title: The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up.
abstract: BACKGROUND
  Systematic reviews indicate that exercise has the most evidence of effectiveness in treatment of midportion Achilles tendinopathy. However, there is a lack of long-term follow-ups (>4 years).
  
  
  OBJECTIVE
  To evaluate the 5-year outcome of patients treated with exercise alone and to examine if certain characteristics, such as level of kinesiophobia, age, and sex, were related to the effectiveness of the treatment.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Thirty-four patients (47% women), 51 ± 8.2 years old, were evaluated 5 years after initiation of treatment. The evaluation consisted of a questionnaire regarding recovery of symptoms and other treatments, the Victorian Institute of Sports Assessment-Achilles questionnaire (VISA-A) for symptoms, the Tampa Scale for Kinesiophobia, and tests of lower leg function.
  
  
  RESULTS
  Twenty-seven patients (80%) fully recovered from the initial injury; of these, 22 (65%) had no symptoms, and 5 (15%) had a new occurrence of symptoms. Seven patients (20%) had continued symptoms. Only 2 patients received another treatment (acupuncture and further exercise instruction). When compared with the other groups, the continued-symptoms group had lower VISA-A scores (P = .008 to .021) at the 5-year follow-up and the previous 1-year follow-up but not at any earlier evaluations. There were no significant differences among the groups in regard to sex, age, or physical activity level before injury. There was a significant (P = .005) negative correlation (-0.590) between the level of kinesiophobia and heel-rise work recovery.
  
  
  CONCLUSIONS
  The majority of patients with Achilles tendinopathy in this study fully recovered in regard to both symptoms and function when treated with exercise alone. Increased fear of movement might have a negative effect on the effectiveness of exercise treatment; therefore, a pain-monitoring model should be used when patients are treated with exercise.
authors.affiliation: Department of Orthopaedics, Institute of Clinical Sciences atSahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. kgs@udel.edu.
authors.forename: Karin Grävare
authors.initials: KG
authors.lastname: Silbernagel
authors.forename: Annelie
authors.initials: A
authors.lastname: Brorsson
authors.forename: Mari
authors.initials: M
authors.lastname: Lundberg
mesh_terms: D000125:Achilles Tendon; D000328:Adult; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D052256:Tendinopathy / Q000534:rehabilitation / Q000628:therapy*; D016896:Treatment Outcome