{"id":11637,"date":"2025-06-24T06:00:45","date_gmt":"2025-06-24T05:00:45","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11637"},"modified":"2025-06-23T10:40:09","modified_gmt":"2025-06-23T09:40:09","slug":"reducing-tendon-compression-in-insertional-achilles-tendinopathy-a-key-to-better-outcomes","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2025\/06\/24\/reducing-tendon-compression-in-insertional-achilles-tendinopathy-a-key-to-better-outcomes\/","title":{"rendered":"Reducing Tendon Compression in Insertional Achilles Tendinopathy: A Key to Better Outcomes?"},"content":{"rendered":"

Keywords: Insertional Achilles tendinopathy, exercise therapy, tendon compression<\/b><\/p>\n

This blog is a summary of a recently published<\/a> randomised clinical trial (1)<\/p>\n

Why is this study important?<\/b><\/p>\n

Insertional Achilles tendinopathy is a stubborn and painful injury at the point where the Achilles tendon attaches to the heel bone. It\u2019s especially common in sport-active individuals and can be difficult to treat. Conventional exercise therapy that works well for mid-portion Achilles tendinopathy often falls short here, with up to 50% of patients ultimately opting for surgery (<\/span>2,3).<\/span> One theory is that compressive loads on the tendon\u2014especially during deep ankle bending (dorsiflexion)\u2014might provoke symptoms during rehabilitation (<\/span>4).<\/span> Until now, however, no study had rigorously tested whether reducing that compression during rehab could actually help.<\/span><\/p>\n

How did the study go about this?<\/b><\/p>\n

In this randomized controlled trial, 42 sport-active patients with chronic insertional Achilles tendinopathy were randomly assigned into two groups. One group followed a low tendon compression rehab program (LTCR), which included exercise therapy that limited ankle dorsiflexion, specific education about compressive loading, avoidance of stretching, and the use of heel lifts. The other group followed a high tendon compression rehab program (HTCR) that included exercise therapy with end-range dorsiflexion, standard education, daily calf stretching, and no heel lifts.<\/span><\/p>\n

Both groups completed an 8\u201312 week progressive tendon-loading program with supervision and home exercises. The main outcome was the VISA-A score, a tool that measures Achilles tendon pain and function. Researchers also evaluated patient satisfaction, return to sport, pain during activities, and changes in tendon thickness using ultrasound.<\/span><\/p>\n

What did the study find?<\/b><\/p>\n

The LTCR group significantly outperformed the HTCR group. At both 12 and 24 weeks, they showed greater improvements in VISA-A scores\u2014enough to be considered clinically meaningful. More participants in the LTCR group reported being satisfied (95% vs. 58%), returned to their desired sport (95% vs. 74%), and experienced less pain during daily activities and hopping tests. Importantly, only the LTCR group showed a significant reduction in tendon thickness over time\u2014suggesting a real improvement in tendon structure, not just symptoms.<\/span><\/p>\n

What are the key take-home points?<\/b><\/p>\n

    \n
  1. Reducing Achilles tendon compression is simple. <\/b>It can be achieved by limiting ankle dorsiflexion during exercise therapy, avoiding excessive stretching, and using heel lifts during daily or sports activities throughout rehabilitation.<\/span><\/li>\n
  2. Low tendon compression rehabilitation works better.<\/b>\u00a0It leads to greater improvements in pain, function, and return to sport for patients with insertional Achilles tendinopathy compared to conventional rehab.<\/span><\/li>\n
  3. LTCR doesn\u2019t just change symptoms\u2014it changes structure.<\/b>\u00a0LTCR reduces tendon swelling, which may help interrupt the vicious cycle of swelling, increased compressive load, and ongoing pain.<\/span><\/li>\n
  4. It\u2019s time to rethink the rehab playbook.<\/b>\u00a0This study supports a shift in strategy: don\u2019t just focus on loading more\u2014focus on loading smarter, starting with less compression. However, because compressive load is a naturally occurring force on the tendon insertion during sports, it should be gradually reintroduced as symptoms improve.<\/span><\/li>\n<\/ol>\n

    \"\"<\/p>\n

    Authors:<\/b><\/p>\n

    Lauren Pringels, A\u00e4ron Van den Abeele, Arne Burssens, Guillaume Planckaert, Evi Wezenbeek, Luc Vanden Bossche<\/span><\/p>\n

    References:<\/b><\/p>\n

      \n
    1. Pringels L, Capelleman R, Van den Abeele A, et al. Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial. <\/span>Br J Sports Med<\/span><\/i>. 2025;59(9):640-650. doi:10.1136\/BJSPORTS-2024-109138<\/span><\/li>\n
    2. Fahlstr\u00f6m M, Jonsson P, Lorentzon R, Alfredson H. Chronic Achilles tendon pain treated with eccentric calf-muscle training. <\/span>Knee Surg Sports Traumatol Arthrosc<\/span><\/i>. 2003;11(5):327-333.<\/span><\/li>\n
    3. Nicholson CW, Berlet GC, Lee TH. Prediction of the success of nonoperative treatment of insertional Achilles tendinosis based on MRI. <\/span>Foot Ankle Int<\/span><\/i>. 2007;28(4):472-477. doi:10.3113\/FAI.2007.0472<\/span><\/li>\n
    4. Cook JL, Purdam C. Is compressive load a factor in the development of tendinopathy? <\/span>Br J Sports Med<\/span><\/i>. 2012;46(3):163-168.<\/span><\/li>\n<\/ol>\n

      <\/p>\n","protected":false},"excerpt":{"rendered":"

      Keywords: Insertional Achilles tendinopathy, exercise therapy, tendon compression This blog is a summary of a recently published randomised clinical trial (1) Why is this study important? Insertional Achilles tendinopathy is a stubborn and painful injury at the point where the Achilles tendon attaches to the heel bone. It\u2019s especially common in sport-active individuals and can […]<\/p>\n

      Read More…<\/a><\/p>\n","protected":false},"author":463,"featured_media":11641,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[604,16068,1399,8191,2786],"class_list":["post-11637","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-achilles-tendinopathy","tag-featured","tag-injury","tag-rehabilitation","tag-tendon"],"yoast_head":"\nReducing Tendon Compression in Insertional Achilles Tendinopathy: A Key to Better Outcomes? - BJSM blog - social media's leading SEM voice<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bjsm\/?p=11637\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Reducing Tendon Compression in Insertional Achilles Tendinopathy: A Key to Better Outcomes? - BJSM blog - social media's leading SEM voice\" \/>\n<meta property=\"og:description\" content=\"Keywords: Insertional Achilles tendinopathy, exercise therapy, tendon compression This blog is a summary of a recently published randomised clinical trial (1) Why is this study important? 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