Comparing Two Types of Treatment For Achilles Tendon Problems
Two types of treatment programs for the treatment of Achilles' tendinopathy were compared in this study. Tendinopathy refers to damage to the tendon. There is usually pain, swelling, and impaired contraction of the tendon where it inserts into the muscle and bone.

Such types of injuries are common in runners or in athletes engaged in jumping activities. But the everyday, average person who is not athletic can also have an Achilles' tendon injury.

The two treatment programs were: eccentric loading and low-energy shock wave therapy (SWT). Eccentric loading is a calf strengthening exercise program. The patient stands on a step facing forward as if going up. All the body weight is on the forefoot of the injured leg.

The heel is slowly lowered below the step. The patient uses the uninjured leg and arms to pull back up to a neutral (starting) position. The exercises were gradually increased until the patient could do three sets of 15 repetitions twice a day. The exercises were done every day with the knee bent and with the knee straight for 12 weeks. Eventually they added a backpack of weights to load the exercise further.

SWT was done once a week for three weeks. A special device was used to send a strong shock through the skin to the tissues. The pulses were sent in groups of eight per second. The shock wave radiated or dispersed through the tissue to the site of injury.

Patients were followed up at four months and again at the end of one year. Results were measured and compared in terms of pain, function, and activity. A special survey designed for patients with Achilles tendon injuries was used. It is called the Victorian Institute of Sport Assessment-Achilles [VISA-A] questionnaire.

In this study, more patients were helped by shock wave therapy than by a program of eccentric loading. The SWT group recovered faster and more completely by the end of four months. The results were still good after a year. Long-term results are not available.
Jan D. Rompe, MD, et al. Eccentric Loading Compared with Shock Wave Treatment for Chronic Insertional Achilles Tendinopathy. In Journal of Bone and Joint Surgery. January 2008. Vol. 90. No. 1. Pp. 52-61.