## 3 Results
### Key Findings
#### 3.3.1 Midportion Achilles Tendinopathy
A greater pain decrease, greater function improvement, and greater and faster self-perceived recovery were found after executing ESWT treatment compared to wait-and-see [29; 68], the sham ESWT treatment [52; 68], footwear modification, or calf stretching [52]. ESWT improved the American Orthopaedic Foot and Ankle Society score (AOEAS for pain, function, and alignment) by 18 points on a 100-point AOFAS scale, while the sham ESWT group improved the AOFAS score by 8 points on the same scale [52]. [PERSON] et al. [68] reported that the most efficient protocol for treating MAT was radial ESWT, which delivers 2000 impulses at 3 bars (with an energy flux density of 0.1 mJ/mm\({}^{2}\)) at 8 Hz for 3 sessions per week. ESWT treatments can be divided into two types according to the energy level of the ESWT--low-energy ESWT and high-energy ESWT [56; 58; 68]. [PERSON] et al. [68] found that a 12-week high-energy ESWT treatment improved function and decreased pain for patients with MAT, while a low-energy ESWT treatment did not. However, [PERSON] et al. [56] pointed out that there was no difference between combined ECC exercise with low-energy ESWT and high-energy ESWT in terms of pain decrease at a 12-month follow-up. The combining of ECC exercise and ESWT protocols caused additional beneficial effects on pain [52; 56; 68], function [52; 56; 68], and sped up the self-perceived recovery [52; 68]. The difference between the combined HECT + ESWT treatment and HECT alone was statistically significant in the case of function improvement (with an MD of 13.9 points on a 100-pointVISA-A scale) [52; 68; 73], but not in the case of pain decrease (with an MD of 1.5 points on a 10-point VAS scale) [52; 68]. It was found that both low-level laser therapy and placebo low-level laser therapy, which were applied on three standardized points on both sides of the Achilles tendon for 30 s, 3 x/week for 4 weeks, decreased the pain and improved function in acute MAT in the short term (<4 weeks), medium term (4-12 weeks), and long term (at a 52-week follow-up) [66]. [PERSON] et al. [56] agreed and suggested low-level laser therapy is useful for treating the reactive state of AT, while the degenerative state needs to be treated with other interventions. They [56] also added that the implementation of low-level laser therapy to the ECC exercise protocol shortened the recovery time for treating recreational athletes with MAT. A 12-week HECT was more effective for decreasing pain than the same duration night splint treatment [29; 31] or AirHeel brace [12]. Immediately post-intervention, HECT was found to be significantly more effective than wearing an AirHeel brace in improving general health status, improving foot and ankle function, and improving quality of life [12]. The implementation of a night splint (which was worn during the night) or AirHeel brace (which was worn during the daytime) to the HECT program did not cause any additional pain decrease [29; 73], nor did it achieve any greater general health level compared to HECT alone for patients with MAT at a 12-week follow-up [73]. Additionally, acupuncture has regularly been compared to ECC exercise [11; 12]. [PERSON] et al. [11] pointed out that acupuncture caused greater function improvement and severity of injury reduction than ECC exercise with an SMD of \(-\)1.23 points on a 100-point VISA-A scale, while [PERSON] et al. [12] reported that the MD was 19.50 points on a 100-point scale in favour of acupuncture treatment. ECC exercise alone did not improve function or reduce the severity of injury as much as a combined protocol of ECC exercise with acupuncture [11]. While acupuncture caused a greater short-term pain decrease, function improvement, and severity of injury reduction for patients with MAT, the ECC exercise resulted in greater long-term treatment effects in populations with the same pathology [66; 12].