Home Exercises vs Physical Therapy for Achilles Tendinopathy

Overseen By Christopher P Chiodo, MD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Brigham and Women's Hospital

Must not be taking: Fluoroquinolone antibiotics

Disqualifiers: Inflammatory arthritis, Prior foot surgery, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 12

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests two methods for treating Achilles tendinopathy, a condition causing pain and swelling in the Achilles tendon. It compares home exercises to formal physical therapy sessions. Researchers aim to determine if these treatments differ in effectiveness. Suitable participants have experienced Achilles pain for at least six weeks without prior exercise or physical therapy treatment. Participants will follow a 12-week plan and report their progress through surveys over a year. As an unphased trial, this study allows participants to contribute to valuable research that could enhance treatment options for Achilles tendinopathy.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, if you are taking fluoroquinolone antibiotics, you may not be eligible to participate.

What prior data suggests that these protocols are safe for Achilles tendinopathy?

Research shows that both formal physical therapy and home-based exercise routines are generally safe for people with Achilles tendinopathy. Studies on formal physical therapy indicate it can improve movement and reduce pain without major safety concerns. Non-surgical treatments like these often lead to good results for various Achilles tendon issues.

For home-based exercise programs, research has shown they can also be safe and effective. One study found that a structured home exercise plan improved pain and function. This type of exercise can even help the tendon heal by building stronger collagen, a protein in the body.

Overall, both treatments are well-tolerated and show promise in managing Achilles tendinopathy without serious side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about comparing home-based exercises to formal physical therapy for Achilles tendinopathy because these methods could offer greater convenience and accessibility. While traditional treatment often relies on regular visits to a physical therapist, the home-based protocol empowers patients to manage their exercises independently, potentially saving time and reducing costs. Both approaches focus on improving tendon strength and flexibility, but the home-based option could make treatment more accessible for those with busy schedules or limited access to professional care. This trial could reveal whether home exercises are just as effective as formal physical therapy, paving the way for more flexible and patient-centered care.

What evidence suggests that this trial's treatments could be effective for Achilles tendinopathy?

Research has shown that formal physical therapy, a treatment option in this trial, can reduce pain and improve movement in people with mid-portion Achilles tendinopathy. Many patients experience less pain and return to their usual activities. Similarly, the home-based exercise protocol, another treatment option in this trial, involves a high-load exercise program that can also reduce pain and improve function. Eccentric training, which includes exercises that lengthen the muscles, can be done at home and supports tendon health by promoting collagen production, an important part of recovery. Both methods show promise, but their effectiveness may vary depending on the specific type of Achilles tendinopathy. ^{1 3 6 7 8}

Who Is on the Research Team?

Christopher P Chiodo, MD

Principal Investigator

Brigham and Women's Hospital

Are You a Good Fit for This Trial?

This trial is for individuals with new onset non-insertional Achilles tendinopathy. Participants will be randomly assigned to either a home-based exercise program or formal physical therapy for 12 weeks and will complete surveys about their progress.

Inclusion Criteria

I have a new diagnosis of Achilles tendinopathy with pain, thickening, and tenderness.

My symptoms have been present for at least 6 weeks.

Exclusion Criteria

I have had surgery on my foot or ankle before.

I have inflammatory arthritis.

Pregnant women

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are randomized to a 12-week home-based or formal physical therapy protocol

12 weeks

Initial visit, 6 weeks, 12 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

9 months

6 months, 1 year

What Are the Treatments Tested in This Trial?

Interventions

• Formal Physical Therapy
• Home-based Exercise Protocol

Trial Overview The study aims to see if there's any difference in effectiveness between doing exercises at home versus going through formal physical therapy sessions when treating Achilles tendinopathy.

How Is the Trial Designed?

Group I: Home-based Protocol Experimental Treatment 1 Intervention

Group II: Formal Physical Therapy Protocol Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Brigham and Women's Hospital

Lead Sponsor

Trials

1,694

Recruited

14,790,000+

Published Research Related to This Trial

A study involving 66 individuals with chronic Achilles tendinopathy found that telehealth and hybrid formats of physical therapy were as effective as in-person therapy in reducing movement-evoked pain after 8 weeks.

All groups showed significant pain reduction, and the telehealth and hybrid groups did not exceed the noninferiority margin compared to in-person therapy, suggesting that telehealth can provide effective rehabilitation while enhancing accessibility and patient preference.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Telehealth for Movement-Evoked Pain in People With Chronic Achilles Tendinopathy: A Noninferiority Analysis. Post, AA., Rio, EK., Sluka, KA., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4127511/

THE EFFECTS OF CONVENTIONAL PHYSICAL THERAPY ... However, clinical outcomes are reported to be more effective in persons with mid‐portion Achilles tendinopathy and less effective with insertional tendinopathy.

2. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK72316/

Effectiveness of physical therapy for Achilles tendinopathy Patients who were given eccentric exercises had a greater pain reduction, and a higher proportion of patients returned to regular athletic activity than those ...

3. sciencedirect.com sciencedirect.com/science/article/pii/S1836955322000893

Physiotherapy management of Achilles tendinopathy This review focuses on two distinct but related conditions: midportion Achilles tendinopathy and insertional Achilles tendinopathy.

4. bmjopensem.bmj.com bmjopensem.bmj.com/content/10/1/e001678

a survey of physical therapists and people with Achilles ... Results 341 PTs and 74 people with AT completed the surveys. In alignment with clinical practice guidelines, more than 94% of PTs surveyed (97% ...

5. jospt.org jospt.org/doi/10.2519/jospt.2024.0302

Achilles Pain, Stiffness, and Muscle Power Deficits ... Tendon loading exercise is effective at reducing pain and improving function for individuals with Achilles tendinopathy, despite variation in ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5956523/

Current Concepts Review Update: Insertional Achilles ... Patients with IAT often report stiffness that is aggravated by prolonged rest as well as pain that is aggravated by physical activity.

7. jospt.org jospt.org/doi/10.2519/jospt.2018.0302

Achilles Pain, Stiffness, and Muscle Power Deficits When evaluating physical impairment over an episode of care for those with Achilles tendinopathy, one should measure ankle dorsiflexion range of ...

8. mdpi.com mdpi.com/2077-0383/14/13/4736

Current Concepts in the Nonoperative Management of ... Results: Nonoperative management results in favorable outcomes for a wide range of Achilles tendon pathologies. Eccentric loading is supported for chronic ...