STUDY DESIGN: Randomized clinical trial. OBJECTIVES: To test the hypothesis that whole-body vibration training results in greater improvements in symptoms and pain, structural changes, and muscle flexibility and strength of the triceps surae muscle-tendon unit than those achieved with eccentric training or with a wait-and-see approach. BACKGROUND: The potential use of vibration training for the treatment of Achilles tendinopathy has not been explored. METHODS: Fifty-eight patients (mean age 46.0 years) with Achilles tendinopathy were randomly assigned to a 12-week intervention using whole-body vibration training, eccentric training, or a wait-and-see approach. Pain, tendon structure and path, and muscle flexibility and strength were assessed at baseline and follow-up, and compared using mixed-factor analyses of variance. RESULTS: Pain improvements at the midsection of the tendon were greater in the vibration- and eccentric-training groups than in the wait-and-see group (mean difference from the vibration-training group -18.0; 95% confidence interval (CI) -35.0 to -1.1; mean difference from the eccentric-training group -27.0; 95% CI -50.9 to -3.1). Improvements in pain at the musculotendinous junction were greater in the eccentric-training group than in the other groups (mean difference from the vibration-training group -31.4; 95% CI -60.7 to -2.0; mean difference from the wait-and-see group -50.2; 95% CI -82.3 to -18.1). Improvements in most participants were achieved in the vibration-training group, followed by the eccentric-training group. CONCLUSION: Vibration training may be an alternative or a complementary treatment in patients who do not respond well to eccentric training, especially in those with insertional pain.

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