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Using pressure massage for Achilles tendinopathy: a single-blind, randomized controlled trial comparing a novel treatment versus an eccentric exercise protocol
Stefansson SH, Brandsson S, Langberg H, Arnason A
Orthopaedic Journal of Sports Medicine 2019 Mar;7(3):2325967119834284
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Eccentric exercises are the only conservative treatment that has shown good clinical results in studies of Achilles tendinopathy (AT), but success rates vary, indicating the need for alternative treatments. Soft tissue treatments are widely used for AT, but strong scientific evidence is lacking to support those treatments. PURPOSE/HYPOTHESES: This study aimed to determine whether pressure massage to the calf muscles is a useful treatment for AT and to compare this treatment versus an eccentric exercise protocol. Our first hypothesis was that pressure massage treatment is equivalent or superior to eccentric exercises with regard to pain reduction time (ie, pain would be reduced more quickly with pressure massage). The second hypothesis was that pressure massage is equivalent or superior to eccentric exercises with regard to function of the calf muscles. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A total of 60 patients with AT were randomized into 3 groups: group 1 underwent an eccentric exercise protocol, group 2 underwent pressure massage, and group 3 underwent pressure massage and the eccentric exercise protocol. Patients were evaluated with the Icelandic version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-IS), an algometer to test the pressure pain threshold (PPT) of the Achilles tendon, tests for ankle range of motion (ROM), and real-time ultrasonographic (US) scanning of tendon thickness and degree of neovascularization. Measurements for VISA-A-IS, PPT, and ROM were taken at 0, 4, 8, 12, and 24 weeks. US scan measurements were taken at 0, 12, and 24 weeks. Mixed-model analysis of variance was used for statistical analysis. RESULTS: All groups improved when evaluated with VISA-A-IS scores (p < 0.0001). The pressure massage group improved significantly more than the eccentric exercise group at week 4, which was the only between-group difference. Ankle ROM increased significantly over time (ROM bent knee p = 0.006 and ROM straight knee p = 0.034), but no significant difference was found between groups. No significant difference was found in evaluations of PPT or US scan measurements. CONCLUSION: Pressure massage is a useful treatment for Achilles tendinopathy. Compared with eccentric exercise treatment, pressure massage gives similar results. Combining the treatments did not improve the outcome.

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