Conservative management of acute lower limb tendinopathies: A systematic review

Abstract

Background Most knowledge regarding conservative management for lower limb tendinopathy (LLT) is for persistent symptoms, with less known about conservative management of acute LLT. Sub‐optimal management of acute LLT is detrimental in many regards, not least the likely conversion to persistent symptoms. Objectives To synthesise existing literature on conservative management of acute LLTs. Design Systematic review of relevant literature (PROSPERO [ID: CRD42018117882]). Method A search was made of multiple databases (MEDLINE, CINAHL and EMBASE) using relevant search terms. Titles, abstracts and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction and quality assessment, using the Grading of Recommendations Assessment, Development and Evaluation, were done independently by two authors. To understand how the interventions impacted the duration of reported symptoms, results were split into three time points: short‐term (<4 weeks), medium‐term (4–12 weeks) and long‐term (>12 weeks). Results Thirteen studies (n = 534) met the criteria for inclusion. There was very low level of certainty for the effectiveness of interventions at short‐term, medium‐term and long‐term follow ups. However, there were large effects seen across a number of different treatments on pain intensity and disability in LLTs. Conclusions This review demonstrates that limited evidence currently exists to guide the management of acute LLT, and the quality of the existing evidence is collectively low. These findings inform the discussion of different treatment options with patients in a shared decision‐making process to empower and enable the patient.

Oxygen–Ozone Therapy in the Rehabilitation Field:State of the Art on Mechanisms of Action, Safety andEffectiveness in Patients with Musculoskeletal Disorders

“…Acute and chronic pathological modifications at tendon level are a pool of musculoskeletal disorders that might involve physicians from different fields, including orthopedics, sports medicine specialists, and PRM specialists [109]. The conservative management of tendinopathies is the first line of intervention and is preferable, when possible, to surgery.…”

Management of recent onset tendon-related pain in a primary contact setting: A survey of practice

“…Isometric exercises were the most popular for both scenarios, despite the limited evidence of effectiveness (Mitham et al, 2020;. Both eccentric and heavy slow resisted exercises were preferred for Achilles scenario, despite current research suggesting no superiority between exercises (Head et al, 2019;.…”

“…Tendonrelated pain affects a wide range of people and affects both function and quality of life (Grimaldi et al, 2015;Malliaras et al, 2015). A wide range of treatments are used to treat people with tendon-related pain, including exercise therapy, injection therapy, shockwave therapy and acupuncture (Mitham et al, 2020;.…”

Management of recent onset tendon‐related pain in a primary contact setting: A survey of practice

“…Isometric exercises were the most popular for both scenarios, despite the limited evidence of effectiveness (Mitham et al., 2021; Vlist et al., 2020). Both eccentric and heavy slow resisted exercises were preferred for Achilles scenario, despite current research suggesting no superiority between exercises (Head et al., 2019; Vlist et al., 2020; Van Der Vlist et al, 2020).…”

“…Tendon‐related pain affects a wide range of people and affects both function and quality of life (Grimaldi et al., 2015; Malliaras et al., 2015). A wide range of treatments are used to treat people with tendon‐related pain, including exercise therapy, injection therapy, shockwave therapy and acupuncture (Mitham et al., 2021; Vlist, et al., 2020).…”