Physiotherapy - Theses
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ItemPhysical therapies for Achilles tendinopathy( 2012)Achilles tendinopathy (AT) is a common condition, causing considerable morbidity in athletes and non-athletes alike. Physical therapies are accepted as first-line management of AT; however, despite a growing volume of research, there remains a lack of high quality studies evaluating their efficacy. Previous systematic reviews for the conservative management of AT provide useful summaries of the available evidence; however, they lack key quality components of systematic reviews. This thesis sought to provide an updated synthesis of the evidence for physical therapies in AT management by conducting a systematic review and meta-analysis (where possible). Inclusion was limited to randomised controlled trials (RCTs) and those with a high risk of bias were excluded. The findings from individual RCTs supported the use of eccentric exercise (EE) in the management of AT. Pooled data suggested additional benefits using laser therapy as an adjunct intervention and similar outcomes when shock wave therapy (SWT) is utilised as an alternative to EE. Despite its common use in clinical practice, the review found only one RCT that evaluated the use of foot orthoses (FO) in AT, but it was excluded due to a high risk of bias. Its findings indicate that FO are more effective than a control group that did not receive treatment. FO are proposed to correct altered biomechanics at the ankle, reducing disproportionate loading across the Achilles tendon. Thus, the second aim of this thesis was to evaluate the immediate rearfoot kinematic and kinetic effects of FO in male runners with AT. A within-participant study of thirteen adult males compared two conditions: (i) prefabricated semi-rigid FO, and (ii) no orthoses during shod running. The results found significantly reduced ankle eversion excursion with the use of FO and no differences for other variables. These findings demonstrated that the immediate effect of FO reduced rearfoot eversion motion in male runners to parameters similar to asymptomatic runners. This effect may lead to a beneficial treatment response. However, further studies are needed to determine the long term biomechanical effects in people with AT and its role in improving pain and function outcomes. In summary, this thesis identified EE, EE with laser therapy and SWT as interventions with evidence of efficacy for AT management. While FO are commonly used in the management of AT there is a paucity of high quality evidence, limiting the current understanding of their role in treatment. This thesis found an immediate reduction in ankle eversion excursion, which is a mechanism that may result in a beneficial treatment response.