title: The limited effectiveness of a home-based eccentric training for treatment of Achilles tendinopathy.
abstract: OBJECTIVE
  Objective was to evaluate the outcome of a standardized heavy load eccentric training program in adults with chronic painful Achilles tendinopathy, and the presence of increased Colour Doppler activity in diseased and non-diseased adults. The hypothesis was that patient satisfaction would fall within the range of average satisfaction present in the literature (60 to 90%).
  
  
  METHODS
  Twenty patients were instructed on a training program based on the Alfredson protocol of straight leg followed by bent knee heel drops and raises. Patient satisfaction was recorded as the primary outcome. Secondary outcomes included the VISA-A and Tegner scales. Twenty one subjects without present or history of lower extremity pain and seven patients presenting at the clinic but without Achilles tendinopathy were included as controls.
  
  
  RESULTS
  Patient satisfaction was significantly lower when compared to the literature as two patients reported that they were satisfied with the treatment while the remaining 15 reported that they were unsatisfied. Three patients were excluded from the analysis as they were unable to complete the exercises. Increased Colour Doppler activity was present in only one participant without the disease and in all patients with the disease at the end of the study (increased Colour Doppler activity was present in 40% of patients with the disease at the beginning of the study).
  
  
  CONCLUSIONS
  Although some patients' symptoms improved over time, eccentric training did not satisfy patient expectations of improvement following treatment despite compliance with the home based program. Although it is a mainstay of treatment, other options, which are both efficacious and effective, need to be provided for patients who prefer a conservative and relatively non-invasive treatment option from the start.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
authors.forename: Rithesh
authors.initials: R
authors.lastname: Ram
authors.forename: Willem
authors.initials: W
authors.lastname: Meeuwisse
authors.forename: Chirag
authors.initials: C
authors.lastname: Patel
authors.forename: David A
authors.initials: DA
authors.lastname: Wiseman
authors.forename: J Preston
authors.initials: JP
authors.lastname: Wiley
mesh_terms: D000125:Achilles Tendon / Q000473:pathology*; D000328:Adult; D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D052256:Tendinopathy / Q000628:therapy*; D016896:Treatment Outcome