Comparing two treatments for Achilles tendinopathy

Electrical Dry Needling as an Adjunct to Eccentric Exercise, Stretching and Manual Therapy for Mid-portion Achilles Tendinopathy: a Multicenter Randomized Clinical Trial

This study tests which treatment works better for people with Achilles tendinopathy by comparing a combination of therapies to a simpler approach over six weeks.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 110 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Alabama Physical Therapy & Acupuncture (Academic / other)
• Locations: 1 site (Columbia, South Carolina)
• Trial ID: NCT03968614 on ClinicalTrials.gov

What this trial studies

This research compares the effectiveness of two treatment approaches for patients with Achilles tendinopathy. One group will receive a combination of eccentric exercise, stretching, manual therapy, and electrical dry needling, while the other group will receive only eccentric exercise, stretching, and manual therapy. Patients will be randomized to receive 8-10 treatments over a period of 6 weeks. The goal is to determine which treatment strategy yields better outcomes for pain relief and functional improvement.

Who should consider this trial

Good fit: Ideal candidates are adults over 18 years old with a clinical diagnosis of Achilles tendinopathy lasting at least 3 months.

Not a fit: Patients who have received physical therapy, massage therapy, chiropractic treatment, or injections for Achilles pain in the last 6 months may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could provide a more effective treatment option for patients suffering from Achilles tendinopathy.

How similar studies have performed: Other studies have explored similar treatment approaches, but the specific combination of electrical dry needling with conventional therapy in this context is relatively novel.

Eligibility criteria

Inclusion Criteria:

1. Adult \>18 years old that is able to speak English.
2. Report of at least 3 months of Achilles pain clinically diagnosed as Achilles tendonitis or Achilles tendinopathy
3. Patient has not had physical therapy, massage therapy, chiropractic treatment or injections for Achilles pain in the last 6 months:
4. Diagnosis of noninsertional tendinopathy, defined as the following

   * Subjective report of pain located 2-6 cm proximal to the insertion of Achilles tendon to the calcaneus, particularly with running or jumping
   * Tenderness to palpation of the Achilles tendon while the clinician gently squeezes the tendon between the thumb and index finger in a proximal to distal direction
   * Positive Arc Sign - Intratendinous swelling moves relative to the malleoli with the tendon during active dorsi/plantar Flexion
   * Royal London Test - Tenderness to palpation decreases significantly or disappears with max dorsiflexion

Exclusion Criteria:

1. Report of red flags to manual physical therapy to include: hypertension infection, diabetes, peripheral neuropathy, heart disease, stroke, chronic ischemia, edema, severe vascular disease, malignancy, etc.
2. History of previous Achilles tendon surgery, ankle arthrodesis, hind foot fracture, or leg length discrepancy of more than one half inch.
3. History of arthrosis or arthritis of the ankle and/or foot.
4. History of significant ankle and/or foot instability
5. Two or more positive neurologic signs consistent with nerve root compression, including any two of the following:

   1. Muscle weakness involving a major lower extremity muscle group
   2. Diminished lower extremity patella or Achilles tendon reflexes
   3. Diminished / absent sensation in any lower extremity dermatome
6. Involvement in litigation or worker's compensation regarding foot pain
7. Any condition that might contraindicate the use of electro-needling
8. The patient is pregnant.

Where this trial is running

Columbia, South Carolina

• Prisma Health - Research PT Specialists — Columbia, South Carolina, United States (Recruiting)

Study contacts

• Principal investigator: James Dunning, DPT — American Academy of Manipulative Therapy
• Study coordinator: James Dunning, DPT

Conditions Achilles Tendinopathy