Can we really say getting stronger makes your tendon feel better? No current evidence of a relationship between change in Achilles tendinopathy pain or disability and changes in Triceps Surae structure or function when completing rehabilitation: A systematic review

Myles C Murphy; Mervyn Travers; Paola Chivers; James Debenham; Sean I Docking; Ebonie K Rio; William Gibson; Clare Ardern

doi:10.1016/j.jsams.2023.03.007

Can we really say getting stronger makes your tendon feel better? No current evidence of a relationship between change in Achilles tendinopathy pain or disability and changes in Triceps Surae structure or function when completing rehabilitation: A systematic review

J Sci Med Sport. 2023 Apr-May;26(4-5):253-260. doi: 10.1016/j.jsams.2023.03.007. Epub 2023 Mar 17.

Authors

Myles C Murphy¹, Mervyn Travers², Paola Chivers³, James Debenham⁴, Sean I Docking⁵, Ebonie K Rio⁶, William Gibson⁷, Clare Ardern⁸

Affiliations

¹ School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Australia; Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia; SportsMed Subiaco, St John of God Healthcare, Australia. Electronic address: myles.murphy@nd.edu.au.
² School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Australia; School of Physiotherapy and Exercise Science, Curtin University, Australia. Electronic address: https://twitter.com/mervtravers.
³ Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia; Institute for Health Research, The University of Notre Dame Australia, Australia. Electronic address: https://twitter.com/drchiverspaola.
⁴ School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Australia. Electronic address: https://twitter.com/debenham_james.
⁵ Monash Department of Clinical Epidemiology, Cabrini Institute, Australia; School of Public Health and Preventative Medicine, Monash University, Australia; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia. Electronic address: https://twitter.com/SI_docking.
⁶ La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia. Electronic address: https://twitter.com/tendonpain.
⁷ School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Australia.
⁸ La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada. Electronic address: https://twitter.com/clare_ardern.

PMID: 36990866
DOI: 10.1016/j.jsams.2023.03.007

Abstract

Objectives: Determine if improvements in pain and disability in patients with mid-portion Achilles tendinopathy relate to changes in muscle structure and function whilst completing exercise rehabilitation.

Design: A systematic review exploring the relationship between changes in pain/disability and muscle structure/function over time, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Methods: Six online databases and the grey literature were searched from database inception to 16th December 2022 whereas clinical trial registries were searched from database inception to 11th February 2020. We included clinical studies where participants received exercise rehabilitation (±placebo interventions) for mid-portion Achilles tendinopathy if pain/disability and Triceps Surae structure/function were measured. We calculated Cohen's d (95 % confidence intervals) for changes in muscle structure/function over time for individual studies. Data were not pooled due to heterogeneity. Study quality was assessed using a modified Newcastle-Ottawa Scale.

Results: Seventeen studies were included for synthesis. No studies reported the relationship between muscle structure/function and pain/disability changes. Twelve studies reported muscle structure/function outcome measures at baseline and at least one follow-up time-point. Three studies reported improvements in force output after treatment; eight studies demonstrated no change in structure or function; one study did not provide a variation measure, precluding within group change over time calculation. All studies were low quality.

Conclusions: No studies explored the relationship between changes in tendon pain and disability and changes in muscle structure and function. It is unclear whether current exercise-based rehabilitation protocols for mid-portion Achilles tendinopathy improve muscle structure or function.

Systematic review registration: PROSPERO (registration number: CRD42020149970).

Keywords: Exercise; Muscle; Pain; Rehabilitation; Tendon.

Publication types

Systematic Review
Review

MeSH terms

Achilles Tendon*
Exercise Therapy / methods
Humans
Muscle, Skeletal
Musculoskeletal Diseases*
Pain
Tendinopathy* / therapy