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Today’s article “Shockwave Therapy Plus Eccentric Exercises Versus Isolated Eccentric Exercises for Achilles Insertional Tendinopathy A Double-Blinded Randomized Clinical Trial” by Mansur et al. is from a team out of Sao Paulo, Brazil. 

The authors take on a tough condition to treat- insertional Achilles tendinopathy. Extended non operative treatment is often undertaken, often with modest results. Surgery can be undertaken for recalcitrant cases but often has a high complication rate. Therefore, we continue to look for successful conservative treatments. 

The authors used a primary outcome of the Victorian Institute of Sports Assessment-Achilles questionnaire. They were able to recruit 119 patients for the study. Two groups were studied: eccentric exercises with extracorporeal shock wave therapy (SWT) and eccentric exercises with sham shockwave therapy (CON). The eccentric exercise was performed by the patient being in a tip toe position and then slowly lowering on the affected leg down to a flat heel. This was performed for 3 sets of 15 with the knee straight and 3 sets of 15 with the knee bent 20 degrees. The exercise was to be performed every day for three months. 

Both groups showed a significant improvement from baseline. For the SWT group the VISA-A improved from 43.9 at baseline to 63.2 at 24 weeks. The control group improved from 40.6 at baseline to 62.3 at 24 weeks. The authors showed a higher failure rate (38.3% SWT vs 11.5% CON) in the shock wave group but a higher recurrence rate in the control group (34.6% CON vs 17.0% SWT). 

The authors do mention other studies suggesting later effects of shock wave therapy. However, the results of this study do question the benefit of extracorporeal shock wave therapy in the treatment of insertional Achilles tendinopathy.