Achilles Tendinopathy Toolkit: Section C - Summary of Evidence and Recommendations for Interventions

Achilles Tendinopathy (mid-substance): 
Summary of the Evidence for Physical Therapy Interventions

Purpose, Scope and Disclaimer

The purpose of this document is to provide physical therapists with a summary of the evidence for interventions commonly used to manage mid‐substance Achilles tendinopathy. This decision‐making tool is evidence‐informed and where there is insufficient evidence, expert‐informed. It is not intended to replace the clinician’s clinical reasoning skills
and inter‐professional collaboration. ‘Acute’ refers primarily to the stage with the cardinal signs of heat, redness, pain, swelling and loss of function and a very recent onset of symptoms.

Manual Therapy

Joint mobs
Stage of pathology	Acute	Chronic
Clinical research evidence	No	Yes
Published expert opinion	Yes	Yes
Take home message	There is no clinical evidence but there is expert level consensus to support	There is a small amount of clinical evidence and more substantial expert level consensus to support the use of joint mobilizations in the chronic stage if assessment reveals joint restriction.
Clinical implication*	May consider using manual therapy in the acute stage after undertaking a comprehensive biomechanical evaluation of the ‐ Joint mobs hip, knee, foot and ankle.	May consider using manual therapy in the chronic stage after undertaking a comprehensive biomechanical evaluation of the hip, knee, foot and ankle.
Soft-tissue techniques
Stage of pathology	Acute	Chronic
Clinical research evidence	No	Yes 1 SR 2 CS
Published expert opinion	No	Yes
Take home message	The clinical evidence neither supports nor refutes the use of frictions in the acute stage.	There is a small amount of clinical evidence to <u>support the use of soft tissue techniques, such as frictions, in the chronic stage.
Clinical implication*	May consider using manual therapy in the acute stage after undertaking a comprehensive biomechanical evaluation of the ‐ Joint mobs hip, knee, foot and ankle.	May consider a trial of soft tissue techniques, such as frictions, in the chronic stage.

• See final page for description of categories.

Exercise

Stage of pathology	Acute	Chronic
Clinical research evidence	No	Yes 14 OS 6 SR 5 RCT
Published expert opinion	Yes	Yes
Take home message	There is a small amount of expert opinion to support the use of stretches in the acute stage.	There is a large amount of clinical evidence to support the use of exercise in the chronic stage but the precise parameters to ensure effectiveness are not clear. Eccentric exercise in particular is supported although some protocols use both concentric and eccentric exercise. Males appear to benefit slightly more than females from eccentric exercise.
Clinical implication*	May consider using stretching exercises in acute stage. No prescription parameters are provided. ACSM recommends 10-30 sec hold, 2‐4 repetitions.	Strongly consider using eccentric exercise in the chronic stage using the following general parameters of a gradual progression to 3 sets of 15 repetitions, twice per day with the knee extended and with the knee flexed. See Appendix A for further details on exercise prescription.

• • See final page for description of categories.

References

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