Achilles tendinopathy is a common condition that affects athletes and individuals who engage in activities that require repetitive stress on the Achilles tendon. It is a debilitating condition that can significantly impair mobility and quality of life. Several treatment options are available, including conservative management, physical therapy, and surgery. Extracorporeal shockwave therapy (ESWT) is an innovative and non-invasive treatment option that has been shown to provide short-term relief for non insertional Achilles tendinopathy (NAT). However, the long-term effectiveness of this treatment modality remains unknown.

Abdelkader et al. (2022) conducted a trial to compare the short-term and long-term effects of an eccentric loading program followed by stretching exercises combined with ESWT or sham ESWT for treating chronic NAT. The study was conducted between 2018 and 2020 and included 50 adult patients with unilateral NAT who failed standard conservative treatment. The participants were randomly allocated to either the study group or the control group, and function and pain were assessed at baseline, one month, and 16 months using the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) and visual analog scale (VAS), respectively.

The results of the study showed that both groups significantly improved post-treatment, with the study group showing significantly superior scores (statistically and clinically) than the control group at both time points. At the 16-month follow-up, outcome scores declined slightly but significantly in the study group and improved in the control group. However, both groups were significantly better than the baseline. These findings suggest that combining eccentric calf loading with stretching exercises resulted in significant improvements in pain and functional scores in patients with NAT. Adding ESWT to this combined protocol resulted in significantly greater improvements in both the short and long term.

The study’s strengths include its double-blind, randomized controlled design and the use of objective outcome measures. The study’s limitations include the relatively small sample size and the lack of a placebo group for eccentric loading and stretching exercises. Additionally, the study did not evaluate the cost-effectiveness of the combined treatment protocol.

In conclusion, this study suggests that combining ESWT with an eccentric loading program followed by stretching exercises provides short-term and long-term relief for non insertional Achilles tendinopathy. This combined treatment protocol may be a viable option for patients who failed standard conservative treatment and want to avoid surgery. Future studies should evaluate the cost-effectiveness of this treatment modality and compare its effectiveness to other non-surgical treatment options.

Reference: Abdelkader NA, Helmy MNK, Fayaz NA, Saweeres ESB. Short- and Intermediate-Term Results of Extracorporeal Shockwave Therapy for Noninsertional Achilles Tendinopathy. Foot Ankle Int. 2021 Jun;42(6):788-797. doi: 10.1177/1071100720982613. Epub 2021 Jan 15. PMID: 33451253.