Objective To assess the effectiveness of heavy eccentric calf training (HECT) in comparison with natural history, traditional physiotherapy, sham interventions or other exercise interventions for improvements in pain and function in mid-portion Achilles tendinopathy.
Design A systematic review and meta-analysis were conducted as per the PRISMA guidelines.
Data sources PUBMED, CINAHL (Ovid) and CINAHL (EBSCO) were searched from inception until 24 September 2018.
Eligibility criteria Randomised controlled trials comparing HECT to natural history, sham exercise, traditional physiotherapy and other exercise interventions were included. Primary outcome assessing pain and function was the Victorian Institute of Sports Assessment-Achilles.
Results Seven studies met the inclusion criteria. This review suggests HECT may be superior to both natural history, mean difference (MD) (95% CI) of 20.6 (11.7 to 29.5, one study) and traditional physiotherapy, MD (95% CI) of 17.70 (3.75 to 31.66, two studies). Following removal of one study, at high risk of bias, due to pre-planned sensitivity analysis, this review suggests HECT may be inferior to other exercise interventions, MD (95% CI) of −5.65 (-10.51 to −0.79, three studies). However, this difference is unlikely to be clinically significant.
Conclusion Current evidence suggests that HECT may be superior to natural history and traditional physiotherapy while HECT may be inferior to other exercise interventions. However, due to methodological limitations, small sample size and a lack of data we are unable to be confident in the results of the estimate of the effect, as the true effect is likely to be substantially different.
Systematic review registry PROSPERO registration number: CRD4201804493
Protocol reference This protocol has been published open access: Murphy M, Travers MJ, Gibson, W. Is heavy eccentric calf training superior to natural history, sham rehabilitation, traditional physiotherapy and other exercise interventions for pain and function in mid-portion Achilles tendinopathy? Systematic Reviews 2018; 7: 58
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Contributors MCM developed the idea, developed the protocol, performed the systematic review, performed the analysis and developed the manuscript. MJT developed the idea, developed the protocol, performed the systematic review and developed the manuscript. JRD, SID, EKR and PC developed the manuscript. WG developed the idea, developed the protocol, supervised the systematic review and developed the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The final data sheet is freely available via figshare (https://figshare.com/articles/Efficacy_of_heavy_eccentric_calf_training_for_treating_mid-portion_Achilles_tendinopathy_a_systematic_review_and_meta-analysis/7562435).
Correction notice This article has been corrected since it published Online First. A reference in table 3 has been corrected.