## 3 Results
### Key Findings
#### 3.3.2 Insertional Achilles Tendinopathy  
IAT was investigated in 9 of 50 included studies [14; 15; 16; 39; 40; 52; 58; 68; 76]. Executing the ECC exercise protocol for plantar and dorsal flexors of the ankle was found to be extremely effective for improving foot and ankle function [15; 16] with a mean improvement of 58.05 points on the 100-point VISA-A scale in patients with IAT [15]. ECC exercise also caused a greater pain decrease [15; 16; 39] and patient satisfaction compared to the baseline [14; 15; 39]. It was found that 67% of the patients with IAT were able to return to normal sports activity after finishing a 12-week ECC exercise program [15]. Different authors [14; 16] reported different outcomes after executing a 12-week classic HECT or modified HECT (modified in the case of the progression of repetitions and loads, or modified in the case of a limited range of motion). [PERSON] and [PERSON] [16] reported that both HECT and modified HECT (with the progression of repetitions and loads) caused similar improvements in function and decreases in pain for patients with IAT after executing a 12-week program. They [16] also claimed that both protocols (i.e., HECT or modified HECT with the progression of repetitions and loads) resulted in a decrease in pain in around 67% of patients with IAT. Meanwhile, [PERSON] et al. [14] reported that modified HECT (with limited range of motion) caused a slightly lower pain decrease compared to classic HECT (with an MD of 0.7 points on a 10-point VAS scale in favour of classic HECT), but it was not the case in terms of patient satisfaction where 70% of patients with IAT who finished a 12-week HECT were neither extremely satisfied nor satisfied with the treatment, whereas 33% of patients with IAT who finished a 12-week modified HECT reported the same level of satisfaction. It was found that modified HECT with the progression of repetitions and loads, was more efficient for treating IAT than [PERSON]'s classic HECT [16]. As mentioned, ESWT treatment can be divided into two types, according to the energy level of the ESWT [15; 39; 58]. The low-energy ESWT (with shockwave energy lower than 0.28 m)/mm\({}^{2}\)) consists of 3-4 applications, while the use of anaesthesia is not required [15; 39]. Meanwhile high-energy ESWT (with shockwave energy higher than 0.60 mJ/mm\({}^{2}\)) consists of one application, while the extra use of anaesthesia is also needed [15; 39]. Both protocols greatly decreased pain and improved the function of the Achilles tendon [15; 39; 58]. Nevertheless, high-energy ESWT caused a greater pain decrease compared to low-energy ESWT, with an MD of 5.10 points on a 10-point VAS scale in the case of high-energy ESWT and an MD of 4.40 points on a 10-point VAS scale in the case of low-energy ESWT [39]. However, the efficacy of ESWT might differ from population to population, while greater improvements in function and decreases in pain at a 5-year follow-up were observed in a younger, active population [15]. [PERSON] et al. [15] reported that cold air and high-energy laser therapy treatment most likely caused faster recovery than ESWT, but the decrease in pain and improvement in function were similar between protocols at a 6-month follow-up. When comparing ECC exercise (i.e., HECT) with other conservative nonpharmacological treatments such as ESWT, ECC exercise was found to be slightly less effective for decreasing pain [14; 15; 16; 39; 52; 58; 76] and improving function in patients with IAT compared to ESWT [15; 16; 39; 52; 76]. Regardless of the fact that both HECT and ESWT treatment caused a great decrease in pain [14; 16; 39; 68] and improvement in function [16; 39; 68], this was statistically significant just in the case of ESWT treatment [16; 68]. The decrease in pain for a group that executed three sessions of ESWT treatment at a 4-month follow-up was up to 5.1 points on a 10-point VAS scale [14]. However, [PERSON] et al. [14] pointed out that HECT as a monotherapy caused similar or even greater patient satisfaction compared to ESWT.