Exercise parameters to consider for Achilles tendinopathy: a modified Delphi study with international experts

Area of Science:

• Sports Medicine
• Rehabilitation Science
• Orthopedics

Background:

• Achilles tendinopathy (AT) is a common condition affecting athletes and active individuals.
• Optimizing rehabilitation strategies for midportion and insertional AT is crucial for patient recovery.
• Expert consensus on exercise parameters can guide effective AT treatment.

Purpose of the Study:

• To establish expert agreement on exercise parameters influencing Achilles tendinopathy (AT) rehabilitation outcomes.
• To differentiate key parameters for midportion versus insertional AT recovery.
• To inform evidence-based AT rehabilitation protocols.

Main Methods:

• A three-round Delphi survey was conducted with 17 international AT rehabilitation experts.
• Experts rated the influence of 16 heel raise exercise parameters on AT rehabilitation using a 5-point Likert scale.
• Consensus criteria were applied to identify parameters with major influence and their importance was ranked.

Main Results:

• Four parameters (contraction intensity, time under tension, repetitions/sets, contraction type) reached consensus for midportion AT.
• Three parameters (ankle dorsiflexion range, contraction intensity, repetitions/sets) reached consensus for insertional AT.
• Contraction intensity was ranked highest for midportion AT; ankle dorsiflexion range for insertional AT.

Conclusions:

• Key exercise parameters influencing AT rehabilitation have been identified through expert consensus.
• Contraction intensity and ankle range of motion are critical variables for midportion and insertional AT, respectively.
• Findings can help clinicians optimize patient-specific exercise prescriptions for improved AT outcomes.