Background Tendinopathy is commonly used to describe overuse injuries in the absence of histological confirmation and includes a range of diagnoses involving injury to the tendon (e.g., tendonitis, peritendinitis, tendinosis). Kvist reviewed 455 athletes with Achilles tendon problems. He found that 53% of them were involved in running sports.

In this case series, we concentrate on tendinopathy of the main body of the Achilles tendon. We shall not deal with Haglund’s condition, insertional tendinopathy, or lesions of the myotendinous junction.

Methods Six patients were included in the study with a given diagnosis of unilateral mid-substance Achilles tendinopathy. This clinical diagnosis had to be confirmed on ultrasound examination. All of them were male runners, with an average age of 35,3±0,7 years, training 12 hours/week and 67±12 km/week.

Patients were excluded if they had a previous injection or surgery or if they had bilateral symptoms.

Study protocol Each patient was examined pre-treatment, post-treatment and at 2 month follow-up. The study protocol was the same at all the measures. It consisted of the following assessments and outcome measures being utilised: Victorian Institute of Sport Assessment-Achilles tendon (VISA-A), Visual Analogue Score (VAS) and mean maximum tendon thickness.

All of them receive treatment with ultrasound-guided intratissue percutaneous electrolysis and dry-needling in gastrocnemius muscles (7±3 sessions), diathermy (4,5±0,5 sessions) and a domiciliary eccentric exercise.

Results Mean VAS scores decreased significantly from baseline to post-treatment review (95% confidence interval (CI), 7,2–1,6, p<0.001) a trend that was maintained at 2 month follow-up (95% CI, 7,2–0,67, p<0.001).

Concurrently the mean VISA-A scores increased significantly from baseline to post-treatment review (95% CI, 30.2–92.6, p<0.001) a trend that was maintained at 2 month follow-up (95% CI, 30.2–95.3, p<0.001).

There was also a significant decrease in the mean maximum tendon diameter from baseline to 2 month follow-up (95% CI, 8.0–6.7 mm, p<0.001).

Conclusions In conclusion, this prospective follow-up study demonstrated that US-guided intratissuepercutaneous electrolysis, dry-needling, diathermy and eccentric exercise appears to be a safe and clinically cost-effective treatment option in the management of mid-substance Achilles tendinopathy when delivered in conjunction with an eccentric exercise programme.