Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 5;10(1):e001678.
doi: 10.1136/bmjsem-2023-001678. eCollection 2024.

Current practice, guideline adherence, and barriers to implementation for Achilles tendinopathy rehabilitation: a survey of physical therapists and people with Achilles tendinopathy

Kohle Merry  1 , Megan M MacPherson  2 , Paul Blazey  1 , Angie Fearon  3 , Michael Hunt  1 , Dylan Morrissey  4   5 , Christopher Napier  6 , Duncan Reid  7 , Jackie L Whittaker  1 , Richard W Willy  8 , Alex Scott  1
Affiliations

Current practice, guideline adherence, and barriers to implementation for Achilles tendinopathy rehabilitation: a survey of physical therapists and people with Achilles tendinopathy

Kohle Merry et al. BMJ Open Sport Exerc Med. .

Abstract

Objective: To explore clinical practice patterns of physical therapists (PTs) who treat people with Achilles tendinopathy (AT), and identify perceived barriers and facilitators for prescribing and engaging with therapeutic exercise among PTs and people with AT.

Methods: Two cross-sectional surveys were electronically distributed between November 2021 and May 2022; one survey was designed for PTs while the second was for people with AT. Survey respondents answered questions regarding their physical therapy training and current practice (PTs), injury history and management (people with AT), and perceived barriers and facilitators (PTs and people with AT).

Results: 341 PTs and 74 people with AT completed the surveys. In alignment with clinical practice guidelines, more than 94% of PTs surveyed (97% of whom had some form of advanced musculoskeletal training) prioritise patient education and therapeutic exercise. Patient compliance, patient knowledge, and the slow nature of recovery were barriers to prescribing therapeutic exercise reported by PTs, while time, physical resources, and a perceived lack of short-term treatment effectiveness were barriers for people with AT.

Conclusions: Consistent with clinical practice guidelines, PTs with advanced training reported prioritising therapeutic exercise and education for managing AT. However, both PTs and people with AT identified many barriers to prescribing or engaging with therapeutic exercise. By addressing misconceptions about the time burden and ineffectiveness of exercise, and by overcoming access issues to exercise space and equipment, PTs may be able to improve intervention adherence and subsequently outcomes for people with AT.

Keywords: Ankle; Physical Therapy; Running; Sports & exercise medicine; Tendon.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Intervention development example using the COM-B model and the Behaviour Change Wheel.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

  • Achilles tendinopathy.
    Traweger A, Scott A, Kjaer M, Wezenbeek E, Scattone Silva R, Kennedy JG, Butler JJ, Gomez-Florit M, Gomes ME, Snedeker JG, Dakin SG, Wildemann B. Traweger A, et al. Nat Rev Dis Primers. 2025 Mar 27;11(1):20. doi: 10.1038/s41572-025-00602-9. Nat Rev Dis Primers. 2025. PMID: 40148342 Review.

References

    1. Scott A, Squier K, Alfredson H, et al. . ICON 2019: International Scientific Tendinopathy Symposium Consensus: clinical Terminology. Br J Sports Med 2020;54:260–2. 10.1136/bjsports-2019-100885 - DOI - PubMed
    1. Lohrer H, David S, Nauck T. Surgical treatment for achilles tendinopathy – A systematic review. BMC Musculoskelet Disord 2016;17. 10.1186/s12891-016-1061-4 - DOI - PMC - PubMed
    1. Malliaras P. Physiotherapy management of Achilles tendinopathy. J Physiother 2022;68:221–37. 10.1016/j.jphys.2022.09.010 - DOI - PubMed
    1. Martin RL, Chimenti R, Cuddeford T, et al. . Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther 2018;48:A1–38. 10.2519/jospt.2018.0302 - DOI - PubMed
    1. de Vos R-J, van der Vlist AC, Zwerver J, et al. . Dutch multidisciplinary guideline on Achilles tendinopathy. Br J Sports Med 2021;55:1125–34. 10.1136/bjsports-2020-103867 - DOI - PMC - PubMed

LinkOut - more resources