Exercise, Radial Pressure Waves, and PBMT for Management of Non-insertional Achilles Tendinopathy in Runners: A Three-arm Non-blinded Randomised Control Trial- BMJ Open Sport and Exercise Medicine
A tenforde, l pham, l gaudette, m funk, k vogel, m bruneau, x yuan, j schroeder, b isaacson, N hager, e metzger, d nolan, j tam, k silbernagel
Non-insertional Achilles tendinopathy (AT) is a common running injury. Exercise loading programme (EXER) is the primary treatment. Other options include radial pressure wave (RPW, commonly referred to as shockwave) and photobiomodulation therapy (PBMT). We hypothesised that EXER+RPW and EXER+RPW+PBMT would result in greater reduction in symptoms measured using the eight-item Victorian Institute of Sports Assessment-Achilles (VISA-A) and greater improvement in functional outcomes compared with EXER. A secondary aim was to explore outcomes using elective treatment for three additional months.
Forty-six runners enrolled (24 males, 22 females; average age±SD:40±12 years). Runners assigned EXER+RPW had a greater improvement than EXER at 3 months in VISA-A (mean 33 vs 18 points, p=0.023; 95% CI 28.4 to 2.4), and no differences were detected between EXER+RPW+ PBMT and EXER (25 vs 18 points, p=0.12; 95% CI 25.9 to –10.8). There were greater improvements in running index measures, pain interference and social roles in EXER+RPW compared with EXER. VISA-A increased over 3 month crossover to EXER+RPW and EXER+RPW+PBMT (11 points, both p<0.05 compared with EXER).
There were 246,041 unique individuals in the cohort with a mean(SD) age of 37.9(12.3) years, 21.9% female, 63.1% on active duty, and 76.3% enlisted. Most patients were initially seen in a primary care setting (80.2%), followed by specialty care (16.7%) and emergency care(3.1%), and 44.4% of the patients were seen by physicians. Across all settings and clinician types, non-specific shoulder diagnosis (i.e. non-specific or unspecified shoulder pain) was the most common (73.9%), followed by rotator cuff-related pain disorders (15.9%), multiple specific diagnoses (3.7%), glenohumeral osteoarthritis (2.0%), and hypomobility disorders (1.8%). Patients who saw a specialty care non-physician were more likely to receive exercise or physical therapy than other clinician-location types, which was fairly consistent across all diagnostic groups.
Combined EXER and RPW had the largest measured reduction in symptoms at 3 months. However, all groups met clinical improvement, highlighting the importance of EXER. Larger studies in other physically active populations may clarify clinical benefits of each treatment.
Tenforde AS, Pham L, Gaudette LW, Funk MM, Vogel KE, Bruneau MM, et al. Exercise, radial pressure waves, and photobiomodulation for management of non-insertional Achilles tendinopathy in runners: a three-arm non-blinded randomised control trial. BMJ Open Sport & Exercise Medicine. 2025;11:e002442. https://doi.org/10.1136/bmjsem-2024-002442