Whole body vibration vs eccentric training or no intervention for Achilles tendinitis

The aim of the presented research by German scientists was to test the effectiveness of a 12-week whole-body vibration training (WBVT) in the treatment of chronic Achilles tendinitis. For comparative purposes, the effects of 12-week conventional eccentric training or the lack of therapeutic intervention during this period were also analyzed in this context. Pain symptoms, structural changes as well as flexibility and strength of the musculotendinous unit of the Achilles tendon and the triceps surae were analyzed.

• Both vibration and eccentric training reduced pain in the medial tendon, but only eccentric training reduced pain in the musculo-tendon junction.
• The improvement in structural (sonographic) parameters and the change in muscle strength after vibration and eccentric training were similar.

Prepared on the basis of:

Whole-body vibration versus eccentric training or a wait-and-see approach for chronic Achilles tendinopathy: a randomized clinical trial. Horstmann T, Jud HM, Fröhlich V et al. J Orthop Sports Phys Ther. 2013 Nov;43(11):794-803.

Study population

Fifty-eight recreational runners (age: 25-55, average age 46) with chronic Achilles tendonitis meeting the relevant criteria.

Test procedure

Study participants were randomly assigned to the 12-week WBVT group, the 12-week eccentric training group, or to the no-intervention during this period control group. Pain, tendon structure, muscle flexibility and strength were assessed at baseline and at the end of the study.

Pain symptoms were measured using a visual analog scale (VAS) ranging from 0 to 100 points, where 0 was no pain and 100 was maximum pain. Structural changes were measured by ultrasound.

Use of vibration in the study

WBV was delivered by the Galileo Fit vibration platform (Novotec Medical GmbH, Germany). The vibration frequency ranged from 13 to 21 Hz, the amplitude from 0.4 to 0.8 mm, the duration of vibration administration from 4 to 7 minutes. Although it was previously reported that vibration frequencies above 20 Hz induce increased muscle performance and could be used here, patients with Achilles tendinitis in the pilot study did not best tolerate vibration frequencies above 21 Hz.

Results

WBVT as well as eccentric training lowered pain symptoms in the middle part of the tendon. Before the interventions, the pain level was 72.9 ± 31.4, 69.0 ± 33.6 or 62.6 ± 28.5 on the VAS scale, in the WBVT group, after eccentric training or in the control group, respectively. After the interventions: 35.4 ± 32.1, 22.6 ± 27.8 or 45.1 ± 31.4, respectively, and was statistically significantly lower (p < 0.05) in each group compared to the level before the interventions.

In the musculo-tendon junction, pain reduction was observed only in the eccentric training group. Before the interventions, the pain level was 33.6 ± 31.4, 47.0 ± 36.1 or 18.7 ± 24.3 on the VAS scale, in the WBVT group, after eccentric training or in the control group, respectively. After interventions: 34.4 ± 34.2, 16.4 ± 24.1 or 39.3 ± 31.4, respectively. Thus, after WBVT, there was no change in pain level in the musculotendinous junction, compared to 66.6% pain reduction after eccentric training and 73.3% pain increase in the control group.

For most ultrasound parameters, improvement in most participants was seen in the WBVT group and, to a lesser extent, after eccentric training. However, with no statistically significant differences between the groups (p > 0.05).

Comment

The authors conclude the presented study by stating that vibration training can be an alternative or adjunctive therapy for chronic Achilles tendinitis in patients who do not respond well to conventional eccentric training.

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