Eccentric and Isometric Exercises in Achilles Tendinopathy Evaluated by the VISA-A Score and Shear Wave Elastography

Abstract

Background: Apart from eccentric exercises (EE), isometric exercises (ISO) might be a treatment option for Achilles tendinopathy. Shear wave elastography (SWE) provides information for diagnosis and for monitoring tissue elasticity, which is altered in symptomatic tendons. Hypothesis: Isometric exercises will have a beneficial effect on patients’ outcome scores. Based on SWE, insertional and midportion tendon parts will differ in their elastic properties according to current symptoms. Study Design: Randomized clinical trial. Level of Evidence: Level 2. Methods: Group 1 (EE; n = 20; 12 males, 8 females; mean age, 52 ± 8.98 years) and group 2 (EE + ISO; n = 22; 15 males, 7 females; mean age, 47 ± 15.11 years) performed exercises for 3 months. Measurement points were before exercises were initiated as well as after 1 and 3 months using the Victorian Institute of Sports Assessment–Achilles (VISA-A) score, American Orthopaedic Foot & Ankle Society score, and SWE (insertion and midportion). Results: Both groups improved significantly, but there were no significant interindividual differences (VISA-A; P = 0.362) between group 1 (n = 15; +15 VISA-A) and group 2 (n = 15; +15 VISA-A). The symptomatic insertion (symptomatic, 136.89 kPa; asymptomatic, 174.68 kPa; P = 0.045) and the symptomatic midportion of the Achilles tendon (symptomatic, 184.40 kPa; asymptomatic, 215.41 kPa; P = 0.039) had significantly lower Young modulus compared with the asymptomatic tendons. The midportion location had significantly higher Young modulus than the insertional part of the tendon ( P = 0.005). Conclusion: Isometric exercises do not have additional benefit when combined with eccentric exercises, as assessed over a 3-month intervention period. SWE is able to distinguish between insertional and midportion tendon parts in a symptomatic and asymptomatic state. Clinical Relevance: The present study shows no additional effect of ISO when added to baseline EE in treating Achilles tendinopathy. Different elastic properties of the insertional and midportion tendon have to be taken into consideration when rating a tendon as pathologic.

Effectiveness of isometric exercise in the management of tendinopathy: a systematic review and meta-analysis of randomised trials

“…Where it was obvious that the outcome assessors were not blinded or where it was not mentioned, studies were labelled as 'high risk' (Parle et al, 32 Clifford et al, 17 Rio et al, 35 van Ark et al, 36 Rio et al, 20 Gatz et al 37 ).…”

“…Reasons for dropouts/withdrawals of participants were adequately reported in all studies ('low' risk). The study by Gatz et al 37 was rated as 'low' risk of attrition bias despite the significant loss to follow-up (25% and 32% in the two groups) as the remaining participants were sufficient for the minimum sample sizes based on their power calculation.…”

“…In the study by Clifford et al, 17 no p values were reported for any of the comparisons ('high' risk). In the study by Gatz et al, 37 Open access Table 3 Quality assessment of included studies (internal validity, external validity, precision and overall quality) Open access out for pain, which is considered an important clinical symptom ('high' risk).…”

“…Statistical power calculation prior to recruitment was performed in only four studies, where their sample size was adequate for at least 80% power (Gatz et al, 37 Holden et al, 22 Dupuis et al 31 and Vuvan et al 34 ); all other studies were characterised as 'high' risk of precision bias. Levels of significance were set at p=0.05 in all studies.…”

Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options

“…Additionally, imaging studies should focus on the diagnostic accuracy and monitoring capacities of MRI versus high-resolution ultrasound and further assessments of promising ultrasound technologies, such as shear wave elastography or ultrasound tissue characterization [ 48 , 49 ]. Evidence-based decision-making for conservative approaches requires prospective trials evaluating the effect of immobilization, heel raises, or physiotherapy [ 50 ]. Moreover, indications for surgical treatment, augmentation procedures, or suture application need to be studied in relation to the location and the size of the rupture.…”