Chronic Achilles tendinosis is commonly seen in clinical practice however the causes are largely unknown. In the last ten years good results have been reported with a range of approaches, one of which is eccentric training. Objective: This study reports on a systematic review of the literature to determine the effectiveness of eccentric training compared with other types of interventions for chronic Achilles tendinosis. Method: A systematic review of the published research literature was conducted to examine the quantity, nature, quality and significance of literature relevant to the effectiveness of eccentric training for chronic Achilles tendinosis. Subject inclusion criteria were being at least 16 years of age, having a minimum of three months of complaints and no other underlying pathologies. Results: Seven databases were searched, and 25 studies were included. They reflected a variety of research designs and study quality. Comparison interventions included surgery, medications and passive treatment. An index combining results and quality showed that the best options for managing Achilles tendinosis were medication and eccentric exercises. Taking account of factors such as cost, safety and inconvenience, eccentric exercises are favoured over drug intervention. Conclusion: Eccentric exercises are simple to perform and provide a cost effective, safe and efficient way to treat Achilles tendinosis. They should be considered first for all patients, before invasive interventions such as surgery and drug therapy.




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