Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial

TY - JOUR

T1 - Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy

T2 - A Randomized Controlled Trial

AU - Beyer, Rikke

AU - Kongsgaard, Mads

AU - Hougs Kjær, Birgitte

AU - Øhlenschlæger, Tommy

AU - Kjær, Michael

AU - Magnusson, S Peter

N1 - © 2015 The Author(s).

PY - 2015/7/3

Y1 - 2015/7/3

N2 - Background: Previous studies have shown that eccentric training has a positive effect on Achilles tendinopathy, but few randomized controlled trials have compared it with other loading-based treatment regimens. Purpose: To evaluate the effectiveness of eccentric training (ECC) and heavy slow resistance training (HSR) among patients with midportion Achilles tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 58 patients with chronic (.3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms (Victorian Institute of Sports Assessment-Achilles), tendon pain during activity (visual analog scale), tendon swelling, tendon neovascularization, and treatment satisfaction were assessed at 0 and 12 weeks and at the 52- week follow-up. Analyses were performed on an intention-to-treat basis. Results: Both groups showed significant (P < .0001) improvements in Victorian Institute of Sports Assessment-Achilles and visual analog scale from 0 to 12 weeks, and these improvements were maintained at the 52-week follow-up. Concomitant with the clinical improvement, there was a significant reduction in tendon thickness and neovascularization. None of these robust clinical and structural improvements differed between the ECC and HSR groups. However, patient satisfaction tended to be greater after 12 weeks with HSR (100%) than with ECC (80%; P = .052) but not after 52 weeks (HSR, 96%; ECC, 76%; P = .10), and the mean training session compliance rate was 78% in the ECC group and 92% in the HSR group, with a significant difference between groups (P<.005). Conclusion: The results of this study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.

AB - Background: Previous studies have shown that eccentric training has a positive effect on Achilles tendinopathy, but few randomized controlled trials have compared it with other loading-based treatment regimens. Purpose: To evaluate the effectiveness of eccentric training (ECC) and heavy slow resistance training (HSR) among patients with midportion Achilles tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 58 patients with chronic (.3 months) midportion Achilles tendinopathy were randomized to ECC or HSR for 12 weeks. Function and symptoms (Victorian Institute of Sports Assessment-Achilles), tendon pain during activity (visual analog scale), tendon swelling, tendon neovascularization, and treatment satisfaction were assessed at 0 and 12 weeks and at the 52- week follow-up. Analyses were performed on an intention-to-treat basis. Results: Both groups showed significant (P < .0001) improvements in Victorian Institute of Sports Assessment-Achilles and visual analog scale from 0 to 12 weeks, and these improvements were maintained at the 52-week follow-up. Concomitant with the clinical improvement, there was a significant reduction in tendon thickness and neovascularization. None of these robust clinical and structural improvements differed between the ECC and HSR groups. However, patient satisfaction tended to be greater after 12 weeks with HSR (100%) than with ECC (80%; P = .052) but not after 52 weeks (HSR, 96%; ECC, 76%; P = .10), and the mean training session compliance rate was 78% in the ECC group and 92% in the HSR group, with a significant difference between groups (P<.005). Conclusion: The results of this study show that both traditional ECC and HSR yield positive, equally good, lasting clinical results in patients with Achilles tendinopathy and that the latter tends to be associated with greater patient satisfaction after 12 weeks but not after 52 weeks.

KW - Achilles Tendon

KW - Adolescent

KW - Adult

KW - Exercise Therapy

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Patient Compliance

KW - Patient Satisfaction

KW - Prospective Studies

KW - Resistance Training

KW - Single-Blind Method

KW - Sports

KW - Tendinopathy

KW - Treatment Outcome

KW - Visual Analog Scale

KW - Young Adult

U2 - 10.1177/0363546515584760

DO - 10.1177/0363546515584760

M3 - Journal article

C2 - 26018970

SN - 0363-5465

VL - 43

SP - 1704

EP - 1711

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

IS - 7

ER -