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

PainSci » bibliography » Beyer et al 2015
updated
Tags: strength, Achilles tendinitis, exercise, self-treatment, treatment

Five pages on PainSci cite Beyer 2015: 1. Strength Training for Pain & Injury Rehab2. Guide to Repetitive Strain Injuries3. Achilles Tendinitis Treatment Science4. Exercise is anti-inflammatory medicine for injuries (Member Post)5. STUDY: Contradictory new data on nitroglycerin for tendinitis

PainSci commentary on Beyer 2015: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Trials have shown promise for eccentric training (contracting while elongating) for Achilles tendinitis (and other tendinitises), but … does it really have to be “eccentric”? Maybe any resistance training will do the job. This trial was designed to test that by comparing eccentric training to a more conventional weightlifting style of heavy slow resistance training.

They tested both approaches for three months in a few dozen people with chronic midportion Achilles tendinitis. The tendons changed! “Significant reduction in tendon thickness and neovascularization”! But …

None of these robust clinical and structural improvements differed between the ECC and HSR groups.

Eccentric wasn’t better. It was actually a little worse in one way: amusingly, people were more satisfied doing the regular exercises — probably because they’re less tedious!

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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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