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Heel-drop exercise program improves pain scores for Achilles tendinopathy patients
Van der Plas A. Br J Sports Med. 2011. doi:10.1136/bjsports-2011-090035
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A heel-drop exercise program improved pain scores at 5-year follow-up when used by patients in the conservative treatment of chronic midportion Achilles tendinopathy.
In an update from a previous study, researchers used the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire score to record the pain status, alternative treatments and ultrasonic neovascularization scores of 70 tendons from 58 patients enrolled in the Alfredson’s heel-drop exercise program, according to the abstract.
Researchers reported that the sagittal tendon thickness in patients had decreased from 8.05 mm at the start of exercising to 7.5 mm at 5-year follow-up. They also reported that although the pain scores improved during the 5 years, some patients still experienced mild pain. VISA-A scores increased significantly for patients from 49.2 at the start of the program to 83.6 after 5 years of exercise. From the 1-year to 5-year follow-up, patient scores improved from 75.0 to 83.4.
The mechanisms by which eccentric exercises help to resolve the pain of tendinopathy remain unclear, and the various theories put forward are not firmly substantiated by histological evidences. The authors have published the longest outcomes of patients who practice this protocol to date and report a high success rate after eccentric training comparable to that noted at shorter follow-up. However, this high responsiveness to eccentric training in the Scandinavian populations have not been confirmed by other authors in other parts of the world.
We encourage the application of this protocol, and we point out that, in other countries, a combination of eccentric training and repetitive low-energy shock-wave has been more successful than either of these modalities on their own. We use this combination in patients striving for a quick and reliable relief of chronic symptoms.
In any case, to better understand the variables which might influence the outcome of eccentric training, including whether training should be painful, home vs. clinic-based training, the speed of the exercise, the duration of eccentric training, and the method of progression, randomized controlled trials are needed.
— Nicola Maffulli MD, MS, PhD, FRCS(Orth)
Center Lead and Professor of Sports and Exercise Medicine
Consultant
Trauma and Orthopaedic Surgeon
Queen Mary University of London Barts
and The London School of Medicine and Dentistry
London
Disclosure: Maffulli is the director of SportsMed UK Ltd.