## 3 Results
### Key Findings
#### 3.3.1 Midportion Achilles Tendinopathy
Patients with MAT who executed ECC exercise were found to be highly satisfied at a 6-month follow-up, whereas the group that executed HSR exercise was found to be highly satisfied even at a 1-year follow-up [55]. While a 12-week ECC exercise caused up to 88% of patients to be satisfied, HSR exercise caused an even greater improvement that was up to 100% of patients at a 6-month follow-up [55]. Meanwhile, HSR exercise decreased tendon thickness and tendon neovascularization, which was observed at different follow-ups (at a 6-week and even a 6-month follow-up) [55]. The Silbernagel combined protocol increased the power and strength of the plantar and dorsal flexors of the ankle, decreased the range of motion of the dorsal flexors of the ankle, and increased the range of motion of the plantar flexors of the ankle [34]. This program caused a greater increase in the ankle plantar flexor's endurance and an improvement in jumping performance compared to either calf raises (i.e.,HECT) or stretching [34]. There was no consensus on whether to engage in sports activities or not while rehabilitating MAT by the Silbernagel combined protocol [34]. The [PERSON] combined protocol also caused a significantly greater pain decrease at 3- and 6-month follow-ups compared to basic ISOT exercise alone [33]. While [PERSON] et al. (2012) reported that ECC exercise caused a slightly greater pain decrease compared to ISOT exercise, similar to the Silbernagel combined protocol, [PERSON] et al. [34] objected and pointed out that the pain decrease and improvement in patient satisfaction were greater after executing the latter. Nevertheless, this program is more appropriate for patients with MAT with weak ankle plantar flexor muscles because it contains both CON and ECC exercises [34]. It was also reported that the Stanish and Curwin protocol resulted in a decrease in pain and a faster return to sports activity after 12 weeks, while [PERSON] et al. [33] reported just the positive effects of the Stanish and Curwin protocol on pain decrease for patients with MAT. As opposed to ECC contraction, CON contraction creates force, greater than the external resistance/load, by shortening the muscle [78]. The isolated CON exercise protocol was found to be less effective than the same duration isolated ECC exercise protocol for decreasing pain [29; 33; 56], increasing muscle strength, improving muscle properties (i.e., improving muscle hypertrophy), improving patient satisfaction, and causing a faster return to a preinjury level of activity [34], but CON exercise decreased pain and caused other positive effects (to a lesser extent) [56]. The increase in muscle strength and muscle hypertrophy (especially type II fibers) was greater in ECC exercise than CON exercise, but only when the patients who executed the ECC exercise protocol used greater loads than the CON exercise group did [34]. On the other hand, CON exercise was found to be especially effective when individuals with MAT were too weak to execute ECC exercise [56]. Symptomatic patients with MAT who executed either ECC or CON heel raise exercises, increased their Achilles tendon volume to a greater level compared to asymptomatic patients [53]. [PERSON] et al. [29] reported that even though ECC exercise decreased pain and improved function for patients with MAT at 3- and 12-month follow-ups, the improvement was not significant compared to the stretching protocol. On the other hand, [PERSON] et al. [56] reported that calf stretching of the plantar flexor muscle was not found to be as important as executing either ECC or CON exercise for treating MAT. That is why ECC exercise was found to be superior in improving function at 3- to 12-month follow-ups compared to the combined protocol, which consisted of stretching, ultrasound, and deep friction massage [30]. ESWT caused similar or lower function improvement [30; 52] and pain decrease for patients with MAT as ECC exercise did [29; 52].