Dear all,

I hope the year has started well and all the best for the remainder !

A solid edition to start the year – including some interesting and surprising studies. Here are some highlights…

Wilson and Stacy have reviewed shockwave therapy in Achilles tendinopathy – there were 6 studies in the review – including 4 RCT’s. 4 studies showed significant clinical improvement with shockwave. A good read but 2 quick points that I’ll raise – 1) they included insertional and midportion together – may be different effects in each; 2) none of the included studies included placebo control and these studies tend to show no effect of shockwave (e.g. Buchbinder Cochrane review 2005). Despite this, I use shockwave on a daily basis – it is useful ‘pain management’ in some specific cases, and provides a definite change in treatment direction that can be beneficial to ‘turn a corner’ (even if we may just be harnessing placebo!). I will blog about my ideas re selecting patients for shockwave soon.

Murley et al found that flat feet are associated with increased thickness of tibialis anterior but a less thick Achilles tendon. Flat foot people with a thinner Achilles may be more at risk of overloading because it is smaller (therefore weaker). Sort of challenges the biomechanical theory of Achilles ‘whipping’ with flat feet / pronation – Munteanu and Barton found an inconclusive relationship between foot posture and Achilles tendinopathy

Zhang et al compared acupuncture alone to versus eccentric training alone and found that they both improved, by the acupuncture group by more after 24 weeks. Incredible! Some issues: 1) VISA was still poor in both groups – 72 in acupuncture, 63 in eccentric at 24 weeks; 2) No blinding of outcome assessors; 3) huge cultural placebo associated with acupuncture in China. Has to be interpreted with these factors in mind.

Jansen et al found that male gender, peak ankle dorsiflexion, peak trunk flexion velocity and eccentric quadriceps strength predicted peak patellar tendon loading (which was mean 5xBW with a 2 leg volleyball stop jump). Makes sense – patellar tendon force is greater for stronger / more explosive. Interesting that patellar tendon force was 5xBW and this was a 2 leg jump – can assume double with single leg !

Interesting tennis elbow prolotherapy study showing pain and functional improvement maintained for 32 weeks compared to wait and see (Rabago et al). Prolotherapy group improved about 30% more than wait and see group so a lot of this could be placebo.

Thorpe et al compared high strain energy storing spring tendons and low-strain positional tendons from horses and found that only the former get stiffer (less interfacicular sliding with age), which may explain the association between age and tendinopathy

Rodriguez-Merchan published a review of patellar tendinopathy treatments with a focus on surgical treatment.

Here is a link Tendinopathy blog January 2013

Hope you enjoy




Buchbinder R, Green SE, Youd JM, et al. Shock wave therapy for lateral elbow pain. Cochrane Database of Syst Rev. 2005;(4):CD003524.

Munteanu SE, Barton CJ. Lower limb biomechanics during running in individuals with achilles tendinopathy: a systematic review. J Foot Ankle Res 2011: 4 (1): 1–15.