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. 2023 Jan 26;15(1):9.
doi: 10.1186/s13102-023-00618-2.

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

Diego Ailton Prudêncio  1 , Nicola Maffulli  2   3   4 , Filippo Migliorini  5 , Thiago Teixeira Serafim  1 , Luis Felipe Nunes  6 , Luciana Sayuri Sanada  1 , Rodrigo Okubo  1
Affiliations

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

Diego Ailton Prudêncio et al. BMC Sports Sci Med Rehabil. .

Abstract

Achilles tendinopathy (AT) is one of the most frequent overuse injuries in the ankle. The evidence base for its conservative management AT continues to evolve, but there is still a gap in the evidence for the efficacy of any modality of treatment in high-quality studies. This systematic review and meta-analysis investigated the efficacy of EE in improving pain and function in adult patients with mid-portion Achilles tendinopathy compared to other forms of exercise. A search was performed in PubMed, BIREME, SportDiscus, Cinahl, Web of Science and PEDro, in November 2022. The methodological quality was evaluated using the Risk of Bias 2 tool (RoB2) of the Cochrane collaboration, and the meta-analysis was performed using the Review Manager 5.1 program. 2024 articles were identified and eight fulfilled the inclusion criteria. RoB2 presented a final score with 62.5% of the studies presented "some concerns", and 37.5% (five and three articles, respectively) presenting "high risk" of bias. EE was effective for the managment of AT. The only variable for which a meta-analysis was possible was pain (five articles), analysed with the visual analogue scale/numerical visual scale. The mean difference (MD) in treatment effect using EE was - 1.21 (- 2.72 to - 0.30) with a 95% of confidence interval (CI), thus identifying a significant positive effect for the improvement of pain in patients with AT in whom EE was used. EE is effective in the management of AT. The meta-analysis shows the need for appropriately powered randomized controlled trials with better design, the use of standard outcome measures and well-planned protocols for conservative management of AT.Level of evidence: Level 1.Registration: CRD42018118016.

Keywords: Achilles tendinopathy; Ankle injuries; Exercise therapy; Physiotherapy modalities; Review.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the literature search
Fig. 2
Fig. 2
Variability of articles in relation to fundamental methodological considerations
Fig. 3
Fig. 3
Methodological quality summary: analysis of the authors' judgments about each item of methodological quality for each included study
Fig. 4
Fig. 4
Meta-analysis for pain intervention with EE
See this image and copyright information in PMC

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