Potential Alternative to Traditional Heavy-Load Resistance Training

“…Despite their being no RCTs completed to date investigating BFRT in tendon rehabilitation, it is clear from a search of currently registered RCTs (clinicaltrials.gov) that increased attention is being given to the potential clinical utility of BFRT in tendon pathology. A recently published conference abstract of a completed yet unpublished RCT on BFRT following surgery for Achilles tendon ruptures, indicates that BFRT is superior compared to standard physical therapy for increasing absolute strength in the operative calf [268]. Whilst full details of the RCT and BFRT parameters are yet to be published, these preliminary findings are encouraging and mirror the findings of the case series and case reports to date on BFRT in tendon pathologies.…”

The Effectiveness of Combined Extracorporeal Shockwave Therapy and Exercise for Plantar Heel Pain: A Systematic Review

“…Future studies should also investigate and compare combined interventions using validated measures, which is reflective of clinical physiotherapy practice that often combines treatments. 14,46 Exercises other than stretching should be combined with ESWT, such as HSRT, and methods for individualising exercise interventions should be considered to improve outcomes compared to standardised interventions. 9, 47 Using standardized intervention protocols and validated outcome measures would also allow better translation of findings.…”