Backward Running on a Negative Slope as a Treatment for Achilles Tendinopathy in Runners
Condition: Achilles Tendinopathy
MeSH terms: Tendinopathy
Study type: Interventional

Summary: 
      This study will look to evaluate the feasibility of a backwards downhill running program as
      an option for the treatment of Achilles tendinopathy in runners. It is known that exercise on
      the Achilles tendon during elongation (eccentric exercise) improves tendon function after
      injury. However, during recovery, the patient is required to stop tendon-loading activities
      such as jumps and sprints. Therefore, during recovery, athletes decline in physical fitness.

      Backward running on a negative slope can achieve a biomechanical load similar to eccentric
      exercise without decreasing physical fitness.
    

Detailed description: 
      The study was a prospective, single-arm feasibility study. Participants were patients who met
      the entry criteria and were referred to the Meuhedet health service Physical Therapy
      outpatient clinic, Jerusalem, from September 2019 to February 2020. The sample size was based
      on previous recommendations for pilot and feasibility studies (Julious 2005; Billingham,
      Whitehead, and Julious 2013). Inclusion criteria were: AT that was clinically determined by
      an orthopedic surgeon (E.S) according to nontraumatic pain and tenderness at the Achilles
      tendon and report of decreased activity levels secondary to Achilles pain; a history of
      running for at least one session a week in the past three months; age > 18 and < 70.
      Exclusion criteria were having other lower extremity injuries; prior treatment with eccentric
      exercise or currently receiving Physical Therapy for AT; received a steroid injection into
      the tendon in the three months prior, or underwent Achilles tendon surgery.

      Participants received a total of nine treatment sessions, twice a week for a total of five
      weeks. Each treatment consisted of backward walking / running over an 8º negatively inclined
      treadmill. (Landice L7 Rehabilitation treadmill, New Jersey, USA) with a warmup and a
      cooldown on a stationary bike. A detailed description of the protocol is presented in Table
      1. As backward locomotion on a treadmill was novel for all participants they were advised to
      hold the treadmill handles during the adjustment period (treatment sessions 1-3).
      Participants were also instructed to refrain from specific sports which involve continuous
      jumping and forward running throughout the intervention period. Patients were informed that
      if they do not feel comfortable with the training protocol, they could terminate their
      participation at any point.

      Assessments took place at baseline, pretreatment four, pretreatment six, and at a separate
      meeting after treatment nine
    

Intervention name(s): Backwards running on a Treadmil with a negative slope
Intervention type(s): Procedure
Intervention description(s): Running backward on a treadmill with a negative slope
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Achilles tendinopathy; backward running; exercise; running overuse injury