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Table 3 Physical therapies for Achilles tendinopathy

From: Physical therapies for Achilles tendinopathy: systematic review and meta-analysis

Study

Intervention(s)

Sample size

Intervention duration (wk)

Comparison and outcome measure

SMD (95% CI)

Study conclusions (where SMD unable to be calculated)

ECCENTRIC EXERCISE

Mafi 2001

A: Eccentric exercise

A: 22

12

A vs B

12wk: ID

Between groups comparisons of pain not presented; Significant within-group improvement in pain VAS for both eccentric and concentric exercise in those who were satisfied with treatment (p < 0.05)

 

B: Concentric exercise

B: 22

 

VASa

  

Niesen-Vertommen 1992

A: Eccentric exercise

A: 8

12

A vs B

4wk: ID

Eccentric exercise had a greater reduction of pain (p < 0.01)

 

B: Concentric exercise

B: 9

 

VASo

8wk: ID

 
     

12wk: ID

 

Rompe 2007

A: Eccentric exercise

A: 25

12

A vs B

16wk:–1.26 (–1.87:–0.65)

 
 

B: Wait and see approach

B: 25

 

VISA-A

  

Knobloch 2007

A: Eccentric exercise

A: 15

12

A vs B

12wk: -1.67 (−2.83: -0.50)

 
 

B: Cryotherapy

B: 5

 

VASo

  

Petersen 2007

A: Eccentric exercise

A: 37

12

A vs B

6wk: ID

No difference between groups (p < 0.05)

 

B: Heel brace

B: 35

 

VASa

12wk: ID

 
     

54wk: ID

 

Rompe 2008

A: Shock wave therapy

A: 25

A: 3

B vs A

16wk: -1.40 (−0.74: -2.06)

 
 

B: Eccentric exercise

B: 25

B: 12

VISA-A

  

Chester 2008

A: Eccentric exercise

A: 8

A: 12

A vs B

6wk: 0.63 (−0.33: 1.58)

 
 

B: Ultrasound

B: 8

B: ≤6

VASs

12wk: 0.24 (−0.69: 1.17)

 

Silbernagel 2001

A: Rehabilitation programme including single leg eccentric loading

A: 22

12

A vs B

6wk: ID

Eccentric loading had better strength and pain outcomes (p < 0.05)

  

B: 18

 

VASj

12wk: ID

 
 

B: Rehabilitation programme

   

26wk: ID

 
     

52wk: ID

 

Herrington 2007

A: Eccentric exercise + deep friction massage + ultrasound + calf stretches

A: 13

12

A vs B

4wk: ID

Eccentric exercise produced superior pain and function outcomes (p = 0.01)

 

B: Deep friction massage + ultrasound + calf stretches

B: 12

 

VISA-A

8wk: ID

 
     

12wk: ID

 

SHOCK WAVE THERAPY

Costa 2005

A: Shock wave therapy

A: 22

12

A vs B

12wk: -0.44 (−1.01: 0.13)

 
 

B: Sham shock wave therapy

B: 27

 

VASw

52 wk: ID

 

Rompe 2007

A: Shock wave therapy

A: 25

A: 3

A vs B

16wk: -1.03 (−1.62:-0.44)

 
 

B: Wait and see approach

B: 25

B: 12

VISA-A

  
 

C: Eccentric exercise

C: 25

C: 12

A vs C

16 wk: 0.29 (−0.27: 0.85)

 
    

VISA-A

  

Rompe 2008

A: Shock wave therapy

A: 25

A: 3

A vs B

16wk: -1.40 (−2.03: -0.78)

 
 

B: Eccentric exercise

B: 25

B: 12

VISA-A

  

Rompe 2009

A: Shock wave therapy + eccentric exercise

A: 34

A: 12

A vs B

16wk: -0.76 (−1.28: -0.24)

 
 

B: Eccentric exercise

B: 34

B: 12

VISA-A

  

Rasmussen 2008

A: Shock wave therapy + conservative therapy

A: 24

4

A vs B

4wk: -0.52 (−1.10: 0.06)

 
 

B: Sham shock wave therapy + conservative therapy

B: 24

 

AOFAS

8wk: ID

 
     

12wk: ID

 

LASER THERAPY

Stergioulas 2008

A: Laser therapy + eccentric exercise

A: 20

8

A vs B

4wk: -1.07 (−1.65: -0.49)

 
 

B: Placebo laser therapy + eccentric exercise

B: 20

 

VASa

8wk: -1.14 (−1.82: -0.47)

 
     

12wk: -0.78 (−1.42: -0.13)

 

Tumilty 2008

A: Laser therapy + eccentric exercise

A: 10

12

A vs B

4wk: 0.53 (−0.36: 1.43)

 
 

B: Placebo laser therapy + eccentric exercise

B: 10

 

VASm

12wk: -0.25 (−1.13: 0.64)

 

MICROCURRENT THERAPY

Chapman-Jones 2002

A: Microcurrent therapy + eccentric exercise

A: 24

12

A vs B

12wk: ID

Microcurrent therapy produced superior pain, stiffness and function outcomes (p < 0.001)

 

B: Eccentric exercise11

B: 24

 

VASa

26wk: ID

 
     

52wk: ID

 

CONTINUED TENDON LOADING

Silbernagel 2007

A: Rehabilitation programme + continued tendon loading activity

A: 26

12- 26

A vs B

6wk: -0.32 (−0.88: 0.25)

 
 

B: Rehabilitation programme + no tendon loading activity (running or jumping)

B: 25

 

VISA-A-S

12wk: -0.17 (−0.73: 0.39)

 
     

26wk: -0.12 (−0.68: 0.44)

 
     

52wk: -0.55 (−1.11: 0.02)

 

NIGHT SPLINT

de Jonge 2010

A: Night splint + eccentric exercise

A: 36

12

A vs B

4wk: -0.12 (−0.61: 0.37)

 
 

B: Eccentric exercise

B: 34

 

VISA-A

12wk: 0.07 (−0.43: 0.56)

 
     

52wk: -0.10 (−0.60: 0.40)

 

McAleenan 2010

A: Night splint + eccentric exercise

A: 5

12

A vs B

12wk: -1.09 (−2.41: 0.22)

 
 

B: Eccentric exercise

B: 6

 

VISA-A

  

HEEL BRACE

Knobloch 2008

A: Heel brace + eccentric exercise

A: 43

12

A vs B

12wk: -0.29 (−0.70: 0.12)

 
 

B: Eccentric exercise

B: 54

 

VASo

  

Petersen 2007

A: Heel brace + eccentric exercise

A: 28

12

A vs B

6wk: ID

No difference between groups (p < 0.05)

 

B: Eccentric exercise

B: 37

 

VASw

12wk: ID

 
     

54wk: ID

 
  1. CI = confidence interval; ID = insufficient data; NR = not reported; PES = Pain Experience Index; SD = standard deviation; SMD = standard mean difference; wk = week; VAS = visual analogue scale; VISA-A = Victorian Institute of Sports Assessment – Achilles; VISA-A-S Victorian Institute of Sports Assessment – Achilles Swedish; VASa = pain during activity; VASj = pain during jumping; VASm = pain in the morning; VASo = pain overall; VASs = pain after sport & recreation; VASw = pain during walking.