The Outcomes of Conservative Nonpharmacological Treatments for Achilles Tendinopathy: An Umbrella Review

Abstract

Achilles tendinopathy (AT) is the most common injury of the Achilles tendon and represents 55–65% of all Achilles tendon clinical diagnoses. AT is characterized by pain, swelling, and impaired performance. ATs can be divided into two types, according to anatomical location—midportion AT (MAT) and insertional AT (IAT). MAT more often occurs in older, less active, and overweight populations, while IAT usually occurs in the more physically active population. Both types of AT can be treated by different treatments, such as surgery, conservative pharmacological treatments, and conservative nonpharmacological treatments. This umbrella review aims to assemble the evidence from all available systematic reviews and/or meta-analyses to determine which conservative nonpharmacological treatments are most commonly used and have the greatest effects. Three major electronic scientific databases (PubMed, Scopus, and Web of Science) were screened. The reference lists of several recent articles on AT were also searched. We found 50 articles that met the inclusion criteria. The methodological quality of the included articles was assessed using the AMSTAR 2 tool. Eccentric (ECC) exercise, isotonic (ISOT) exercise, and acupuncture treatment showed the greatest effects for treating MAT as a standalone therapy. Meanwhile, extracorporeal shockwave therapy and ECC exercise provided the best outcomes for treating IAT as individual treatments. However, an even greater pain decrease, greater function improvement, and greater patient satisfaction for treating either MAT or IAT were achieved with combined protocols of ECC exercise with extracorporeal shockwave therapy (in both cases), ECC exercise with cold air and high-energy laser therapy (in the case of IAT), or ECC exercise with ASTYM therapy (in the case of IAT).