Eccentric Exercise and Soft Tissue Treatment (ASYTM) for Insertional Achilles Tendinopathy

Evidence-Based Practice – Issue 2-2016

Eccentric Exercise Versus Eccentric Exercise and Soft Tissue Treatment (ASYTM) in the Management of Insertional Achilles Tendinopathy: A Randomized Controlled Trial

Article.  McCormack JR, et al., Eccentric Exercise Versus Eccentric Exercise and Soft Tissue Treatment (ASTYM) in the Management of Insertional Achilles Tendinopathy: A Randomized Controlled Trial. Sports Health 2016; 8(3):  230-237.

Purpose.  The purpose of this study was to compare the outcomes between eccentric exercise only and eccentric exercise plus soft tissue treatment (ASTYM) for subjects with insertional Achilles tendonitis.  

Study Design. Prospective randomized controlled trial.

Methods

• Subjects
  • 16 participants older than 18 years with insertional Achilles tendinitis.
    • 9 subjects randomized in the exercise group
    • 7 subjects randomized in the ASTYM group
      • No statistical difference in age, BMI, or self reported pain or functional scales of the two groups

• Data Collection
  • Victorian Institute of Sport Assessment Achilles-Specific Questionnaire
  • Numeric Pain Rating Scale
  • The Global Rating of Change
  • Subjects in both groups were instructed to perform modified eccentric protocol.
    • Subjects performed 3 sets of 15 repetitions per session/2 sessions per day for a total of 12 weeks.
    • In addition to performing the eccentric protocol, subjects in the soft tissue treatment (ASTYM) group were seen in the clinic 2 times per week for 12 visits.
    • Soft tissue treatment (ASTYM) was performed per the foot, ankle, and knee protocol.  
    • Each treatment session lasted approximately 20 to 30 minutes.

• Subjects in both groups were instructed to avoid activities such as running for at least the first 4 weeks of treatment, but could resume activities as tolerated after 4 weeks.

Figure 1. Eccentric exercise as performed in current study for a subject with right side insertional Achilles tendinopathy. Step 1: Perform heel raise with unaffected leg; step 2: Transfer weight to affected leg; step 3: Slowly lower heel of affected leg to floor.

Results

• Significantly greater improvements on the VISA-A were noted in the soft tissue treatment (ASTYM) group over the 12-week intervention period, and these differences were maintained at the 26 and 52-week follow-ups.
• Both groups experienced a similar statistically significant improvement in pain over the short and long term.
• A significantly greater number of subjects in the soft tissue treatment (ASTYM) group achieved a successful outcome at 12 weeks.

Clinical Relevance. Soft tissue treatment (ASTYM) plus eccentric exercise appears to be a beneficial treatment program that clinicians should consider incorporating into the management of their patients with insertional Achilles tendinitis.