An Evidence-based review of Achilles pain from The Physio Co.
The Achillies Heel!
Achilles tendonopathy / tendonits is a frequent cause of pain and disability in people with an active lifestyle, with some researchers estimating the problem accounts for up to 18 percent of injuries in runners, and 4 percent of patients presenting to sports injuries clinics (Magnussen et al, 2009).
Scientific evidence for the many proposed causes of Achilles pain is scarce so there is no consensus as to the optimal treatment approach despite an abundance of options.
Eccentric loading exercises (ELE's) prescribed by physiotherapists have been recommended since the mid-1980's. A significant piece of research was conducted by Alfredson et al (1998) who made patients perform 180 eccentric calf muscle contractions daily for 12 weeks. The patients in this study all described their recovery as "excellent". The study prompted further studies and it is now widely accepted by doctors and surgeons that there is currently more evidence in support of physio-based eccentric exercises than any other treatment for Achilles tendonpathy. (Magnussen et al, 2009).
What does the research say? Clinical trials are the only way to establish whether a treatment option is effective. Here some of a few things that so far have NOT been shown to be effective:
Achilles tendonopathy / tendonits is a frequent cause of pain and disability in people with an active lifestyle, with some researchers estimating the problem accounts for up to 18 percent of injuries in runners, and 4 percent of patients presenting to sports injuries clinics (Magnussen et al, 2009).
Scientific evidence for the many proposed causes of Achilles pain is scarce so there is no consensus as to the optimal treatment approach despite an abundance of options.
Eccentric loading exercises (ELE's) prescribed by physiotherapists have been recommended since the mid-1980's. A significant piece of research was conducted by Alfredson et al (1998) who made patients perform 180 eccentric calf muscle contractions daily for 12 weeks. The patients in this study all described their recovery as "excellent". The study prompted further studies and it is now widely accepted by doctors and surgeons that there is currently more evidence in support of physio-based eccentric exercises than any other treatment for Achilles tendonpathy. (Magnussen et al, 2009).
What does the research say? Clinical trials are the only way to establish whether a treatment option is effective. Here some of a few things that so far have NOT been shown to be effective:
In all cases of Achilles pain the cause of the problem must be established. A detailed physiotherapy assessment will look at - hip control, foot position, calf muscle tightness and gastrocnemius muscle strength (to
name but a few). Identifying underlying problems in any of these areas could lead to their correction and a reduction in pain. As you can see by our depth of knowledge on this subject, the physiotherapists at The Physio Co are extensively trained in the assessment and treatment of Achilles tendon pain.
References:
Alfredson, H., Pietila, T., Jonsson, P., Lorentzon, R. 1998 Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis . American Journal of Sports Medicine 26(3) pp 360-6
Brown, R., Orchard J., Kinchington M., Hooper A., Nalder, G. 2006. Aprotinin in the management of Achilles tendinopathy: a randomized controlled trial. British Journal of Sports Medicine 40, pp 275-9
De Vos, R.J., Weir, A., Visser, R.J.A., De Winter, Th.C., Tol., J.L. 2007. The Additional Value of a night splint to eccebtric exercises in chronic midportion Achilles tensinopathy: a randomized controlled trial. British Journal of Sports Medicine, 41, :e5
Rompe, J.D., Furia, J.P., Mafulli, N. 2009 Eccentric Loading Versus eccentric loading plus shockwave treatment for midportion Achilles tendinopathy. American Journal of Sports Medicine 37(3) pp 463-70
Yelland, M.J., Sweeting, K.R., Lytfogt, J.A., Ng, S.K., Scuffham, P.A., Evans, K.A., 2009 Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomized trial British Journal of Sports Medicine
Brown, R., Orchard J., Kinchington M., Hooper A., Nalder, G. 2006. Aprotinin in the management of Achilles tendinopathy: a randomized controlled trial. British Journal of Sports Medicine 40, pp 275-9
De Vos, R.J., Weir, A., Visser, R.J.A., De Winter, Th.C., Tol., J.L. 2007. The Additional Value of a night splint to eccebtric exercises in chronic midportion Achilles tensinopathy: a randomized controlled trial. British Journal of Sports Medicine, 41, :e5
Rompe, J.D., Furia, J.P., Mafulli, N. 2009 Eccentric Loading Versus eccentric loading plus shockwave treatment for midportion Achilles tendinopathy. American Journal of Sports Medicine 37(3) pp 463-70
Yelland, M.J., Sweeting, K.R., Lytfogt, J.A., Ng, S.K., Scuffham, P.A., Evans, K.A., 2009 Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomized trial British Journal of Sports Medicine