The limited effectiveness of a home-based eccentric training for treatment of achilles tendinopathy

NewsBot · Aug 3, 2013

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The limited effectiveness of a home-based eccentric training for treatment of achilles tendinopathy.
Ram R, Meeuwisse W, Patel C, Wiseman DA, Wiley JP.
Clin Invest Med. 2013 Aug 1;36(4):E197.

Purpose: Objective was to evaluate the outcome of a standardized heavy load eccentric training program in adults with chronic painful Achilles tendinopathy, and the presence of increased Colour Doppler activity in diseased and non-diseased adults. The hypothesis was that patient satisfaction would fall within the range of average satisfaction present in the literature (60 to 90%).

Methods: Twenty patients were instructed on a training program based on the Alfredson protocol of straight leg followed by bent knee heel drops and raises. Patient satisfaction was recorded as the primary outcome. Secondary outcomes included the VISA-A and Tegner scales. Twenty one subjects without present or history of lower extremity pain and seven patients presenting at the clinic but without Achilles tendinopathy were included as controls.

Results: Patient satisfaction was significantly lower when compared to the literature as two patients reported that they were satisfied with the treatment while the remaining 15 reported that they were unsatisfied. Three patients were excluded from the analysis as they were unable to complete the exercises. Increased Colour Doppler activity was present in only one participant without the disease and in all patients with the disease at the end of the study (increased Colour Doppler activity was present in 40% of patients with the disease at the beginning of the study).

Conclusion: Although some patients' symptoms improved over time, eccentric training did not satisfy patient expectations of improvement following treatment despite compliance with the home based program. Although it is a mainstay of treatment, other options, which are both efficacious and effective, need to be provided for patients who prefer a conservative and relatively non-invasive treatment option from the start.
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Admin2 · Aug 3, 2013

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NewsBot · Aug 4, 2015

Factors affecting adherence to Alfredson’s eccentric training programme in patients with chronic mid-portion Achilles tendinopathy
Green, Ben
Masters Thesis; Cardiff Met University 2015

Objectives: To explore, from the participants perspective, what factors affected adherence to Alfredson's eccentric training programme when prescribed it for chronic mid-portion Achilles tendinopathy.
Design: A qualitative design, with descriptive phenomenological approach, using semi-structured interviews.
Setting: Participants were interviewed in a private room in their local community hospital.
Participants: Five participants with a clinical diagnosis of chronic mid-portion Achilles tendinopathy who had been prescribed the full Alfredson eccentric exercise program.
Results: Through thematic analysis 3 main themes of factors that affected adherence were developed: beliefs about the condition, belief in the rehabilitation program, and motivation and support. Specifically, negative beliefs about the condition and fear of rupture limited adherence but could be addressed by the physiotherapist if good communication was present. A lack of belief in the efficacy of the program also reduced adherence, mediated in part by a lack of rationale for the program. The severity of the impact of the condition also effected adherence, if normal activities were significantly limited then motivation and adherence were high. Lack of early improvement reduced adherence as this produced a negative outlook due to the duration of the program. Follow-up appointments provided support and motivation, while difficulty fitting the exercises into the daily routine was a major barrier.
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Conclusions: Specific factors affected adherence to Alfredson's eccentric training programme in patients who had been prescribed it for chronic mid-portion Achilles tendinopathy. Some of these can be addressed when prescribing the program and may enhance adherence. Recommendations for prescribing this program in future include: proactively addressing the fear of rupture; highlighting the positive prognosis of the condition and efficacy of the program; explaining the rationale for the programme; offering follow-up appointments; and helping patients fit the program into their routine.
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