Rehabilitation of midportion Achilles tendinopathy in athletes: Loading programmes, hip muscle function and return to sport

Midportion Achilles tendinopathy is a common injury of the lower extremity, most prevalent in sports involving running and jumping. The injury may cause severe limitations of sports participation and treatment is often difficult. This thesis, entitled “Rehabilitation of midportion Achilles tendinopathy in athletes” describes a set of studies focusing on exercise therapy, function of the hip muscles and return to sport, aiming to enhance the effectiveness of conservative treatment of this challenging injury. The results showed that different exercise programmes (eccentric and combined concentric and eccentric) are effective in reducing symptoms and improving functional performance of the lower extremity in athletes. We did not find that one programme was more effective than the other, suggesting that both programmes can be used in daily practice. Furthermore, we showed that symptomatic athletes have remarkable strength deficits in the hip muscles of both legs, when compared with matched asymptomatic participants. We found no unambiguous definition of when athletes are ready to return to their previous sports activity, nor did we find which criteria should be used to decide whether athletes are ready. In conclusion, exercise therapy of the calf muscles, whether eccentric or combined concentric and eccentric, appears an effective treatment for midportion Achilles tendinopathy. Furthermore, athletes with midportion Achilles tendinopathy may present with considerable hip muscle dysfunction. When athletes are ready to resume their sport and how this should be established remains unknown. Therefore, the search for optimal treatment and outcomes for midportion Achilles tendinopathy should continue.