This study aims to investigate how Austrian physiotherapists manage lower limb tendinopathies. It will compare their practices with recommended guidelines and it should identify any deficiencies in the current approach to managing this condition
This study presents a web-survey design. Convenience sampling has been done to recruit participants. Data collection has been done through a standardized questionnaire containing multiple and single choice questions. Data analysis with SPSS will include descriptive statistics, such as percentages, to summarize the prevalence of treatment options.
57 completed cases have been recorded and 43 participants out of the 53 answered every close ended question. Achilles tendinopathy (98,1% of participants) was the most commonly treated tendinopathy, closely followed by patellar tendinopathy (77,4% of participants).
The most commonly used active treament was eccentric training (86,4% of participants), followed by stretching of the tendon (65,4% of participants). Other exercise options used were global exercises for the lower extremity (61,4 % of participants), aerobic training (50%) and isotonic (50%) exercises.
The most commonly used passive was fascia therapy (59,1% of participants) closely followed by mobilization (56,8% of participants). However, trigger point therapy (43,2% of participants) and deep friction massage 43,2% of participants) were also nearly used by half the participants.
The meta-analysis from Challoumas et al. (2023) suggested no strong evidence that any adjunct therapies, whether used alone or in combination with exercise, are more effective than exercise alone. As a result the authors concluded that exercise monotherapy remains the first-line treatment for patients with common lower limb tendinopathy.
Every participant of the study is applying some form of exercise therapy, which correlates with current literature. There is a lack of agreement regarding the criteria for load progression among different exercise protocols (Escriche-Escuder et al. 2019). Therefore, these authors suggest progressive exercise to be the primary treatment approach for tendinopathies.
However, a lot of participants recommend stretching as a form of treatment. This could also worsen the condition, as it leads to more compressive force on the tendon (Docking et al., 2013). It is therefore not recommended for most lower limb tendinopathies.
Adjunct therapies like fascia therapy, trigger point therapy or deep friction massage were heavily used by participants as well. Those treatments do not demonstrate any meaningful benefit in the treatment of lower limb tendinopathies and/or are not studied enough.
The finding suggests that physiotherapists should reconsider or limit the use of adjunct passive therapies as well as stretching as it is time consuming and even worsen tendinopathy. Exercise therapy seems to be still the leading treatment by austrian physiotherapists. Curricula may need to be updated to emphasize the importance of exercise monotherapy.
Survey
Exercise
