title: Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study.
abstract: BACKGROUND
  Achilles tendinopathy is a common overuse injury, especially among athletes involved in activities that include running and jumping. Often an initial period of rest from the pain-provoking activity is recommended.
  
  
  OBJECTIVE
  To prospectively evaluate if continued running and jumping during treatment with an Achilles tendon-loading strengthening program has an effect on the outcome.
  
  
  METHODS
  Randomized clinical control trial; Level of evidence, 1.
  
  
  METHODS
  Thirty-eight patients with Achilles tendinopathy were randomly allocated to 2 different treatment groups. The exercise training group (n = 19) was allowed, with the use of a pain-monitoring model, to continue Achilles tendon-loading activity, such as running and jumping, whereas the active rest group (n = 19) had to stop such activities during the first 6 weeks. All patients were rehabilitated according to an identical rehabilitation program. The primary outcome measures were the Swedish version of the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A-S) and the pain level during tendon-loading activity.
  
  
  RESULTS
  No significant differences in the rate of improvements were found between the groups. Both groups showed, however, significant (P < .01) improvements, compared with baseline, on the primary outcome measure at all the evaluations. The exercise training group had a mean (standard deviation) VISA-A-S score of 57 (15.8) at baseline and 85 (12.7) at the 12-month follow-up (P < .01). The active rest group had a mean (standard deviation) VISA-A-S score of 57 (15.7) at baseline and 91 (8.2) at the 12-month follow-up (P < .01).
  
  
  CONCLUSIONS
  No negative effects could be demonstrated from continuing Achilles tendon-loading activity, such as running and jumping, with the use of a pain-monitoring model, during treatment. Our treatment protocol for patients with Achilles tendinopathy, which gradually increases the load on the Achilles tendon and calf muscle, demonstrated significant improvements. A training regimen of continued, pain-monitored, tendon-loading physical activity might therefore represent a valuable option for patients with Achilles tendinopathy.
authors.affiliation: Lundberg Laboratory of Orthopaedic Research, Department of Orthopaedics, Göteborg University, Sahlgrenska University Hospital, Gröna Stråket 12, 413 45 Göteborg, Sweden. karin.gravare-silbernagel@orthop.gu.se
authors.forename: Karin Grävare
authors.initials: KG
authors.lastname: Silbernagel
authors.forename: Roland
authors.initials: R
authors.lastname: Thomeé
authors.forename: Bengt I
authors.initials: BI
authors.lastname: Eriksson
authors.forename: Jon
authors.initials: J
authors.lastname: Karlsson
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D010147:Pain Measurement / Q000592:standards*; D011446:Prospective Studies; D012420:Running; D013177:Sports; D011795:Surveys and Questionnaires; D013548:Sweden; D052256:Tendinopathy / Q000534:rehabilitation*; D014463:Ultrasonography