Exercise, radial pressure waves, and photobiomodulation for management of non-insertional Achilles tendinopathy in runners: a three-arm non-blinded randomised control trial

Objectives Non-insertional Achilles tendinopathy (AT) is a common running injury. Exercise loading programme (EXER) is the primary treatment. Other options include radial pressure wave (RPW, commonly referred to as shockwave) and photobiomodulation therapy (PBMT). We hypothesised that EXER+RPWand EXER+RPW+PBMT would result in greater reduction in symptoms measured using the eight-item Victorian Institute of Sports Assessment-Achilles (VISA-A) and greater improvement in functional outcomes compared with EXER. A secondary aim was to explore outcomes using elective treatment for three additional months. Methods Runners with AT and symptoms exceeding 3 months were randomised to EXER, EXER+RPW or EXER+RPW+PBMT. RPW was delivered once weekly for three treatments. Those assigned to receive PBMT additionally received treatment two times a week for 3weeks. VISA-A, University of Wisconsin Running Injury and Recovery Index and Patient-Reported Outcomes Measurement Information System 29-item were obtained at baseline and intervals over 3months. Afterwards, runners could elect to receive a different treatment for three additional months. Results Forty-six runners enrolled (24 males, 22 females; average age±SD:40±12 years). Runners assigned EXER+RPW had a greater improvement than EXER at 3months in VISA-A (mean 33 vs 18 points, p=0.023; 95% CI 28.4 to 2.4), and no differences were detected between EXER+RPW+PBMT and EXER (25 vs 18 points, p=0.12; 95% CI 25.9 to –10.8). There were greater improvements in running index measures, pain interference and social roles in EXER+RPW compared with EXER. VISA-A increased over 3month crossover to EXER+RPWand EXER+RPW+PBMT (11 points, both p<0.05 compared with EXER). Discussion Combined EXER and RPW had the largest measured reduction in symptoms at 3 months. However, all groups met clinical improvement, highlighting the importance of EXER. Larger studies in other physically active populations may clarify clinical benefits of each treatment.