This review was undertaken to describe different exercise protocols and to determine the most effective training parameters, specifically with eccentric exercise training (EET).

Studies were eligible if they were randomized controlled trials or clinical control trials evaluating the effect of EET for patients with chronic mid-portion Achilles tendinopathy. Studies that only investigated concentric or combined concentric eccentric exercise regimens were not included. Subjects had to be > 18 years-old and the mean duration of symptoms should be = 3 months. Reviews, cohort studies, and case reports were excluded, as were studies on ruptures of the Achilles tendon. Methodological quality was assessed using the PEDro score.

Levels of evidence were interpreted using the classification of Van Tulder et. al. Included studies with a score of = 6/10 were considered of high quality, where a score of 5/50 or lower was considered as low methodological quality. 12 studies met the criteria. The included studies investigated a total of 794 patients, less than 50% received EET as a single intervention. Seven studies used the exact protocol as described by Alfredson, patients performed 3x15 repetitions twice daily for a period of 12 weeks. Exercises were performed with both straight and bent knee, non-disabling pain was allowed during the exercises. Two studies used a protocol similar to Alfredson but with a gradual onset of exercises during the first week. Several other protocols were used for the remaining studies. Protocols were dependent on patients and used progressive loading based on patient tolerance. Overall there is strong evidence for the use of EET. There is no protocol that appeared to have superior results. Compliance and stage of tendinopathy may be underlying factors that are responsible.

Further research is needed, since EET is not for every patient different training parameters such as concentric-eccentric, isometric, and heavy slow resistance training should be studied.

Extremities: Reviews