Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis

Prudêncio, Diego Ailton; Maffulli, Nicola; Migliorini, Filippo; Serafim, Thiago Teixeira; Nunes, Luis Felipe; Sanada, Luciana Sayuri; Okubo, Rodrigo

doi:10.1186/s13102-023-00618-2

BMC Sports Science, Medicine and Rehabilitation

Table 2 Source: Own author/2019

From: Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis

Study	Intervention(s)	Sample size	Gender (M/F)	Age (mean)	Intervention duration (wk)	Comparison and outcome measure	Study conclusions (p value/SMD—95% CI)
Eccentric exercise vs another exercise therapy or rest/wait-and-see
Mafi 2001	EE	22	12/10	48.1 ± 9.5	12	VAS	The results after treatment with EE was significantly better (p < 0.002) than the results of treatment with the concentric training regimen; Between groups comparisons of pain not presented
Mafi 2001	Concentric exercise	22	12/10	48.4 ± 8.3	12	VAS
Silbernagel 2001	Eccentric overload training;	22	17/5	47 ± 14.7	12	VAS Jumping test; toe-raise test	Eccentric loading had better strength and pain outcomes (p < 0.05)
Silbernagel 2001	Light training	18	14/4	41 ± 10.2	12	VAS Jumping test; toe-raise test
Beyer 2015	EE	25	18/7	48 ± 2	12	VISA-A VAS_H VAS_R	VISA-A: there was no significant interaction (p = 0.26) or difference between groups (p = 0.62). VAS_H and VAS_R there was no significant interaction (VAS_H, p = 0.08; VAS_R, p = 0.38) or difference between groups (VAS_H p = 0.77; VAS_R, p = 0.71). Similar treatments
Beyer 2015	HSR	22	14/8	48 ± 2	12	VISA-A VAS_H VAS_R
Rompe 2007	EE	25	9/16	48.1 ± 9.9	12	1 vs 3 VISA-A VNE	VISA-A and VNE: Patients from group 1 achieved significantly better results than patients from group 3 (p < 0.001)
	SWT	25	11/14	51.2 ± 10.2
	Wait-and-see	25	9/16	46.4 ± 11.4
Horstmann 2013	Vibration training	23	13/10	46.0 ± 6.9	12	2 vs 3 VAS Isokinetic	Pain improvements were greater in the EE groups than in the wait-and-see group (– 27.0; 95% CI –50.9, – 3.1)
	EE	19	10/9	45.7 ± 8.5
	Wait-and-see	16	9/7	44.4 ± 7.7
Silbernagel 2007	EE	19	12/7	44 ± 8.8	6–52	VISA-A-S VAS Jump tests, strength tests, endurance test	Both groups showed significant (p < .01) improvements on the VISA-A-S score and decrease in pain during hopping at 6 weeks and at 3, 6, and 12-month evaluations
Silbernagel 2007	EE + active	19	8/11	48 ± 6.8	6–52	VISA-A-S VAS Jump tests, strength tests, endurance test
Stasinopoulos 2013	Stanish protocol	21	NR	48.44 ± 5.12	12	VISA-A	VISA- A: there were significant differences in the magnitude of improvement between the groups at weeks 12 and 36 (p < 0.05)
Stasinopoulos 2013	Alfredson protocol	20	NR	48.24 ± 5.09	12	VISA-A
Stevens 2014	Alfredson protocol	15	6/9	48.2 ± 10.8	6	VISA-A VAS	The between-group difference change score was not statistically significant at week 6 for VISA-A (ITT, p = 0.20; PP, p = 0.32) and VAS (ITT, p = 0.14; PP, p = 0.73)
Stevens 2014	Alfredson protocol (do-as-tolerated)	13	5/8	49.2 ± 11.3	6	VISA-A VAS

SMD, standard mean difference; M, male; F, female; NR, not reported; CI, confidence interval; EE, eccentric exercise; VAS, visual analogue scale; VISA-A, Victorian Institute of Sports Assessment-Achilles; HSR, heavy slow resistance; VAS_H, visual analogue scale heel rises; VAS, VAS, visual analogue scale running; SWT, shock-wave therapy; VNE, visual numerical scale; VISA-A-S Victorian Institute of Sports Assessment-Achilles Swedish; ITT, intention-to-treat; PP, per-protocol

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