Ankle Mobilization for Achilles Tendon Pain

Overseen By Scott Lowe

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Philadelphia College of Osteopathic Medicine

Must not be taking: Cortisone

Disqualifiers: Surgery, Instability, Pregnancy, others

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

Compensation: Varies

Number of Visits: 4

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to understand how manual physical therapy changes pain sensation in people with Achilles tendon pain. Researchers will test participants' Achilles tendons for heat and cold sensitivity before and after ankle mobilization therapy, a common and safe technique used by physical therapists. The trial includes two groups: one receiving actual treatment and the other undergoing a similar process without the therapeutic effect (sham treatment). It suits those who have experienced pain in the back of their heel for at least three months. As an unphased trial, this study offers participants the opportunity to contribute to valuable research that could improve future treatment options for Achilles tendon pain.

Do I need to stop taking my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What prior data suggests that this device and technique are safe for use in ankle mobilization?

Research has shown that ankle mobilization, a common technique in physical therapy, is very safe. Studies have found that this method can improve movement and function, especially for those with tendon problems. Physical therapists, chiropractors, and doctors use it, involving a quick stretch of the ankle. This technique is generally well-tolerated and has a strong safety record.

Previous patients benefited from this treatment without major side effects. This suggests that ankle mobilization is a low-risk option for managing Achilles tendon pain and enhancing movement. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about ankle mobilization for Achilles tendon pain because it offers a hands-on, non-invasive approach that might provide relief without drugs or surgery. Unlike traditional treatments like rest, ice, compression, elevation (RICE), or pain medications, this technique involves a specific manual manipulation of the ankle joint, potentially offering immediate benefits. The mobilization approach targets joint movement directly, which could improve mobility and reduce pain quickly, even if no audible joint cavitation, or "pop," is heard. This technique might present a new, efficient option, especially for those seeking alternatives to medications or more invasive procedures.

What evidence suggests that ankle mobilization is effective for Achilles tendon pain?

This trial will compare ankle mobilization with a sham treatment for Achilles tendon pain. Research has shown that moving the ankle joint can alleviate Achilles tendon pain. Studies have found that manual therapy, including methods like ankle mobilization, can reduce pain and improve mobility in people with tendon issues. Some research indicates that the treatment can be effective even without a joint "pop." While the evidence is promising, individual responses may vary. Many health professionals commonly and safely use this technique to ease Achilles tendon discomfort. ^{1 2 6 7 8}

Who Is on the Research Team?

Scott W Lowe

Principal Investigator

PCOM

Are You a Good Fit for This Trial?

This trial is for adults with heel pain in the Achilles tendon lasting over 3 months, confirmed by a clinical screen. It's not for those who've had lower extremity surgery, recent cortisone injections in the tendon, diagnosed ankle instability, are pregnant, under 18 or can't consent.

Inclusion Criteria

I have been diagnosed with Achilles tendinopathy by a doctor.

I have had pain in the back of my heel for at least 3 months.

Exclusion Criteria

Current pregnancy

I am under 18 years old.

I have had surgery below the knee on the affected leg.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Baseline Testing

Standardized assessment of heat and cold pain thresholds using the Medoc TSA Air2 device

1 day

1 visit (in-person)

Intervention

Participants receive either talocrural joint manipulation or sham treatment, followed by re-testing of pain thresholds

1 day

1 visit (in-person)

Follow-up

Participants are monitored for changes in pain thresholds after intervention

1 hour

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Ankle mobilization
• Sham treatment

Trial Overview The study tests how manual therapy affects Achilles tendon pain. Participants will undergo heat/cold discomfort testing before and after receiving ankle mobilization—a quick stretch by a therapist—to see if there's any change in their pain sensation.

How Is the Trial Designed?

Group I: Intervention Experimental Treatment 1 Intervention

Subjects assigned to the intervention group will then receive a talocrural joint high velocity, low amplitude thrush mobilization/manipulation. Standardized technique for this procedure involves the subject long-sitting with their back supported on the treatment table. The provider will then passively dorsiflex and evert the ankle to the point at which a joint tension end-feel is obtained. A small amplitude of movement is rapidly provided by the provider in a caudal direction. The provider may attempt up to three treatment thrust impulses, or until an audible cavitation is heard, indicating joint movement. Even without an audible cavitation, no more than three impulses will be provided. Some research in other body regions indicates that treatment effect is present even in those with whom audible joint cavitation is not noted.

Group II: Control Placebo Group 1 Intervention

Subjects in the control group will receive 1 minute of passive ankle movement into ankle dorsiflexion. The researcher will not move the subjects ankle into a point where tissue stretch/tension is perceived. This will serve as an appropriate sham treatment since it still involves the subjects perception of treatment and includes the hands-on element of manual therapy, without the use of any tissue intervention which would theoretically effect change.

Who Is Running the Clinical Trial?

Philadelphia College of Osteopathic Medicine

Lead Sponsor

Trials

11

Recruited

1,300+

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5294940/

JOINT MOBILIZATION IN THE MANAGEMENT OF ... Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage in runners, with prevalence estimates ranging between 6.5-18%. The etiology of ...

2. jospt.org jospt.org/doi/10.2519/jospt.2024.0302

Achilles Pain, Stiffness, and Muscle Power Deficits ... The diagnosis of midportion Achilles tendinopathy is primarily based on clinical exam with symptoms located in the midportion of the Achilles ...

3. sportsmedicine-open.springeropen.com sportsmedicine-open.springeropen.com/articles/10.1186/s40798-022-00545-5

Evidence-Based High-Loading Tendon Exercise for 12 Weeks ... In Achilles tendinopathy, 12 weeks of heavy load resistance training did not result in superior effects in VISA-A score, pain, tendon thickness ...

4. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5430449/

Manual therapy and eccentric exercise in the management of ... Eccentric exercise can decrease pain and improve function for those with chronic degenerative tendon changes; however, some individuals have continued pain ...

5. trialsjournal.biomedcentral.com trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1697-2

Efficacy of early controlled motion of the ankle compared with ... This trial is the first to investigate the safety and efficacy of early controlled motion in the treatment of acute Achilles tendon rupture in a randomized ...

6. ijspt.scholasticahq.com ijspt.scholasticahq.com/article/122643-rehabilitation-and-return-to-sports-after-achilles-tendon-repair

Rehabilitation and Return to Sports after Achilles Tendon Repair This commentary focuses on rehabilitation strategies following acute Achilles tendon repair (ATR), emphasizing early mobilization and progressive loading.

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

Achilles Pain, Stiffness, and Muscle Power Deficits Clinicians may consider using joint mobilization to improve mobility and function and soft tissue mobilization to increase range of motion for ...

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

Current Concepts in the Nonoperative Management of ... A recent study reported an annual incidence of Achilles tendon rupture as high as 40 cases per 100,000 individuals [3]. Achilles tendonitis is an inflammatory ...