Is physiotherapy effective for patients with a chronic mid-body Achilles tendinopathy? A systematic review of non-surgical and non-pharmacological interventions
Hutchison AM., Beard D., Pallister I., Topliss CJ., Williams P.
Objective: To assess the effectiveness of physiotherapy interventions (non-surgical and nonpharmacological) for a chronic mid-body Achilles tendinopathy. Materials and methods: A search of published and grey literature databases was undertaken (January 1999 to January 2011). Two reviewers independently assessed the studies for eligibility using a strict inclusion and exclusion criteria. All eligible articles were assessed critically using the PEDro score. Data on cohort characteristics, diagnostic criteria, treatment intervention, outcome measures, and results were extracted. A narrative research synthesis method was adopted since there were insufficient data to conduct a metaanalysis. Results: Two hundred and ninety studies were identified. Nine publications met the review inclusion criteria. Methodological quality was adequate for all nine studies; however, blinding was a limitation for most. Interventions investigated were; exercises (n= 2), low-level laser therapy (n = 1), low-energy shockwave treatment (SWT) (n= 3), air cast brace (n = 2), and insoles (n = 1). Some evidence exists for eccentric exercises in combination with SWT or laser. In contrast to other reviews, eccentric exercises alone were not found to be superior to other physiotherapy treatments. Conclusion: There is an insufficient evidence to determine which method of physiotherapy is most appropriate for a chronic mid-body Achilles tendinopathy. Further well-designed randomized controlled trials assessing physiotherapy interventions with specific diagnostic criteria and appropriate outcome tools are required to determine the efficacy of physiotherapy for the condition. © The Society of Orthopaedic Medicine and the British Institute of Musculoskeletal Medicine 2011.