Sports Medicine

, Volume 48, Issue 8, pp 1875–1891 | Cite as

Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis

  • Myles MurphyEmail author
  • Mervyn Travers
  • William Gibson
  • Paola Chivers
  • James Debenham
  • Sean Docking
  • Ebonie Rio
Systematic Review



Mid-portion Achilles tendinopathy is prevalent within both the athletic and non-athletic populations and loading protocols for Achilles tendinopathy are effective over time, though the rate of symptom change throughout rehabilitation is unknown.


The objective of this study was to determine the rate of change in pain and function over time in patients while completing a loading protocol for mid-portion Achilles tendinopathy.


A systematic review and longitudinal meta-analysis was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases PubMed, CINAHL (Ovid) and CINAHL (EBSCO) were searched for articles published from inception until 31 July, 2017. Our search focused on clinical trials and cohort studies examining changes in pain and function when completing a loading protocol for mid-portion Achilles tendinopathy. The primary outcome measure assessing pain and function was the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire.


A total of 31 separate cohorts (24 studies) were eligible, with follow-up ranging from 2 weeks to 6 months. The data were pooled to create the mean (standard deviation) of change from baseline at each time point. The data demonstrated an improvement in pain and function as early as 2 weeks that appeared to peak at 12 weeks with a mean (standard deviation) of 21.11 (6.61) points of change on the VISA-A.


The improvement in pain and function during rehabilitation suggests future research should be directed toward investigating contributing mechanisms as tendon structure on imaging does not change within 2 weeks and muscular hypertrophy is not seen for at least 4 weeks following the inception of a loading protocol. Systematic Review Registry: PROSPERO registration number: CRD42017062737 (



Myles Murphy acknowledges the support from the Australian Governments Research Training Program Scholarship. Ebonie Rio acknowledges the support from the National Health and Medical Research Councils Early Career Fellowship Scheme. All authors acknowledge the contributions of Dr. Clare Ardern (Linköping University, Linköping, Sweden) and Prof. Max Bulsara (Institute of Health Research, The University of Notre Dame, Fremantle, WA, Australia) for their assistance in developing the protocol for this systematic review.

Authors’ Contributions

MM, WG and ER conceptualised the study. MM, MT, WG, JD, SD, PC and ER developed the study design and protocol. All authors contributed and approved the final manuscript.

Compliance with Ethical Standards


No financial support was received for the conduct of this study or preparation of this article.

Conflict of Interest

Myles Murphy, Mervyn Travers, William Gibson, Paola Chivers, James Debenham, Sean Docking and Ebonie Rio have no conflicts of interest directly relevant to the content of this article.

Data Availability

The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. The data sheet used for the meta-analysis was also registered and stored on Figshare ( [28].

Supplementary material

40279_2018_932_MOESM1_ESM.docx (102 kb)
Supplementary material 1 (DOCX 103 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of PhysiotherapyUniversity of Notre Dame AustraliaFremantleAustralia
  2. 2.SportsMed Subiaco, St John of God Health CareSubiacoAustralia
  3. 3.Sports Science Sports Medicine DepartmentWestern Australian Cricket AssociationEast PerthAustralia
  4. 4.School of Physiotherapy and Exercise ScienceCurtin UniversityBentleyAustralia
  5. 5.Institute for Health Research, University of Notre Dame AustraliaFremantleAustralia
  6. 6.Exercise Medicine Research Institute and School of Medical and Health Sciences, Edith Cowan UniversityJoondalupAustralia
  7. 7.La Trobe Sports and Exercise Medicine Research Centre, La Trobe UniversityBundooraAustralia
  8. 8.Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP)BundooraAustralia

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