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

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Abstract

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusion

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 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=62737)

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References

  1. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409–16. https://doi.org/10.1136/bjsm.2008.051193.

    Article  PubMed  CAS  Google Scholar 

  2. Habets B, van Cingel RE. Eccentric exercise training in chronic mid-portion Achilles tendinopathy: a systematic review on different protocols. Scand J Med Sci Sports. 2015;25(1):3–15. https://doi.org/10.1111/sms.12208.

    Article  PubMed  CAS  Google Scholar 

  3. van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19(5):835–41. https://doi.org/10.1007/s00167-010-1374-z.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cook JL, Rio E, Purdam CR, Docking SI. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50(19):1187–91. https://doi.org/10.1136/bjsports-2015-095422.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Lopes AD, Hespanhol LC, Yeung SS, Costa LOP. What are the main running-related musculoskeletal injuries? Sports Med. 2012;42(10):891–905. https://doi.org/10.1007/bf03262301.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Albers IS, Zwerver J, Diercks RL, Dekker JH, Van den Akker-Scheek I. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population: a cross sectional study. BMC Musculoskelet Disord. 2016;17(1):16. https://doi.org/10.1186/s12891-016-0885-2.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Couppe C, Svensson RB, Silbernagel KG, Langberg H, Magnusson SP. Eccentric or concentric exercises for the treatment of tendinopathies? J Orthop Sports Phys Ther. 2015;45(11):853–63. https://doi.org/10.2519/jospt.2015.5910.

    Article  PubMed  Google Scholar 

  8. Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360–6.

    Article  PubMed  CAS  Google Scholar 

  9. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42–7. https://doi.org/10.1007/s001670000148.

    Article  PubMed  CAS  Google Scholar 

  10. Silbernagel KG, Thomee R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35(6):897–906. https://doi.org/10.1177/0363546506298279.

    Article  PubMed  Google Scholar 

  11. Silbernagel KG, Thomee R, Thomee P, Karlsson J. Eccentric overload training for patients with chronic Achilles tendon pain: a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports. 2001;11(4):197–206.

    Article  PubMed  CAS  Google Scholar 

  12. Beyer R, Kongsgaard M, Hougs Kjaer B, Ohlenschlaeger T, Kjaer M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43(7):1704–11. https://doi.org/10.1177/0363546515584760.

    Article  PubMed  Google Scholar 

  13. Meyer A, Tumilty S, Baxter GD. Eccentric exercise protocols for chronic non-insertional Achilles tendinopathy: how much is enough? Scand J Med Sci Sports. 2009;19(5):609–15. https://doi.org/10.1111/j.1600-0838.2009.00981.x.

    Article  PubMed  CAS  Google Scholar 

  14. Allison GT, Purdam C. Eccentric loading for Achilles tendinopathy: strengthening or stretching? Br J Sports Med. 2009;43(4):276–9. https://doi.org/10.1136/bjsm.2008.053546.

    Article  PubMed  CAS  Google Scholar 

  15. Arnoczky SP, Lavagnino M, Egerbacher M. The mechanobiological aetiopathogenesis of tendinopathy: is it the over-stimulation or the under-stimulation of tendon cells? Int J Exp Pathol. 2007;88(4):217–26. https://doi.org/10.1111/j.1365-2613.2007.00548.x.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shalabi A, Kristoffersen-Wilberg M, Svensson L, Aspelin P, Movin T. Eccentric training of the gastrocnemius-soleus complex in chronic Achilles tendinopathy results in decreased tendon volume and intratendinous signal as evaluated by MRI. Am J Sports Med. 2004;32(5):1286–96. https://doi.org/10.1177/0363546504263148.

    Article  PubMed  Google Scholar 

  17. O’Neill S, Watson PJ, Barry S. Why are eccentric exercises effective for achilles tendinopathy? Int J Sports Phys Ther. 2015;10(4):552–62.

    PubMed  PubMed Central  Google Scholar 

  18. Rio E, Kidgell D, Moseley GL, Gaida J, Docking S, Purdam C, et al. Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med. 2016;50(4):209–15. https://doi.org/10.1136/bjsports-2015-095215.

    Article  PubMed  Google Scholar 

  19. Maquirriain J. Leg stiffness changes in athletes with Achilles tendinopathy. Int J Sports Med. 2012;33(7):567–71. https://doi.org/10.1055/s-0032-1304644.

    Article  PubMed  CAS  Google Scholar 

  20. Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277–83. https://doi.org/10.1136/bjsports-2014-094386.

    Article  PubMed  Google Scholar 

  21. Gabriel DA, Kamen G, Frost G. Neural adaptations to resistive exercise: mechanisms and recommendations for training practices. Sports Med. 2006;36(2):133–49.

    Article  PubMed  Google Scholar 

  22. DeFreitas JM, Beck TW, Stock MS, Dillon MA, Kasishke PR 2nd. An examination of the time course of training-induced skeletal muscle hypertrophy. Eur J Appl Physiol. 2011;111(11):2785–90. https://doi.org/10.1007/s00421-011-1905-4.

    Article  PubMed  Google Scholar 

  23. de Jonge S, Tol JL, Weir A, Waarsing JH, Verhaar JA, de Vos RJ. The tendon structure returns to asymptomatic values in nonoperatively treated achilles tendinopathy but is not associated with symptoms: a prospective study. Am J Sports Med. 2015;43(12):2950–8. https://doi.org/10.1177/0363546515605077.

    Article  PubMed  Google Scholar 

  24. de Vos RJ, Heijboer MP, Weinans H, Verhaar JA, van Schie JT. Tendon structure’s lack of relation to clinical outcome after eccentric exercises in chronic midportion Achilles tendinopathy. J Sport Rehabil. 2012;21(1):34–43.

    Article  PubMed  Google Scholar 

  25. de Vos RJ, Weir A, Tol JL, Verhaar JA, Weinans H, van Schie HT. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med. 2011;45(5):387–92. https://doi.org/10.1136/bjsm.2010.076398.

    Article  PubMed  Google Scholar 

  26. Gardin A, Movin T, Svensson L, Shalabi A. The long-term clinical and MRI results following eccentric calf muscle training in chronic Achilles tendinosis. Skeletal Radiol. 2010;39(5):435–42. https://doi.org/10.1007/s00256-009-0798-3.

    Article  PubMed  Google Scholar 

  27. van Ark M, Cook JL, Docking SI, Zwerver J, Gaida JE, van den Akker-Scheek I, et al. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomised clinical trial. J Sci Med Sport. 2016;19(9):702–6. https://doi.org/10.1016/j.jsams.2015.11.006.

    Article  PubMed  Google Scholar 

  28. Murphy M, Travers MJ, Gibson W, Chivers P, Debenham J, Docking S, et al. The rate of improvement of pain and function in mid-portion Achilles tendinopathy with loading protocols: a systematic review and longitudinal meta-analysis. In: Figshare.2018. Available from: https://figshare.com/articles/The_rate_of_improvement_of_pain_and_function_in_mid-portion_Achilles_tendinopathy_with_loading_protocols_A_Systematic_Review_and_Longitudinal_Meta-Analysis_/6143210. Accessed 5 May 2018.

  29. Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35(5):335–41.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Scott A, Docking S, Vicenzino B, Alfredson H, Murphy RJ, Carr AJ, et al. Sports and exercise-related tendinopathies: a review of selected topical issues by participants of the second International Scientific Tendinopathy Symposium (ISTS) Vancouver 2012. Br J Sports Med. 2013;47(9):536–44. https://doi.org/10.1136/bjsports-2013-092329.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Murphy M, Rio E, Debenham J, Docking S, Travers MJ, Gibson W. Evaluating the progress of mid-portion Achilles tendinopathy during rehabilitation: a review of outcome measures for self-reported pain and function. Int J Sports Ther. 2018;13(2):283–92. https://doi.org/10.26603/ijspt20180283.

    Article  Google Scholar 

  32. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. https://doi.org/10.1136/bmj.b2700.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Higgins JPT, Sterne JAC, Savović J, Page MJ, Hróbjartsson A, Boutron I, Reeves B, Eldridge S. A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev. 2016. https://doi.org/10.1002/14651858.cd201601.

    Article  Google Scholar 

  34. Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919. https://doi.org/10.1136/bmj.i4919.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. http://www.handbook.cochrane.org. Accessed 5 May 2018.

  36. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. https://doi.org/10.1136/bmj.328.7454.1490.

    Article  PubMed  Google Scholar 

  38. Dechartres A, Trinquart L, Boutron I, Ravaud P. Influence of trial sample size on treatment effect estimates: meta-epidemiological study. BMJ. 2013;346:f2304. https://doi.org/10.1136/bmj.f2304.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Ishak KJ, Platt RW, Joseph L, Hanley JA, Caro JJ. Meta-analysis of longitudinal studies. Clin Trials. 2007;4(5):525–39. https://doi.org/10.1177/1740774507083567.

    Article  PubMed  Google Scholar 

  41. Balius R, Álvarez G, Baró F, Jiménez F, Pedret C, Costa E, et al. A 3-arm randomized trial for Achilles tendinopathy: eccentric training, eccentric training plus a dietary supplement containing mucopolysaccharides, or passive stretching plus a dietary supplement containing mucopolysaccharides. Curr Ther Res Clin Exp. 2016;78:1–7. https://doi.org/10.1016/j.curtheres.2016.11.001.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Bell KJ, Fulcher ML, Rowlands DS, Kerse N. Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy: double blind randomised controlled trial. BMJ. 2013;346:f2310. https://doi.org/10.1136/bmj.f2310.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion Achilles tendinopathy: a randomized double-blinded prospective study. Am J Sports Med. 2017;45(9):2034–43. https://doi.org/10.1177/0363546517702862.

    Article  PubMed  Google Scholar 

  44. Brown R, Orchard J, Kinchington M, Hooper A, Nalder G. Aprotinin in the management of Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2006;40(3):275–9. https://doi.org/10.1136/bjsm.2005.021931.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. de Vos RJ, Weir A, Visser RJ, de Winter T, Tol JL. The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2007;41(7):e5. https://doi.org/10.1136/bjsm.2006.032532.

    Article  PubMed  Google Scholar 

  46. Kearney RS, Parsons N, Costa ML. Achilles tendinopathy management: a pilot randomised controlled trial comparing platelet-richplasma injection with an eccentric loading programme. Bone Joint Res. 2013;2(10):227–32. https://doi.org/10.1302/2046-3758.210.2000200.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. Knobloch K, Schreibmueller L, Kraemer R, Jagodzinski M, Vogt PM, Redeker J. Gender and eccentric training in Achilles mid-portion tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):648–55. https://doi.org/10.1007/s00167-009-1006-7.

    Article  PubMed  Google Scholar 

  48. Maffulli N, Walley G, Sayana MK, Longo UG, Denaro V. Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Disabil Rehabil. 2008;30(20–22):1677–84. https://doi.org/10.1080/09638280701786427.

    Article  PubMed  Google Scholar 

  49. McAleenan M, McVeigh JG, Cullen M, Sayers F, McCrea K, Baxter D. The effectiveness of night splints in achilles tendinopathy: a pilot study. Physiother Pract Res. 2010;31(1):28–33.

    Google Scholar 

  50. Munteanu SE, Scott LA, Bonanno DR, Landorf KB, Pizzari T, Cook JL, et al. Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2015;49(15):989–94. https://doi.org/10.1136/bjsports-2014-093845.

    Article  PubMed  Google Scholar 

  51. Pearson J, Rowlands D, Highet R. Autologous blood injection to treat achilles tendinopathy? A randomized controlled trial. J Sport Rehabil. 2012;21(3):218–24.

    Article  PubMed  Google Scholar 

  52. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37(3):463–70. https://doi.org/10.1177/0363546508326983.

    Article  PubMed  Google Scholar 

  53. Rompe JD, Nafe B, Furia JP, Maffulli N. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 2007;35(3):374–83. https://doi.org/10.1177/0363546506295940.

    Article  PubMed  Google Scholar 

  54. Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport. 2007;10(1):52–8. https://doi.org/10.1016/j.jsams.2006.05.008.

    Article  PubMed  Google Scholar 

  55. Stasinopoulos D, Manias P. Comparing two eccentric exercise programmes for the management of Achilles tendinopathy: a pilot trial. J Bodyw Move Ther. 2013;17(3):309–15. https://doi.org/10.1016/j.jbmt.2012.11.003.

    Article  Google Scholar 

  56. Stevens M, Tan CW. Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. J Orthopaed Sports Phys Ther. 2014;44(2):59–67. https://doi.org/10.2519/jospt.2014.4720.

    Article  Google Scholar 

  57. Tumilty S, Mani R, Baxter GD. Photobiomodulation and eccentric exercise for Achilles tendinopathy: a randomized controlled trial. Lasers Med Sci. 2016;31(1):127–35. https://doi.org/10.1007/s10103-015-1840-4.

    Article  PubMed  Google Scholar 

  58. Tumilty S, McDonough S, Hurley DA, Baxter GD. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: a randomized controlled trial. Arch Phys Med Rehabil. 2012;93(5):733–9. https://doi.org/10.1016/j.apmr.2011.08.049.

    Article  PubMed  Google Scholar 

  59. Tumilty S, Munn J, Abbott JH, McDonough S, Hurley DA, Baxter GD. Laser therapy in the treatment of achilles tendinopathy: a pilot study. Photomed Laser Surg. 2008;26(1):25–30. https://doi.org/10.1089/pho.2007.2126.

    Article  PubMed  Google Scholar 

  60. Yelland MJ, Sweeting KR, Lyftogt JA, Ng SK, Scuffham PA, Evans KA. Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis: a randomised trial. Br J Sports Med. 2011;45(5):421–8. https://doi.org/10.1136/bjsm.2009.057968.

    Article  PubMed  Google Scholar 

  61. Zhang BM, Zhong LW, Xu SW, Jiang HR, Shen J. Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Chin J Integr Med. 2013;19(12):900–4. https://doi.org/10.1007/s11655-012-1218-4.

    Article  PubMed  Google Scholar 

  62. Stanish WD, Rubinovich RM, Curwin S. Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res. 1986;208:65–8.

    Google Scholar 

  63. Herrington L, McCulloch R. The role of eccentric training in the management of Achilles tendinopathy: a pilot study. Phys Ther Sport. 2007;8(4):191–6. https://doi.org/10.1016/j.ptsp.2007.07.001.

    Article  Google Scholar 

  64. Drew BT, Smith TO, Littlewood C, Sturrock B. Do structural changes (eg, collagen/matrix) explain the response to therapeutic exercises in tendinopathy: a systematic review. Br J Sports Med. 2014;48(12):966–72. https://doi.org/10.1136/bjsports-2012-091285.

    Article  PubMed  Google Scholar 

  65. Rio E, Moseley L, Purdam C, Samiric T, Kidgell D, Pearce AJ, et al. The pain of tendinopathy: physiological or pathophysiological? Sports Med. 2014;44(1):9–23. https://doi.org/10.1007/s40279-013-0096-z.

    Article  PubMed  Google Scholar 

  66. Tompra N, van Dieen JH, Coppieters MW. Central pain processing is altered in people with Achilles tendinopathy. Br J Sports Med. 2016;50(16):1004–7. https://doi.org/10.1136/bjsports-2015-095476.

    Article  PubMed  Google Scholar 

  67. McAuliffe S, Synott A, Casey H, Mc Creesh K, Purtill H, O’Sullivan K. Beyond the tendon: Experiences and perceptions of people with persistent Achilles tendinopathy. Musculoskelet Sci Pract. 2017;29:108–14. https://doi.org/10.1016/j.msksp.2017.03.009.

    Article  Google Scholar 

  68. Travaline JM, Ruchinskas R, D’Alonzo GE Jr. Patient-physician communication: why and how. J Am Osteopath Assoc. 2005;105(1):13–8. https://doi.org/10.7556/jaoa.2005.105.1.13.

    Article  PubMed  Google Scholar 

  69. Cook CE. Clinimetrics corner: the minimal clinically important change score (MCID): a necessary pretense. J Man Manip Ther. 2008;16(4):E82–3. https://doi.org/10.1179/jmt.2008.16.4.82E.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Silbernagel KG, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up. Am J Sports Med. 2011;39(3):607–13. https://doi.org/10.1177/0363546510384789.

    Article  PubMed  Google Scholar 

  71. van der Plas A, de Jonge S, de Vos RJ, van der Heide HJ, Verhaar JA, Weir A, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46(3):214–8. https://doi.org/10.1136/bjsports-2011-090035.

    Article  PubMed  Google Scholar 

  72. Murphy M, Travers MJ, Gibson W. Is heavy eccentric calf training superior to wait-and-see, sham rehabilitation, traditional physiotherapy and other exercise interventions for pain and function in mid-portion Achilles tendinopathy. Syst Rev. 2018;7(58):1–7. https://doi.org/10.1186/s13643-018-0725-6.

    Article  Google Scholar 

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Acknowledgements

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.

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Authors and Affiliations

  1. School of Physiotherapy, University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, WA, 6959, Australia

    Myles Murphy, Mervyn Travers, William Gibson & James Debenham

  2. SportsMed Subiaco, St John of God Health Care, Subiaco, WA, Australia

    Myles Murphy

  3. Sports Science Sports Medicine Department, Western Australian Cricket Association, East Perth, WA, Australia

    Myles Murphy

  4. School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia

    Mervyn Travers

  5. Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia

    Paola Chivers

  6. Exercise Medicine Research Institute and School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

    Paola Chivers

  7. La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, VIC, Australia

    Sean Docking & Ebonie Rio

  8. Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Bundoora, Australia

    Ebonie Rio

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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.

Corresponding author

Correspondence to Myles Murphy.

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Funding

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 (https://doi.org/10.6084/m9.figshare.6143210.v1) [28].

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Murphy, M., Travers, M., Gibson, W. et al. Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis. Sports Med 48, 1875–1891 (2018). https://doi.org/10.1007/s40279-018-0932-2

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