Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(20):13 Br J Sports Med . 2025 Apr 24;59(9):640-650.What this means for my practice?
Limiting ankle dorsiflexion (reducing compression) within a progressive loading program, coupled with education and heel lifts, leads to superior pain/function outcomes for insertional Achilles tendinopathy versus end-range dorsiflexion loading. Clinically, adopting an LTCR approach should be considered first-line for sport-active patients. Key limitations: participants could not be blinded to the intervention; the multicomponent LTCR prevents isolating active ingredients; the sample was sport-active with chronic symptoms; and VISA-A validity concerns have been raised relative to newer tools.
Study Summary
Forty-two sport-active patients with chronic insertional Achilles tendinopathy were randomized to low tendon compression rehabilitation (LTCR; n=20) or high tendon compression rehabilitation (HTCR; n=22). The primary outcome was VISA-A at 12 and 24 weeks. Secondary outcomes included patient satisfaction, return-to-sport, pain on hopping (VAS-HOP) and during ADLs (VAS-ADL), single-leg heel-raise repetitions, and ultrasound tendon thickness; outcomes were assessed at baseline, 12, and 24 weeks. Overall, the results of the study revealed larger VISA-A gains with LTCR at both 12 weeks and 24 weeks, alongside higher satisfaction and better pain metrics. In short, limiting tendon compression during progressive loading—plus education and heel lifts—improved pain/function versus end-range dorsiflexion loading.
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