A Randomized Clinical Trial

Thomas Horstmann, MD

Study Design
Randomized clinical trial.

Objectives
To test the hypothesis that whole-body vibration training results in greater improvements in symptoms and pain, structural changes, and muscle flexibility and strength of the triceps surae muscle-tendon unit than those achieved with eccentric training or with a wait-and-see approach.

Background
The potential use of vibration training for the treatment of Achilles tendinopathy has not been explored.

Methods
Fifty-eight patients (mean age, 46.0 years) with Achilles tendinopathy were randomly assigned to a 12-week intervention using whole-body vibration training, eccentric training, or a wait-and-see approach. Pain, tendon structure and path, and muscle flexibility and strength were assessed at baseline and follow-up, and compared using mixed-factor analyses of variance.

Results
Pain improvements at the midsection of the tendon were greater in the vibration- and eccentric-training groups than in the wait-and-see group (mean difference from the vibration-training group, −18.0; 95% confidence interval [CI]: −35.0, −1.1; mean difference from the eccentric-training group, −27.0; 95% CI: −50.9, −3.1). Improvements in pain at the musculotendinous junction were greater in the eccentric-training group than in the other groups (mean difference from the vibration-training group, −31.4; 95% CI: −60.7, −2.0; mean difference from the wait-and-see group, −50.2; 95% CI: −82.3, −18.1). Improvements in most participants were achieved in the vibration-training group, followed by the eccentric-training group.

Conclusion
Vibration training may be an alternative or a complementary treatment in patients who do not respond well to eccentric training, especially in those with insertional pain.

Level of Evidence
Therapy, level 2b-. J Orthop Sports Phys Ther 2013;43(11):794–803. Epub 9 September 2013. doi:10.2519/jospt.2013.4762

Journal Abstract:  http://www.jospt.org/doi/abs/10.2519/jospt.2013.4762