Achilles Tendinopathy

The following study highlights the effectiveness of conservative care with soft tissue and manual therapy approaches for Achilles tendinopathy.  Precision neuromuscular therapy gets amazing results using such interventions!

   Stefansson et al. examined the difference between “pressure massage” and eccentric exercise for Achilles tendinopathy. A total of 60 participants were randomized into 3 groups. Group 1 underwent an eccentric exercise protocol, group 2 underwent pressure massage, and group 3 underwent pressure massage and the eccentric exercise protocol.

Inclusion criteria for the study were participants had to have been diagnosed by a clinician, had pain and swelling in the tendon, confirmed the injury via ultrasound and had the injury greater than 12 weeks.

Group 1 performed a progressive eccentric loading protocol eventually performing 3×15 repetitions from week 3-12. Group 2 received pressure massage 2x a week with 2-3 days in between for 6 weeks then 1x per week for 6 weeks. The therapist used his or her knee (I am not sure why they just didn’t use their hands…) to put pressure on the soleus muscle at 3 different locations. The pressure was held until the pain started to decrease and the muscle started to relax but not for more than 60 seconds. The patient’s pain tolerance was used to control the amount of pressure. Points were then looked for along the medial and lateral soleus and were treated with the same protocol, however this time with the thumb. Group 3 received both interventions.

Following the study, all groups improved according to the Icelandic version of the Victorian Institute of Sports Assessment-Achilles. The pressure massage ONLY group was statistically different compared to the other two groups at 4 weeks, but all groups were equal at 24 weeks.

The take-home message both massage and eccentrics works for Achilles tendon pain. I would like to see a 1 year follow up in this study. My conclusion, use manual therapy to address pain, use the eccentrics to address function.


Steffansson et al. (2019) Using Pressure Massage for Achilles Tendinopathy: A Single-Blind, Randomized Controlled Trial Comparing a Novel Treatment Versus an Eccentric Exercise Protocol. Orthop J Sports Med, 7, 3, 2325967119834284. doi: 10.1177/2325967119834284


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