Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without an AirHeel Brace. A randomized controlled trial. B: Effects of compliance

Purpose. To evaluate microcirculatory variables in and around the Achilles tendon (AT) in patients undergoing a programme of daily eccentric training for the management of tendinopathy of the main body of the AT in non-compliant in contrast to compliant patients. Methods. A total of 116 patients with tendinopathy of the AT were enrolled for prospective eccentric training. Non-compliant patients were defined following drop-out due to less than 80% participation in the daily eccentric training regimen. Results. Overall 12-week-compliance was 79% (92/116). The reasons for non-compliance were moving out of town (21%, 5/24), overwhelming pain (25%, 6/24), limited discipline (29%, 7/24), and surgery (17%, 4/24). Capillary blood flow, tendon and paratendon oxygen saturation as well as postcapillary venous filling pressures were not significantly different between compliant and non-compliant patients. Gender, age, BMI, non steroidal anti inflammatory drugs, corticosteroid medication and smoking habits were not significantly different. Only the use of oral contraceptives (non- vs. compliant: 54% vs. 10%, p=0.0001) and walking/swimming (46% vs. 70%, p=0.041) were significantly different. Pain level was reduced (5.61.9 to 2.91.2, p0.05) following eccentric training. Conclusions. In patients undergoing eccentric training for tendinopathy of the main body of the AT, there is no difference in microcirculatory variables regardless of compliance with the eccentric exercises programme. With the exception of the more frequent use of oral contraceptive medication and less often walking/swimming, no predictive factors could be identified in non-compliant patients.

PURPOSE: To compare eccentric training and the combination of eccentric training with the AirHeel Brace for the management of tendinopathy of the main body of the Achilles tendon. METHODS: We recruited 116 subjects with unilateral tendinopathy of the main body of the Achilles tendon, who were randomized in two groups. Group A performed a regimen of daily eccentric training associated with the AirHeel Brace (Donjoy Orthopedics, Vista, CA, USA). Group B performed the same eccentric training without the AirHeel Brace. Tendon microcirculatory mapping was performed using combined Laser-Doppler and spectrophotometry. Pre- and post-operative FAOS score and VAS score were used to evaluate the patients. RESULTS: The FAOS score and the VAS score showed significant improvements from pre-operative to post-operative values in both groups (A 5.1 +/- 2 vs. 2.9 +/- 2.4, 43% reduction and B: 5.4 +/- 2.1 vs. 3.6 +/- 2.4, 33% reduction, both p = 0.0001). There were no statistically significant differences in FAOS score and VAS score when comparing the two groups after the end of the intervention. In Group A, tendon oxygen saturation in the main body of the Achilles tendon showed significant increase from pre- to post-management values (68 +/- 12 vs.74 +/- 8%, p = 0.003). Post-capillary venous filling pressures showed significant reduction from pre- to post-intervention values. CONCLUSION: Eccentric training, associated or not with the AirHeel Brace, produces the same effect in patients with tendinopathy of the main body of the Achilles tendon. The combination of eccentric training with the AirHeel Brace can optimize tendon microcirculation, but these micro-circulator advantages do not translate into superior clinical performance when compared with eccentric training alone