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First published online May 27, 2015

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

Abstract

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.

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Published In

Article first published online: May 27, 2015
Issue published: July 2015

Keywords

  1. Achilles tendon
  2. tendinopathy
  3. eccentric training
  4. heavy slow resistance training

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© 2015 The Author(s).
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History

Published online: May 27, 2015
Issue published: July 2015
PubMed: 26018970

Authors

Affiliations

Rikke Beyer, PT, MSc
Department of Physical Therapy, Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Mads Kongsgaard, PhD
Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Birgitte Hougs Kjær, PT, MSc
Department of Physical Therapy, Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
Tommy Øhlenschlæger, MD
Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Michael Kjær, MD, DMSci
Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
S. Peter Magnusson, PT, DMSci
Department of Physical Therapy, Musculoskeletal Rehabilitation Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
Institute of Sports Medicine, Bispebjerg Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Investigation performed at Bispebjerg Hospital, Copenhagen, Denmark, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

Notes

Peter Magnusson, PT, DMSci, Institute of Sports Medicine, Bispebjerg Hospital, Department 8, 1st Floor, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark (email: [email protected]).

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