title: Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid injections in a clinical setting.
abstract: In published efficacy studies on Achilles tendinopathy (AT) exercise alone results in improvement in 60-90% of the cases. However, this high success rate cannot be expected in usual clinical practice. We prospectively investigated the effectiveness of a treatment regimen consisting of home-based exercises (concentric, eccentric, and stretching) and optional glucocorticosteroid (GCS) injections in patients with (AT) in a usual clinical setting. Patients unable to commence or progress in exercise were offered GCS, hypothesizing that the GCS would facilitate exercise. Ninety-three consecutive patients with AT referred to two outpatient rheumatology clinics were registered, and seen at five visits over a 6-month period. Exercises seemed to have a slow, but long-lasting effect with GCS having a dramatic short-term effect on symptoms. Twenty-six percent of the patients could proceed with training alone, the remainder received one to three supplementary GCS. There were significant improvements on all outcome variables over time (P ≤ 0.001). At follow-up, 42 had no more symptoms, 29 good result, 16 slightly improved, 4 unchanged, and 2 slightly worse. Overall, 94% of the patients had improved, and we thus recommend the use of GCS injections in AT patients if training alone does not lead to improvement.
authors.affiliation: Institute of Sports Medicine Copenhagen (ISMC), Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Wetke
authors.affiliation: Institute of Sports Medicine Copenhagen (ISMC), Bispebjerg Hospital, Copenhagen, Denmark.|Private Rheumatology Clinic, Furesø Reumatologerne, Farum, Denmark.
authors.forename: F
authors.initials: F
authors.lastname: Johannsen
authors.affiliation: CopenRehab, Section of Social Medicine, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Langberg
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D005938:Glucocorticoids
keywords: Achilles tendon overuse; concentric; eccentric; effectiveness; steroid injection; stretching; training