The prevalence of Achilles tendinopathy is greatest in activities including middle and long distance running, tennis, badminton, volleyball, and its incidence is increasing. However, currently no gold standard treatment for Achilles tendinopathy exists, although eccentric exercises are commonly recommended.
PURPOSE:
This study aimed to investigate the changes in clinical scores when administering a) acupuncture and b) sham acupuncture to the Achilles tendon in patients diagnosed with Achilles tendinopathy who did not respond to modified eccentric exercises.
METHODS:
Twenty-two patients were randomised and received either acupuncture or the control sham acupuncture treatment. VISA-A, NPRS, EQ-5D and GRC were recorded before treatment at week 0, then at week 2, week 4 with a final follow-up review at week 12.
MAIN RESULTS:
Acupuncture resulted in significant differences between groups and time points in VISA-A, NPRS, EQ-5D and GRC. The Acupuncture group reached the minimum clinically important difference (MCID) threshold for important difference, when compared to sham acupuncture. The difference between treatments would suggest a beneficial response following the use of acupuncture to the Achilles tendon in Achilles tendinopathy.
PRINCIPAL CONCLUSIONS:
The overall findings suggest the use of a standardised acupuncture protocol to the Achilles tendon is a viable treatment alternative, which could be used as a second line treatment in patients diagnosed with Achilles tendinopathy who did not respond to eccentric exercises. However, in view of the small sample size, the results of this feasibility study should be viewed with caution.
ClementDB, TauntonJE, SmartGW. Achilles tendinitis and peritendinitis: Etiology and treatment. Am J Sports Med. 1984;12:179–84.
5.
JohanssonC. Injuries in enlite orienteers. Am J Sports Med. 1986;14:410–5.
6.
LysholmJ, WiklanderJ. Injuries in runners. Am J Sports Med. 1987;15:168–71.
7.
de JongeS, van den BergC, de VosRJ, van der HeideHJ, WeirA, VerhaarJA, Bierma-ZeinstraSM, TolJL. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45:1026–8.
8.
AlfredsonH, CookJ. A treatment algorithm for managing Achilles tendinopathy: New treatment options. Br J Sports Med. 2007;41:211–6.
MaffulliN, LongoU, LoppiniM, DenaroV. Current treatment options for tendinopathy. Expert Opin Pharmacother. 2010;11:2177–86.
11.
ZwiersR, WiegerinckJI, van DijkCN. Treatment of midportion Achilles tendinopathy: An Evidence-based overview. Knee Surg Sport Traumatol Arthrosc. 2014;1–9.
12.
ScottL, MunteanuSE, MenzHB. Effectiveness of orthotic devices in the treatment of achilles tendinopathy: A Systematic review. Sport Med. 2015;45:95–110.
13.
SandkühlerJ. Models and mechanisms of hyperalgesia and allodynia. Physiol Rev. 2009;89:707–58.
14.
Le BarsD, VillanuevaL, BouhassiraD, WillerJC. Diffuse noxious inhibitory controls (DNIC) in animals and in man. Patol fiziol Eksp Ter. 1992;55–65.
15.
ZhangB, ZhongL, XuS, JiangH, ShenJ. Acupuncture for chronic achilles tendnopathy: A Randomized controlled study. Chin J Integr Med. 2012;19:900–4.
16.
BreivikEK, BjörnssonGA, SkovlundE. A Comparison of pain rating scales by sampling from clinical trial data. Clin J Pain. 2000;16:22–8.
17.
AlfredsonH, PietilaT, JonssonP, LorentzonR. Heavy-Load eccentric calf muscle training for the treatment of chronic achilles. The American Journal of Sports Medicine. 1998;26:360–6.
18.
KishmishianB, SelfeJ, RichardsJ. A Historical review of acupuncture the the Achilles tendon and the development of a standardized protocol for its use. J Acupunct Assoc Chart Physiother. 2012;69–78.
19.
StreitbergerK, KleinhenzJ. Introducing a placebo needle into acupuncture research. Lancet. 1998;352:364–5.
20.
PengelL, RefshaugeK, MaherC. Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine. 2004;29:879–83.
21.
FerreiraM, FerreiraP, LatimerJ, HerbertR, MaherC, RefshaugeK. Relationship between spinal stiffness and outcome in patients with chronic low back pain. Man Ther. 2009;14:61–7.
22.
KamperS, MaherC, MackayG. Global rating of change scales. A Review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17:163–70.
23.
The Chartered society of physiotherapy. Quality assurance standards. CSP: London, 2014.
24.
GolickiD, NiewadaM, KarlinskaA, BuczekJ, KobayshiA, JanssenM, PickardA. Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients. Qual Life Res. 2014;24:1555–63.
25.
JanssenM, PickardA, GolickiD, GudexC, NiewadaM, ScaloneL, SwinburnP, BusschbachJ. Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: A Multi-country study. Qual Life Res. 2013;22:1717–27.
26.
TogoK, MatsuokaN, HashigakiS, ImaiK, MoriyaT. Clinically important effects in new drug development. Drug Inf J. 2011;45:805–10.
27.
TumiltyS, McDonoughS, HurleyD, BaxterG. Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles’ tendinopathy: A Randomized controlled trial. Arch Phys Med Rehabil. 2012;93:733–9.
28.
FarrarJ, PritchettY, RobinsonM, PrakashA, ChappellA. The Clinical importance of changes in the 0 to 10 Numeric Rating Scale for Worst, Least, and Average Pain Intensity. J Pain. 2010;11:109–18.
29.
WaltersSJ, BrazierJE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005;14:1523–32.
30.
van der RoerN, OsteloR, BekkeringG, van TulderM, de VetH. Minimal clinically important change for pain intensity, functional status, and general health status in patients with nonspecific low back pain. Spine. 2006;31:578–82.
31.
CollinsN, CrosselyK, BellerE, DarnellR, McPoilT, VicenzinoB. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: Randomised clinical trial. Br J Sports Med. 2009;43:169–71.
32.
RompeJ, NafeB, FuriaJ, MaffulliN. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: A Randomized controlled trial. Am J Sports Med. 2007;35:374–83.
33.
RompeJ, FuriaJ, MaffulliN. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion achilles tendinopathy: A Randomized controlled trial. Am J Sports Med. 2009;37:463–70.
34.
LundebergT. To be or not to be: The Needling sensation (de qi) in acupuncture. Acupunct Med. 2013;31:129–31.
35.
LundI, NäslundJ, LundebergT. Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: A Physiologist’s perspective. Chin Med. 2009;4:1–9.
36.
TianD, XiongJ, PanQ, LiuF, WangL, XuS, HuangG, WangW. De Qi, a Threshold of the stimulus intensity, Elicits the specific response of acupoints and intrinsic change of human brain to acupuncture. Evid Based Complement Alternat Med. 2014;1–11.
37.
CarlssonC. Acupuncture mechanisms for clinically relevant long-term effects-reconsideration and a hypothesis. Acupunct Med. 2002;20:82–99.
38.
ShinbaraH, OkuboM, KimuraK, MizunumaK, SumiyaE. Contributions of nitric oxide and prostaglandins to the local increase in muscle blood flow following manual acupuncture in rats. Acupunct Med. 2015;33:65–71.
39.
LundebergT. Acupuncture mechanisms in tissue healing: Contribution of NO and CGRP. Acupunct Med. 2013;7–8.
40.
DochevaD, MullerSA, MajewskiM, EvansCH. Biologics for tendon repair. Adv Drug Deliv Rev. 2015;84:222–39.
41.
SereyskyJB, FlatowEL, Andarawis-PuriN. Musculoskeletal regeneration and its implications for the treatment of tendinopathy. Int J Exp Pathol. 2013;94:293–303.
42.
HuiKK, MarinaO, LiuJ, RosenBR, KwongKK. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Auton Neurosci. 2010;157:81–90.
43.
LangevinHM, WaynePM, MacphersonH, SchnyerR, MilleyRM, NapadowV, Laol, ParkJ, HarrisR, CohenM, ShermanK, HaramatiA, HammerschlagR. Paradoxes in acupuncture research: Strategies for moving forward. Evid Based Complement Alternat Med. 2011;1:1–11.
