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Background: Most knowledge regarding conservative management for lower limb tendinopathy (LLT) is for persistent symptoms, with less known about conservative management of acute LLT. Sub-optimal management of acute LLT is detrimental in many regards, not least the likely conversion to persistent symptoms., Objectives: To synthesise existing literature on conservative management of acute LLTs., Design: Systematic review of relevant literature (PROSPERO [ID: CRD42018117882])., Method: A search was made of multiple databases (MEDLINE, CINAHL and EMBASE) using relevant search terms. Titles, abstracts and then full texts were filtered to find articles that met the strict inclusion/exclusion criteria. Searching, data extraction and quality assessment, using the Grading of Recommendations Assessment, Development and Evaluation, were done independently by two authors. To understand how the interventions impacted the duration of reported symptoms, results were split into three time points: short-term (<4 weeks), medium-term (4-12 weeks) and long-term (>12 weeks)., Results: Thirteen studies (n = 534) met the criteria for inclusion. There was very low level of certainty for the effectiveness of interventions at short-term, medium-term and long-term follow ups. However, there were large effects seen across a number of different treatments on pain intensity and disability in LLTs., Conclusions: This review demonstrates that limited evidence currently exists to guide the management of acute LLT, and the quality of the existing evidence is collectively low. These findings inform the discussion of different treatment options with patients in a shared decision-making process to empower and enable the patient., (© 2020 John Wiley & Sons Ltd.)

Introduction: This study evaluated the feasibility of a large longitudinal cohort study utilizing an online platform to investigate the association and predictive relationship of working alliance, outcome expectations, adherence and self-efficacy with outcome in Achilles tendinopathy. The objectives were: (1) to determine the recruitment and retention rate and (2) to carry out preliminary data analysis of the selected variables and clinical outcomes., Methods: A multi-centred, longitudinal feasibility cohort study was used. Eligible participants were directed to a bespoke online platform hosting study information and the outcome measures in the form of an online questionnaire. Responses from the online questionnaire were collected on three occasions: at baseline, at 6 and at 12 weeks following completion of the first questionnaire. Feasibility outcomes (recruitment and retention rates) were described using descriptive statistics., Results: The website recorded a total 55 views. These 55 views resulted in 24 participants consenting to join the study. The questionnaire at baseline was started 63 times and completed on 60 separate occasions resulting in a 95% conversion rate. Retainment for completion of the questionnaire for a second time was 83.3% and for the third time was 66.6%. All questionnaires were completed fully yielding a missing data indicator of 0%., Conclusions: Feasibility studies ask the question 'can this be done'? Based on the data from recruitment and rates and exploratory correlation analysis a future study can be done; this previously untested online platform appears feasible, but changes could be useful before proceeding to a much larger study., (© 2020 John Wiley & Sons, Ltd.)

Objective: Achilles tendinopathy is a common type of overuse condition, with isolated eccentric loading (ECL) programmes being the principal conservative treatment of choice. However, alternative protocols, involving different contraction types, have more recently been investigated. The purpose of the present review was to examine the evidence from studies comparing two or more different types of loading programmes in relation to patient-reported outcomes for people with Achilles tendinopathy., Methods: A systematic review was undertaken, and the risk of bias of included papers were assessed using the Cochrane Risk of Bias tool. An electronic search of CINAHL, MEDLINE, Embase and SPORTDiscus was undertaken from their inception to May 2018. The eligibility criteria for selecting studies were randomized controlled or clinical controlled trials investigating two or more different loading programmes for chronic (>3 months) Achilles tendinopathy., Results: Seven articles were included in the review. Low-quality evidence exists that a do-as-tolerated modification of the Alfredson programme is more effective than the standardized programme at improving function in the short term. Very-low-quality evidence suggests that ECL is superior at reducing pain levels than concentric in isolation, but no more effective at improving pain or disability than concentric-eccentric programmes., Conclusions: There is conflicting evidence regarding the superiority of ECL over other contraction types, challenging the current approach to managing Achilles tendinopathy. There is also evidence that do-as-tolerated repetition volumes are more effective at improving function in the short term compared with those recommended by the standardized Alfredson protocol., (© 2019 John Wiley & Sons, Ltd.)