25/08/2025
This is good research about Achilles tendinopathy treatment protocols
What are the latest guidelines for Achilles Tendinopathy?
Chimenti et al. (2024) published an extensive update of the Clinical Practice Guidelines (CPG) for Achilles Tendinopathy. It’s open access so I’d recommend reading it in full (reference below).
Exercise should be a first line treatment and should be combined with education about tendinopathy, pain and load management.
Rehab should be progressive and can include all contraction types - eccentric, heavy slow resistance, isometric and plyometrics where tolerated.
Those with irritable symptoms and low load tolerance may benefit from lower-level exercises initially with education and interventions to help reduce pain.
Patient’s with high load tolerance and low irritability may be able to start with higher levels of load, for example progressing from 15RM to 6RM over approximately 12 weeks (see Beyer et al. 2015).
It should be noted that in many areas there was minimal evidence or contradictory findings. In some areas, such as stretching, no evidence update was provided so previous recommendations from the 2018 CPG were retained.
Shockwave therapy was not included in this review as it was considered outside of typical scope of practice. However, Iontophoresis was included and recommended with moderate evidence (grade B) despite it not being used widely in practice.
🗣️What do you think? Anything you’d add or change?
Reference:
Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision - 2024. J Orthop Sports Phys Ther. 2024 Dec;54(12):CPG1-CPG32. doi: 10.2519/jospt.2024.0302. PMID: 39611662.
