Exercise, orthoses and splinting for treating Achilles tendinopathy: A systematic review with meta-analysis

Fiona Wilson, Margaret Walshe, Tom O'Dwyer, Kathleen Bennett, David Mockler, Christopher Bleakley

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Objectives To assess the efficacy of exercise, orthoses and splinting on function, pain and quality of life (QoL) for the management of mid-portion and insertional Achilles tendinopathy, and to compare different types, applications and modes of delivery within each intervention category. Design Systematic review and meta-analysis. Data sources Medline, CINAHL, Embase, AMED, WHO ICTRP, Web of Science, PEDro and Cochrane Library from inception to October 2017. Citation tracking of published studies and conference proceedings and contacting experts in the field. Study eligibility criteria Controlled clinical trials evaluating either exercise, orthoses or splinting for the management of Achilles tendinopathy. Methods Independent reviewers undertook searches, screening and risk of bias appraisal. Primary outcomes of interest were function, pain and QoL. Results Twenty-two studies were included (1137 participants). Moderate level evidence favoured eccentric exercise over control for improving pain and function in mid-portion tendinopathy. Moderate level evidence favoured eccentric exercise over concentric exercise for reducing pain. There was moderate level evidence of no significant difference in pain or function between eccentric exercise and heavy slow resistance exercise. There was low level evidence that eccentric exercise was not superior to stretching for pain or QoL. There was moderate level evidence that a combined exercise protocol was not superior to a lower dosage protocol for improving functional performance. There was moderate to low level evidence of a significant difference in pain (mean difference (MD) 6.3 mm, 95% CI -4.45 to 17.04, moderate) or function (MD 1.83 Victoria Institute of Sport Assessment points, 95% CI -7.47 to 11.12, low) between high-dose and low-dose eccentric training. There was high to moderate level evidence of no difference in pain (moderate) or function (high) between orthoses and control. There was low level evidence of no significant benefit in adding a night splint to an eccentric exercise programme for function, and moderate level evidence for no reduction in pain (MD -3.50, 95% CI -10.49 to 3.48). Eccentric exercise was not superior to splinting for pain (moderate evidence) or function (low level evidence). Summary We conditionally recommend exercise for improving pain and function in mid-portion Achilles tendinopathy. The balance of evidence did not support recommendation of one type of exercise programme over another. We conditionally recommend against the addition of a splint to an eccentric exercise protocol and we do not recommend the use of orthoses to improve pain and function in Achilles tendinopathy.

LanguageEnglish
Pages1564-1574
Number of pages11
JournalBritish Journal of Sports Medicine
Volume52
Issue number24
Early online date31 Aug 2018
DOIs
Publication statusPublished - 1 Dec 2018

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Orthotic Devices
Tendinopathy
Meta-Analysis
Pain
Splints
Quality of Life
Victoria
Information Storage and Retrieval
Controlled Clinical Trials
Libraries
Sports

Keywords

  • achilles
  • exercise
  • orthotics
  • rehabilitation
  • tendinopathy

Cite this

Wilson, Fiona ; Walshe, Margaret ; O'Dwyer, Tom ; Bennett, Kathleen ; Mockler, David ; Bleakley, Christopher. / Exercise, orthoses and splinting for treating Achilles tendinopathy : A systematic review with meta-analysis. In: British Journal of Sports Medicine. 2018 ; Vol. 52, No. 24. pp. 1564-1574.
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Exercise, orthoses and splinting for treating Achilles tendinopathy : A systematic review with meta-analysis. / Wilson, Fiona; Walshe, Margaret; O'Dwyer, Tom; Bennett, Kathleen; Mockler, David; Bleakley, Christopher.

In: British Journal of Sports Medicine, Vol. 52, No. 24, 01.12.2018, p. 1564-1574.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Exercise, orthoses and splinting for treating Achilles tendinopathy

T2 - British Journal of Sports Medicine

AU - Wilson, Fiona

AU - Walshe, Margaret

AU - O'Dwyer, Tom

AU - Bennett, Kathleen

AU - Mockler, David

AU - Bleakley, Christopher

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Objectives To assess the efficacy of exercise, orthoses and splinting on function, pain and quality of life (QoL) for the management of mid-portion and insertional Achilles tendinopathy, and to compare different types, applications and modes of delivery within each intervention category. Design Systematic review and meta-analysis. Data sources Medline, CINAHL, Embase, AMED, WHO ICTRP, Web of Science, PEDro and Cochrane Library from inception to October 2017. Citation tracking of published studies and conference proceedings and contacting experts in the field. Study eligibility criteria Controlled clinical trials evaluating either exercise, orthoses or splinting for the management of Achilles tendinopathy. Methods Independent reviewers undertook searches, screening and risk of bias appraisal. Primary outcomes of interest were function, pain and QoL. Results Twenty-two studies were included (1137 participants). Moderate level evidence favoured eccentric exercise over control for improving pain and function in mid-portion tendinopathy. Moderate level evidence favoured eccentric exercise over concentric exercise for reducing pain. There was moderate level evidence of no significant difference in pain or function between eccentric exercise and heavy slow resistance exercise. There was low level evidence that eccentric exercise was not superior to stretching for pain or QoL. There was moderate level evidence that a combined exercise protocol was not superior to a lower dosage protocol for improving functional performance. There was moderate to low level evidence of a significant difference in pain (mean difference (MD) 6.3 mm, 95% CI -4.45 to 17.04, moderate) or function (MD 1.83 Victoria Institute of Sport Assessment points, 95% CI -7.47 to 11.12, low) between high-dose and low-dose eccentric training. There was high to moderate level evidence of no difference in pain (moderate) or function (high) between orthoses and control. There was low level evidence of no significant benefit in adding a night splint to an eccentric exercise programme for function, and moderate level evidence for no reduction in pain (MD -3.50, 95% CI -10.49 to 3.48). Eccentric exercise was not superior to splinting for pain (moderate evidence) or function (low level evidence). Summary We conditionally recommend exercise for improving pain and function in mid-portion Achilles tendinopathy. The balance of evidence did not support recommendation of one type of exercise programme over another. We conditionally recommend against the addition of a splint to an eccentric exercise protocol and we do not recommend the use of orthoses to improve pain and function in Achilles tendinopathy.

AB - Objectives To assess the efficacy of exercise, orthoses and splinting on function, pain and quality of life (QoL) for the management of mid-portion and insertional Achilles tendinopathy, and to compare different types, applications and modes of delivery within each intervention category. Design Systematic review and meta-analysis. Data sources Medline, CINAHL, Embase, AMED, WHO ICTRP, Web of Science, PEDro and Cochrane Library from inception to October 2017. Citation tracking of published studies and conference proceedings and contacting experts in the field. Study eligibility criteria Controlled clinical trials evaluating either exercise, orthoses or splinting for the management of Achilles tendinopathy. Methods Independent reviewers undertook searches, screening and risk of bias appraisal. Primary outcomes of interest were function, pain and QoL. Results Twenty-two studies were included (1137 participants). Moderate level evidence favoured eccentric exercise over control for improving pain and function in mid-portion tendinopathy. Moderate level evidence favoured eccentric exercise over concentric exercise for reducing pain. There was moderate level evidence of no significant difference in pain or function between eccentric exercise and heavy slow resistance exercise. There was low level evidence that eccentric exercise was not superior to stretching for pain or QoL. There was moderate level evidence that a combined exercise protocol was not superior to a lower dosage protocol for improving functional performance. There was moderate to low level evidence of a significant difference in pain (mean difference (MD) 6.3 mm, 95% CI -4.45 to 17.04, moderate) or function (MD 1.83 Victoria Institute of Sport Assessment points, 95% CI -7.47 to 11.12, low) between high-dose and low-dose eccentric training. There was high to moderate level evidence of no difference in pain (moderate) or function (high) between orthoses and control. There was low level evidence of no significant benefit in adding a night splint to an eccentric exercise programme for function, and moderate level evidence for no reduction in pain (MD -3.50, 95% CI -10.49 to 3.48). Eccentric exercise was not superior to splinting for pain (moderate evidence) or function (low level evidence). Summary We conditionally recommend exercise for improving pain and function in mid-portion Achilles tendinopathy. The balance of evidence did not support recommendation of one type of exercise programme over another. We conditionally recommend against the addition of a splint to an eccentric exercise protocol and we do not recommend the use of orthoses to improve pain and function in Achilles tendinopathy.

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DO - 10.1136/bjsports-2017-098913

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