Nine core domains for tendinopathy have been identified. For Achilles tendinopathy there is large variation in outcome measures used, and how these fit into the core domains has not been investigated. To identify all available outcome measures outcome measures used to assess the clinical phenotype of Achilles tendinopathy in prospective studies and to map the outcomes measures into predefined health-related core domains. Systematic review. Embase, MEDLINE (Ovid), Web of Science, CINAHL, The Cochrane Library, SPORTDiscus and Google Scholar. Clinical diagnosis of Achilles tendinopathy, sample size ≥ ten participants, age ≥ 16 years, and the study design was a randomized or non-randomized clinical trial, observational cohort, single-arm intervention, or case series. 9376 studies were initially screened and 307 studies were finally included, totaling 13,248 participants. There were 233 (177 core domain) different outcome measures identified across all domains. For each core domain outcome measures were identified, with a range between 8 and 35 unique outcome measures utilized for each domain. The proportion of studies that included outcomes for predefined core domains ranged from 4% for the psychological factors domain to 72% for the disability domain. 233 unique outcome measures for Achilles tendinopathy were identified. Most frequently, outcome measures were used within the disability domain. Outcome measures assessing psychological factors were scarcely used. The next step in developing a core outcome set for Achilles tendinopathy is to engage patients, clinicians and researchers to reach consensus on key outcomes measures. CRD42020156763.

ICON 2020—International Scientific Tendinopathy Symposium Consensus: A Systematic Review of Outcome Measures Reported in Clinical Trials of Achilles Tendinopathy

Abstract Introduction Exercise therapy is usually prescribed as first-line treatment for lower limb tendinopathies. The multitude of exercise- and non-exercise-based management options can be overwhelming for the treating sports professional and patient alike. We chose to investigate the comparative effectiveness of exercise therapy with or without adjuncts for managing the commonest lower limb tendinopathies. Methods Through an extensive systematic literature search using multiple databases, we aimed to identify eligible randomised controlled trials (RCTs) on Achilles tendinopathy, patellar tendinopathy or greater trochanteric pain syndrome (GTPS) that included at least one exercise intervention in their treatment arms. Our primary outcomes were patient-reported pain and function (Victorian Institute of Sport Assessment; VISA). Follow-up was defined as short-term (≤ 12 weeks), mid-term (&gt; 12 weeks to &lt; 12 months) and long-term (≥ 12 months). The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE-NMA tools, respectively. Analyses were performed separately for each one of the three tendinopathies. Results A total of 68 RCTs were included in the systematic review. All pairwise comparisons that demonstrated statistically and clinically significant differences between interventions were based on low or very low strength of evidence. Based on evidence of moderate strength, the addition of extracorporeal shockwave therapy to eccentric exercise in patellar tendinopathy was associated with no short-term benefit in pain or VISA-P. From the network meta-analyses, promising interventions such as slow resistance exercise and therapies administered alongside eccentric exercise, such as topical glyceryl trinitrate for patellar tendinopathy and high-volume injection with corticosteroid for Achilles tendinopathy were based on low/very low strength of evidence. Conclusion In this network meta-analysis, we found no convincing evidence that any adjuncts administered on their own or alongside exercise are more effective than exercise alone. Therefore, we recommend that exercise monotherapy continues to be offered as first-line treatment for patients with Achilles and patellar tendinopathies and GTPS for at least 3 months before an adjunct is considered. We provide treatment recommendations for each tendinopathy. PROSPERO registration number CRD42021289534. 

Effectiveness of Exercise Treatments with or without Adjuncts for Common Lower Limb Tendinopathies: A Living Systematic Review and Network Meta-analysis

Background: The Achilles tendon is the largest & longest tendon in the body. Although Achilles tendinopathy is chiefly a runner’s problem but can affect other populations exposed to a prolonged standing position. Aim: To assess the prevalence of Achilles tendinopathy in nurses due to long standing position and its association with other factors resulting in symptoms. Study design: Cross-sectional study. Methodology: The information was gathered using a standardized VISA-A scale. The study's sample size was 110 subjects. The VISA A questionnaire had eight items for assessing the condition. Over the course of six months, data was collected from female nurses in Lahore. The data from the questionnaire was organized. Data was analyzed by SPSS software, version 19 as qualitative variables were expressed as mean ± SD. Frequencies and percentages were calculated for individual items. Results: In this study, 39(35.5%) nurses have mild pain, 49(44.5%) nurses have moderate pain & 21(19.1%) nurses have severe pain after walking on flat ground for 30 minutes. The Cross tabulation of Visa- A scale showed that there was a weak or frail relationship between Achilles tendinopathy and prolong standing position. Conclusion: We concluded that there is a weak or frail relationship in Achilles tendinopathy in nurses due to prolong standing position. Most of the population falls in between no pain to mild pain. Keywords: Achilles tendinopathy, Nurses, VISA-A questionnaire and Pakistan

Prevalence of Achilles Tendinopathy in Female Nurses in Lahore-Pakistan

Determine the capacity of individual items on the Tendinopathy Severity Assessment - Achilles (TENDINS-A), Foot and Ankle Outcome Score (FAOS), and Victorian Institute of Sports Assessment - Achilles (VISA-A) to differentiate patients with mild and severe tendon-related disability in order to provide clinicians the best questions when they are consulting patients with Achilles tendinopathy.Cross-sectional.Seventy participants with Achilles tendinopathy (61.4% mid-portion only, 31.4% insertional only, 7.2% both).The discrimination index was determined for each TENDINS-A, FAOS, and VISA-A item to determine if items could discriminate between mild and severe disability. A Guttman analysis for polytomous items was conducted.All 62 tems from the TENDINS-A, FAOS, and VISA-A were ranked with the best items relating to pain with physical tendon loading, time for pain to settle following aggravating activities and time for the tendon to 'warm-up' following inactivity.Pain with loading the Achilles tendon, time for pain to settle following aggravating activity, as well as time taken for the tendon symptoms to subside after prolonged sitting or sleeping are the best questions indicative of the severity of disability in patients with Achilles tendinopathy. These questions can assist clinicians with assessing baseline severity and monitoring treatment response. 

Are we asking the right questions to people with Achilles tendinopathy? The best questions to distinguish mild versus severe disability to improve your clinical management

ABSTRACT Background Pushing isometric muscle actions (PIMA) are utilized to evaluate strength, fatigue, and neuromechanical aspects. Holding isometric muscle actions (HIMA) are largely unknown, although practitioners prescribe them in rehabilitation and performance contexts. The lack of knowledge and consensus on the distinction between two isometric types combined with limited scientific backing makes appropriate application difficult. Objective To gather research directly comparing PIMA and HIMA, and summarize and synthesize findings. We also aimed to identify potential practical applications for both tasks. Lastly, we highlight existing gaps in the literature and propose directions for future research. Methods CINAHL, Embase, MEDLINE, PubMed and Web of Science databases were searched for peer-reviewed articles comparing PIMA and HIMA in humans. Risk-of-bias and study quality were assessed via established assessments for quasi-experimental studies and funnel plots. Findings were synthesized where possible, with meta-analyses and meta-regressions performed on time-to-task-failure (TTF), ratings of perceived exertion (RPE), heart rate (HR), and mean arterial pressure (MAP). Results Fifty-four studies (publication year 2012.9±6.9; 1995-2024) were identified (N=919 participants; ∼29.8±10.7 years). Thirty-five included performance parameters (e.g., TTF), 45 examined neurological outputs (e.g., electromyography (EMG), electroencephalography (EEG)), and 14 explored cardiovascular or metabolic variables (e.g., glucose uptake, oxygenation). Meta-analysis of 23 studies revealed consistently longer TTF for PIMA vs HIMA at the same absolute intensity (n=407; g =−0.74, p &lt;0.001), except for two studies examining axial muscles ( g =1.78-3.59, p &lt;0.001). Meta-analyses of 6-11 studies detected no absolute differences in HR, MAP, or RPE (n=136-194; g =−0.11-0.18, p =0.07-0.96), except for RPE at 50% of TTF being greater during PIMA (n=164; g =−0.31, p =0.01). PIMA mostly showed higher force fluctuations, discharge rates, D1-inhibition and peak torque, while HIMA indicated higher heteronymous facilitation, EMG burst rates, interspike interval variation, muscular glucose uptake, and faster increases in force/position fluctuations, EMG amplitude, RPE, HR, and MAP. Findings on muscle activation were mixed and mostly insignificant. Brain activity differed partly between both types, with unclear directions. Conclusions Evidence suggests distinguishing two types of isometric muscle action indicating more complex control strategies for HIMA than PIMA. Findings revealed similarities to anisometric actions, suggesting that the control strategies of HIMA and PIMA resemble the ones for muscle lengthening and shortening, respectively. HIMAs could provide novel diagnostics and injury prevention strategies, and time-efficient muscular, neural, and cardiovascular adaptations in rehabilitation. PIMA may be beneficial for prolonged activation and agonist neuromuscular adaptations. Methods varied widely across studies, making additional meta-analyses impossible. More consistent methodology and data reporting are recommended. Randomized controlled trials are required to confirm the use of PIMA vs HIMA in clinical or performance contexts. The knowledge of both isometric types should be implemented in research and education. Registration The original protocol was prospectively registered at the National Institute of Health Research PROSPERO (CRD42024530386). Key Points The two distinct isometric muscle actions are not regularly recognized, although sports medicine practitioners increasingly distinguish and use pushing (PIMA) and holding (HIMA) isometric muscle actions in rehabilitation and sports performance; yet, limited evidence supports their differentiated use. The reduced time-to-task-failure in appendicular muscles under HIMA is presumably reasoned by specific alterations regarding neuromuscular and metabolic parameters suggesting more complex neuromuscular control strategies. While randomized control trials are needed, HIMA appears beneficial for diagnostics, injury prevention and time-efficient muscular, neural and cardiovascular rehabilitation, while PIMA appears more suitable for agonist neuromuscular adaptations. 

Pushing versus holding isometric muscle actions; what we know and where to go: A scoping and systematic review with meta-analyses

The objectives of this randomized, cross-over pilot study were to determine whether isometric plantarflexion exercises resulted in an immediate change in Achilles tendon pain during a loading task, and whether this differed in knee extension or flexion Eleven participants with mid-portion Achilles tendinopathy were recruited from NHS community physiotherapy services and local running clubs Participants were then randomized to complete an isometric calf muscle exercise with the knee fully extended or flexed to 80° Participants switched to the alternate exercise after a minimum seven-day period Achilles tendon pain during a specific, functional load test was measured on a 11-point numeric pain rating scale (NPRS) pre- and post-intervention There was a small, immediate, mean reduction in pain following isometric plantar flexion performed in both knee extension (16, 95%CI 083 to 245, p=0001) and knee flexion (13, 95%CI 031 to 219, p=0015) There were no significant differences between the two positions A non-significant, potentially clinically relevant finding was a 20% larger reduction in symptoms in knee extension versus flexion (p=0110) In conclusion, isometric plantarflexion holds gave an approximately 50% immediate reduction in Achilles tendon pain with a functional load test There were no significant differences between the two positions and both were well tolerated

Immediate Effects of two Isometric Calf Muscle Exercises on Mid-portion Achilles Tendon Pain

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Immediate Effects of two Isometric Calf Muscle Exercises on Mid-portion Achilles Tendon Pain