Eccentric Exercise vs. Ultrasound for Achilles Tendo Pain

Eccentric calf muscle training compared with therapeutic ultrasound for chronic Achilles tendon pain–a pilot study. Chester R, Costa ML, Shepstone L, Cooper A, Donell ST. Man Ther. 2008 Dec;13(6):484-91. Epub 2007 Jul 26.

Abstract

A number of studies have indicated that eccentric calf muscle training has beneficial effects in the management of Achilles tendon pain for recreational athletes. The purpose of this prospective randomised single blind pilot study was to investigate their potential effectiveness compared with therapeutic ultrasound in subjects with relatively sedentary lifestyles in an NHS hospital setting. Eleven men and five women (mean age 53+/-21 years) with Achilles tendon pain of minimum duration 4 months were randomised to one of two treatment groups; either eccentric loading or ultrasound. Administration of ultrasound and regular supervision of exercises occurred over a period of 6 weeks, with unsupervised exercises continuing for another 6 weeks. Outcome measurements were taken prior to and after 2, 4, 6 and 12 weeks after commencing treatment. They included: pain on a visual analogue scale, functional index of the leg and lower limb, and the five question EuroQol generalised health questionnaire. The difference in mean score was calculated together with 95% confidence intervals assuming a normal distribution. There were no statistically significant differences between groups or clear trends over time. In addition there was considerable overlap between the confidence intervals. This is not unexpected given the small sample size. Both interventions proved acceptable to the patients with no adverse effects. On this basis we intend conducting a full multi-centred study.

Diagnosis: Achilles Tendinitis

Outcome: FILLA and VAS “during rest, walking, and if appropriate during recreational sport” Graphs of VAS not significantly different between exercise or ultrasound and not different from what I would expect from natural course without treatment.

When Assessed: 2, 4, 6 and 12 weeks, TREATMENT WAS ONLY 6 WEEKS

Subjects: 4 male and 4 female in exercise group with average age of 59, while ultrasound group had 7 male and 1 female average age of 48.

Protocol: Exercise was eccentric, slow of UP TO 3 x 15 reps with a TEN SECOND REST at bottom of each rep, with both straight knee and bent knee, once per day 7 days per week for 6 WEEKS. Instructed to continue unless pain is disabling. “only one subject progressed to using a backpack with weights and a number of subjects were unable to progress to performing the exercise with a bent knee.”

Other Activity: Group was largely sedentary. “It is reasonable to suggest that the sedentary or relatively sedentary lifestyle in our study in comparison with the majority of the subjects in the studies above is a likely contributing factor to our results.”

Chad’s Comments:  I think this study is difficult to assess in relation to others. The subjects did not progress on exercises very well, the treatment weeks was only 6 weeks compared to 12 in others, the exercise protocol included a 10 second stretch on every rep while no others did so, and the randomization procedure led to non-random and unequal treatment groups for which they admit “the subjects in the eccentric loading group were older, had a greater proportion of women to men, had a longer duration of symptoms and had a greater number of additional pathologies than the subjects allocated to the ultrasound group.”

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

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