The comparision between eccentric exercise and extracorporeal shock wave treatment on tendon thickness, vascularity and elasticity of patients with achilles tendinopathy: A randomized controlled trial

Objective: The aim of the study was to compare the effect of eccentric exercises and extracorporeal shock wave therapy (ESWT) and evaluate tendon thickness, vascularity and elasticity of chronic midportion Achilles tendinopathy. Materials and Methods: This study was conducted as a randomized controlled intervention study in patients with chronic midportion Achilles tendinopathy between April 2017- January 2018 at Dokuz Eylül University Medical School Sports Medicine Department. Patients were randomly assigned to groups. VAS and VISA-A scales were used in the evaluation of the patients. Ultrasonography measurements assessed tendon thickness, vascularization and elasticity. The first group received eccentric exercise for 3 months with the Alfredson protocol and the second group received 4 sessions of ESWT in the middle part of Achilles, one week in total. The VAS and VISA-A scales and ultrasonography measurements were repeated 3 months after the beginning of treatment. Results: There were 32 patients in Group 1 and 31 patients in Group 2. Patients were ranging in age from 18-55, avarage 37,4 years. Both groups were similar in sex, weight, height, body mass index, job, smoking (p>0,05). 70% of the patients were doing sports. The groups were similar in number and duration of sports (p> 0,05). While the VAS scores were significantly decreased in both groups, the VISA-A scores increased significantly. (P <0,001). Eccentric exercise increased tendon thickness and stiffness (p = 0,002, p = 0,039), but ESWT did not change tendon thickness and stiffness (p> 0,05). Conclusion: In this study, it was determined that eccentric exercise and ESWT treatments were effective in decreasing pain and increasing tendon function in chronic midportion Achilles tendinopathy. Eccentric exercise has been shown to increase tendon thickness and stiffness and lead to changes in tendon structure, whereas ESWT treatment may not effective on tendon elasticity and thickness.