Electrical Dry Needling + Physical Therapy for Achilles Tendinopathy

Overseen By James Dunning, DPT

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Alabama Physical Therapy & Acupuncture

Disqualifiers: Hypertension, Diabetes, Heart disease, others

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

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 10

Duration: 6 weeks

110 Participants Needed

Trial Summary

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Electrical Dry Needling + Physical Therapy for Achilles Tendinopathy is an effective treatment?

The available research shows that combining dry needling with physical therapy, which includes exercises and manual techniques, is being explored for its potential benefits in treating Achilles tendinopathy. While the specific effects of dry needling on this condition are not fully known, the research suggests that it could be a promising addition to traditional physical therapy methods. Other studies highlight the effectiveness of eccentric exercises, which are a type of physical therapy, in improving pain and function in patients with Achilles tendinopathy. However, the exact benefits of adding dry needling to these exercises need further investigation. ^{1 2 3 4 5}

What safety data exists for electrical dry needling and physical therapy for Achilles tendinopathy?

The available research includes various studies on related treatments such as noxious electrical stimulation, eccentric exercises, and trigger point dry needling. These studies suggest that these interventions are being explored for their effects on pain and function in Achilles tendinopathy, but specific safety data is not detailed in the provided abstracts. The feasibility of larger trials is being tested, indicating ongoing research in this area. ^{1 2 6 7 8}

Is the treatment Eccentric Exercise, Stretching and Manual Therapy promising for Achilles Tendinopathy?

Yes, Eccentric Exercise, Stretching, and Manual Therapy are promising treatments for Achilles Tendinopathy. They help improve pain and physical function, making them a good option for managing this condition. ^{1 2 3 6 9}

What is the purpose of this trial?

The purpose of this research is to compare two different approaches for treating patients with achilles tendinopathy: eccentric exercise, stretching and manual therapy VS Electric dry needling, eccentric exercise, stretching and manual therapy. Physical therapists commonly use all of these techniques to treat achilles tendinopathy. This study is attempting to find out if one treatment strategy is more effective than the other.

Research Team

James Dunning, DPT

Principal Investigator

American Academy of Manipulative Therapy

Eligibility Criteria

Adults over 18 with Achilles tendinopathy, experiencing pain for at least 3 months, who haven't had related treatments in the last 6 months. Suitable for those without previous Achilles surgery, significant foot instability or conditions that rule out electro-needling like pregnancy.

Inclusion Criteria

My Achilles tendon hurts when it is gently squeezed.

Royal London Test - Tenderness to palpation decreases significantly or disappears with max dorsiflexion

I have been diagnosed with noninsertional tendinopathy.

Exclusion Criteria

The patient is pregnant.

Involvement in litigation or worker's compensation regarding foot pain

I have had arthritis or arthrosis in my ankle or foot.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either electrical dry needling with eccentric exercise, stretching, and manual therapy or just eccentric exercise, stretching, and manual therapy

6 weeks

8-10 treatments (1-2 treatments per week)

Follow-up

Participants are monitored for changes in Achilles tendinopathy severity, pain, and foot and ankle ability

3 months

Assessments at baseline, 2 weeks, 6 weeks, and 3 months

Treatment Details

Interventions

• Eccentric Exercise, Stretching and Manual Therapy
• Electric Dry Needling, Eccentric Exercise, Stretching and Manual Therapy

Trial Overview The trial is testing if adding electric dry needling to conventional physical therapy (eccentric exercise, stretching and manual therapy) provides better outcomes than conventional physical therapy alone for treating Achilles tendinopathy.

Participant Groups

Group I: Electrical Dry Needling and conventional PT Experimental Treatment 1 Intervention

Electrical Dry Needling, Eccentric Exercise, Stretching and Manual Therapy

Group II: Conventional PT Active Control 1 Intervention

Eccentric Exercise, Stretching and Manual Therapy

Eccentric Exercise, Stretching and Manual Therapy is already approved in European Union, United States, Canada for the following indications:

Approved in European Union as Physical Therapy for:

• Achilles tendinopathy
• Musculoskeletal injuries
• Chronic pain management

Approved in United States as Physical Therapy for:

• Achilles tendinopathy
• Musculoskeletal injuries
• Chronic pain management
• Rehabilitation

Approved in Canada as Physical Therapy for:

• Achilles tendinopathy
• Musculoskeletal injuries
• Chronic pain management
• Sports injuries

Who Is Running the Clinical Trial?

Alabama Physical Therapy & Acupuncture

Lead Sponsor

Trials

15

Recruited

2,200+

Universidad Rey Juan Carlos

Collaborator

Trials

137

Recruited

10,300+

Findings from Research

The study tested the feasibility of a larger randomized controlled trial comparing trigger point dry needling (TDN) with manual therapy and exercise in 22 patients with Achilles tendinopathy, but found high attrition rates (68% at 3 months) indicating challenges in recruitment and retention.

Both treatment groups showed significant improvements in function and pain measures over 4 weeks and 3 months, but no significant differences were found between the TDN and control groups, suggesting that TDN may not provide additional benefits over standard treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Trigger point dry needling, manual therapy and exercise versus manual therapy and exercise for the management of Achilles tendinopathy: a feasibility study. Koszalinski, A., Flynn, T., Hellman, M., et al.[2021]

Eccentric overload training shows promise in reducing pain for patients with chronic Achilles tendinopathy, based on a systematic review of nine clinical trials.

However, due to significant methodological shortcomings in most studies, the exact effectiveness of this training method remains unclear, highlighting the need for larger, well-designed trials to confirm its benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Kingma, JJ., de Knikker, R., Wittink, HM., et al.[2022]

A comprehensive treatment plan combining active and passive warm-up, soft tissue mobilization techniques (Graston and Active Release), eccentric exercise, static stretching, and cryotherapy led to significant pain reduction and functional improvement in a patient with chronic Achilles tendinopathy.

This approach suggests that a multi-faceted conservative treatment strategy can effectively address the symptoms and underlying issues of chronic Achilles tendinopathy, promoting rapid recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. Miners, AL., Bougie, TL.[2022]

A case report of a 51-year-old male with persistent insertional Achilles tendinopathy showed significant improvement in symptoms and running capacity after four physical therapy sessions over two months, utilizing joint mobilization and self-mobilization techniques.

The patient achieved clinically significant improvements in functional measures and remained asymptomatic for a year, suggesting that addressing mobility deficits through targeted manual therapy can effectively enhance recovery in chronic tendon conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT. Jayaseelan, DJ., Post, AA., Mischke, JJ., et al.[2020]

Eccentric strengthening exercises (ESE) significantly improved symptoms in athletic patients with Achilles tendinopathy, with average VISA-A scores rising from 36 to 52 after 12 weeks of treatment, indicating a positive effect on their condition.

Approximately 60% of the patients responded well to ESE alone, while those who did not improve were offered alternative treatments, such as aprotinin injections or surgery, highlighting the need for a multi-faceted approach in managing this condition.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Eccentric calf muscle training in athletic patients with Achilles tendinopathy. Maffulli, N., Walley, G., Sayana, MK., et al.[2022]

A 27-year-old male runner with chronic bilateral Achilles tendinopathy experienced significant pain threshold improvements after a single session of noxious electrical stimulation, indicating its potential effectiveness in altering pain perception.

Following the treatment, the runner was able to progress to more intense workouts, with notable improvements in functional scores (LEFS from 73 to 76 and VISA-A from 64% to 96%), suggesting that noxious electrical stimulation can aid recovery and enhance athletic performance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

IMPROVED PRESSURE PAIN THRESHOLDS AND FUNCTION FOLLOWING NOXIOUS ELECTRICAL STIMULATION ON A RUNNER WITH CHRONIC ACHILLES TENDINOPATHY: A CASE REPORT. Eckenrode, BJ., Stackhouse, SK.[2020]

In a study of 52 recreational athletes with chronic Achilles tendinopathy, the addition of low-level laser therapy (LLLT) to eccentric exercises (EEs) significantly reduced pain intensity during physical activity compared to a placebo group, showing improvements as early as 4 weeks.

LLLT not only accelerated pain relief but also improved secondary outcomes like morning stiffness and active dorsiflexion, indicating that it enhances the overall recovery process from Achilles tendinopathy when combined with EEs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy. Stergioulas, A., Stergioula, M., Aarskog, R., et al.[2022]

A single session of noxious electrical stimulation (NES) or eccentric exercise significantly reduced pain sensitivity in the Achilles tendon of 39 asymptomatic participants, indicating potential neurophysiological mechanisms at play.

The effects of both interventions were immediate, with the eccentric exercise group maintaining reduced pain sensitivity into the next day, suggesting that these methods could be effective for managing pain in individuals with Achilles tendinopathy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Noxious Electrical Stimulation and Eccentric Exercise on Pain Sensitivity in Asymptomatic Individuals. Stackhouse, SK., Taylor, CM., Eckenrode, BJ., et al.[2018]

A systematic review of seven studies found low-quality evidence suggesting that a modified version of the Alfredson eccentric loading program is more effective than the standard version for improving function in patients with chronic Achilles tendinopathy.

There is very-low-quality evidence indicating that eccentric loading (ECL) may reduce pain more effectively than concentric loading alone, but it does not show a significant advantage over concentric-eccentric programs in terms of pain or disability improvement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The efficacy of loading programmes for improving patient-reported outcomes in chronic midportion Achilles tendinopathy: A systematic review. Head, J., Mallows, A., Debenham, J., et al.[2020]

References

1. England pubmed.ncbi.nlm.nih.gov

Trigger point dry needling, manual therapy and exercise versus manual therapy and exercise for the management of Achilles tendinopathy: a feasibility study. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. [2022]

3. Canada pubmed.ncbi.nlm.nih.gov

Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT. [2020]

5. England pubmed.ncbi.nlm.nih.gov

Eccentric calf muscle training in athletic patients with Achilles tendinopathy. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

IMPROVED PRESSURE PAIN THRESHOLDS AND FUNCTION FOLLOWING NOXIOUS ELECTRICAL STIMULATION ON A RUNNER WITH CHRONIC ACHILLES TENDINOPATHY: A CASE REPORT. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Effects of Noxious Electrical Stimulation and Eccentric Exercise on Pain Sensitivity in Asymptomatic Individuals. [2018]

9. England pubmed.ncbi.nlm.nih.gov

The efficacy of loading programmes for improving patient-reported outcomes in chronic midportion Achilles tendinopathy: A systematic review. [2020]