Achilles Tendinopathy Treated With Training and Injections
Condition: Achilles Tendinopathy
MeSH terms: Tendinopathy
Study type: Interventional
Phase: Phase 4

Summary: 
      The purpose of this study is to compare in a randomized double blinded controlled trial the
      effect of heavy slow resistance exercises combined with ultrasound guided injections with
      local anesthetic with or without glucocorticosteroid in patients with achilles tendinopathy.
    

Detailed description: 
      Achilles tendinopathy is a common and often longlasting condition especially in a sports
      population. The highest incidence is seen in sports involving running and jumping.

      As the primary treatment eccentric exercises is recommended and 60-90% will benefit by that.
      Other studies have shown equal effect of stretching exercises. In a new study heavy slow
      resistance exercises has proven effective in achilles tendinopathy and the best treatment in
      lig.patellae tendinopathy.

      Injection with glucocorticosteroid is often used in the daily clinic, though inflammation is
      rarely found. Fredberg 2004 found a good short term effect of glucocorticosteroid injection
      in an RCT, but no effect in the long term, which the investigators explained by an aggressive
      rehabilitation with running after a few days. Even though 60-90% will benefit from exercises
      in efficacy studies, a recent pragmatic effectiveness study by Weetke 2015 found that only
      26% did benefit from training alone, but if supplemented by need with 1-3 injections of
      glucocorticosteroid 76% achieved excellent or good result.

      To our knowledge no randomized clinical trials have investigated the combined effect of
      training and injections. The hypothesis of this study is, that training and slowly
      progressive rehabilitation combined with glucocorticosteroid injections will have better
      effect than the same training and rehabilitation combined with injections of local
      anesthetic.
    

Intervention name(s): Reduction in running and jumping; Training; Ultrasound guided injection with Glucocorticosteroid; Ultrasound guided injection with local anaestethic
Intervention type(s): Behavioral; Other; Drug; Drug
Intervention description(s): Advocate to avoid running and jumping sports for the first 3 months, thereafter slowly progressing to normal sport activity.; Patients are instructed to carry out strengthening exercises for the diseased achilles tendon 3 times a week. Physiotherapist will instruct all patients in these heavy slow resistance exercises. First time one week after the first injection, and then week 3, 6, 10. The patient will register all training on a diary and on an App.; Ultrasound guided injection in Kagers triangle underneath the thickest part of the achilles tendon with 1ml Lidocain 5 mg/ml and 1 ml methylprednisolone 40mg/ml. Injection is given every months until the tendon pain is markedly reduced (VAS morning pain: 0-20, and VAS training pain: 0-40, and Global recovery rating scale (-5 to +5) is +3 to +5 ). (max 3 injections).; Ultrasound guided injection in Kagers triangle underneath the thickest part of the achilles tendon with 1ml Lidocain 5 mg/ml and 1 ml of intralipid (for blinding). Injection is given every months until the tendon pain is markedly reduced (VAS morning pain: 0-20, and VAS training pain: 0-40, and Global recovery rating scale (-5 to +5) is +3 to +5 ). (max 3 injections).
Other intervention name(s): Impact reduction; Heavy slow resistance training; Glucocorticosteroid; local anaestethic
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Strength training, injection, glucocorticoid