Comparison of isolated eccentric exercise and eccentric exercise combined with shock wave therapy in non-insertional Achilles tendinopathy.

Abstract

This study aimed to compare the effectiveness of eccentric exercise (EE) alone versus combined treatment with EE and extracorporeal shock wave therapy (ESWT) for treating noninsertional Achilles tendinopathy. Seventy-eight patients who underwent treatment with EE alone or combined with ESWT were retrospectively evaluated. Results were compared between the two groups before and after treatment, at the third-month, and after an average follow-up period of 6.3 years. The VAS and Likert scale scores were significantly better after treatment and at the third-month follow-up for those who underwent combined treatment (p < 0.05). Both groups showed statistically significant improvements in VISA-A and VAS scores compared to baseline levels after treatment, in the third-month, and at the final follow-up (p < 0.05). The final follow-up results revealed no significant differences between the VISA-A, VAS, and Likert scores of both groups. Fifty-six out of 78 patients (71.8%) who rated themselves as Likert 1 (fully healed) or 2 (much better) on the 6-point Likert scale were deemed successful. While both treatment groups reached minimal clinically important difference (MCID) in VAS scores, the intergroup MCID was not clinically significant. This study underscores the efficacy of EE in noninsertional Achilles tendinopathy, and the clinical effect of ESWT remains controversial. However, ESWT+EE combination therapy may be a viable option for specific patient groups requiring rapid recovery, such as athletes.