Alfredson versus Silbernagel exercise therapy in chronic midportion Achilles tendinopathy: study protocol for a randomized controlled trialReportar como inadecuado

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BMC Musculoskeletal Disorders

, 18:296

Rehabilitation, physical therapy and occupational health


BackgroundMidportion Achilles tendinopathy AT is a common overuse injury, usually requiring several months of rehabilitation. Exercise therapy of the ankle plantar flexors i.e. tendon loading is considered crucial during conservative rehabilitation. Alfredson’s isolated eccentric and Silbernagel’s combined concentric-eccentric exercise programs have both shown beneficial results, but it is unknown whether any of these programs is superior for use in clinical practice. Therefore, the primary objective of this study is to compare the effectiveness of both programs on clinical symptoms. Secondary objectives are to compare the effectiveness of both programs on quality of life and functional outcome measures, to investigate the prognostic value of baseline characteristics, to investigate differences in cost-effectiveness.

Methods-DesignEighty-six recreational athletes 21–60 years of age with unilateral chronic midportion AT i.e. ≥ 3 months will be included in this multicenter assessor blinded randomized controlled trial. They will be randomly allocated to either a group performing the Alfredson isolated eccentric training program n = 43, or a group performing the Silbernagel combined concentric-eccentric program n = 43. In the Alfredson group, participants will perform eccentric heel-drops on their injured side, twice daily for 12 weeks, whereas in the Silbernagel group, participants perform various concentric-eccentric heel-raise exercises, once daily for 12 weeks. Primary outcome measure will be the Victorian Institute of Sport Assessment – Achilles VISA-A questionnaire. Secondary outcomes will be a visual analogue scale VAS for pain during daily activities and sports, duration of morning stiffness, global perceived effect, the 12-item Short Form Health Survey and the Euroqol instrument, and functional performance measured with the heel-raise test and the countermovement jump. Additionally, alongside the RCT, a cost-effectiveness analysis will be performed. Assessments will be performed at baseline and after 12, 26, and 52 weeks.

DiscussionThis study is the first to directly compare the Alfredson and the Silbernagel exercise program in a randomized trial. The results can further enlarge the evidence base for choosing the most appropriate exercise program for patients with midportion AT.

Trial registrationDutch Trial register: NTR5638. Date of registration: 7 January 2016.

KeywordsAchilles tendinopathy Achilles tendon Exercise therapy Eccentric Concentric Physical therapy Physiotherapy Rehabilitation AbbreviationsANOVAanalysis of variance

ATAchilles tendinopathy

CMJcountermovement jump

EQ-5DEuroqol instrument

GPEglobal perceived effect

HSRTheavy slow resistance training


QOLquality of life

RCTrandomized controlled trial

SF-1212-item short form health survey

UMCUUniversity Medical Center Utrecht

VASvisual analog scale

VISA-AVictorian Institute of Sports Assessment – Achilles

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Autor: Bas Habets - Robert E. H. van Cingel - Frank J. G. Backx - Bionka M. A. Huisstede


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