Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid injections in a clinical setting

In published efficacy studies on Achilles tendinopathy (AT) exercise alone results in improvement in 60–90% of the cases. However, this high success rate cannot be expected in usual clinical practice. We prospectively investigated the effectiveness of a treatment regimen consisting of home‐based exercises (concentric, eccentric, and stretching) and optional glucocorticosteroid (GCS) injections in patients with (AT) in a usual clinical setting. Patients unable to commence or progress in exercise were offered GCS, hypothesizing that the GCS would facilitate exercise. Ninety‐three consecutive patients with AT referred to two outpatient rheumatology clinics were registered, and seen at five visits over a 6‐month period. Exercises seemed to have a slow, but long‐lasting effect with GCS having a dramatic short‐term effect on symptoms. Twenty‐six percent of the patients could proceed with training alone, the remainder received one to three supplementary GCS. There were significant improvements on all outcome variables over time (P ≤ 0.001). At follow‐up, 42 had no more symptoms, 29 good result, 16 slightly improved, 4 unchanged, and 2 slightly worse. Overall, 94% of the patients had improved, and we thus recommend the use of GCS injections in AT patients if training alone does not lead to improvement.