Table 2 Characteristics of included studies.
| Study ID | Type of study | Participants' characteristics | Interventions | Outcomes |
|---|---|---|---|---|
| Cannell 200157 | RCT | Participants: 19 subjects involved in various sports. | Ice, AIs and rest for the first two weeks of the study; then 12‐week intervention. | Length of follow‐up: no follow‐up past intervention |
| Method of randomisation: sealed envelope draw. | EE = 10: 7 male, 3 female, Age = 26 (23–29) years, DOS = 3.1 (1.6–4.6) mths. | EE group: 3 sets of 20 drop‐squats 1/day, 5 days/week. Load increase over 4 levels and dependent on body weight. Activity level could increase over this period. | Outcomes assessed: | |
| 2 groups: drop‐squats (EE) or leg extension/curl exercises (CE). | CE = 9: 6 male, 3 female, Age = 26 (19–33) years, DOS = 4.2 (2.3–6.1) mths. | CE group: 3 sets of 10 lifts of each exercise, 1/day, 5 days/week. Weights increased as per table over 4 levels. Activity increased over this period as able. | Pain: VAS | |
| Return to sport: reported at the 12‐week stage –y/n | ||||
| Muscle strength: quads and hamstrings moments of force 30°/sec on both legs. | ||||
| Jonsson 200545 | RCT | Participants: 15 patients active in various sports. | 12‐week intervention. | Length of follow‐up: 32.6 months. |
| Method of randomisation: not stated. | EE = 10: 7 male, 1 female. Age = 25.7±9.9 years, DOS = 15.4±6 mths. | No sports‐specific training for 6 weeks. Given by same physiotherapist. Both groups performed exercise on decline board. Training was meant to be painful. Load increased to attain this. | Outcomes assessed: | |
| 2 groups: EE and CE. | CE = 9: 6 male, 1 female, Age = 24.1±6.1 years, DOS = 19.6±20.3 mths. | EE group: exercises done 2 times a day, 7 days/week. 3×15 reps. Concentric activity done by uninjured leg. | Pain: VAS | |
| CE group: a/a, eccentric activity avoided as much as possible. | Function: VISA score for knee function. | |||
| Patient satisfaction: satisfied/not satisfied. | ||||
| Mafi 200127 | RCT | Participants: 44 patients referred as potential surgical candidates: 24 male, 20 female. | 12‐week intervention. | Length of follow‐up: no follow‐up past intervention. |
| Method of randomisation: envelope. | EE = 22, Age = 48.1±9.5 years, DOS = 18 (3–120) mths. | EE group: exercises done 2 times a day, 7 days/week. Two exercises used short and long calf muscle loading. Each 3×15 reps. Concentric activity done by uninjured leg. Increased load when exercise became pain free. | Outcomes assessed: | |
| 2 groups: EE and CE. | CE = 22, Age = 48.4±8.3 years, DOS = 23 (5–120) mths. | CE group: various concentric exercises used, from calf raises to side jumps. | Pain: VAS | |
| Patient satisfaction: satisfied/not satisfied. | ||||
| Martinez‐Silvestrini 200546 | RCT | Participants: 94 subjects: 50 male, 44 female. | 6‐week intervention. | Length of follow‐up: no follow‐up past intervention. |
| Method of randomisation: not stated. | DOS: >3 mths. | Stretching group: 2 times/day 3 repetitions held for 30 secs, 30 sec rest between. | Outcomes assessed: | |
| 3 groups: stretching, EE + stretching, CE + stretching. | Age: | EE group: eccentric resistance band exercises, avoiding concentric activity. 3 sets of 10 reps 1 time/day 2, 5 minutes of rest between sets. | Grip strength: pain free. | |
| St = 43.1 years. | CE group: a/a but eccentric load avoided during exercise. | Patient‐rated forearm evaluation questionnaire. | ||
| EE + St = 46.6 years. | Advice on ice massage and strap use was also given to all patients. | DASH | ||
| CE + St = 47.0 years. | SF–36. | |||
| Pain: VAS | ||||
| Patient satisfaction: 5 point scale. | ||||
| Neisen‐Vertommen 199259 | RCT. | Participants: 17 non‐competitive recreational athletes | 12‐week intervention. | Length of follow‐up: no follow‐up past intervention. |
| Method of randomisation: not stated. | EE = 8 | 5 sets of 10 reps, in a pain free ROM, 1 time/day 6/week. | Outcomes assessed: | |
| 2 groups: EE and CE. | 4 male, Age = 39.5±3.2 years, DOS: 3.7±1.1 mths. | |||
| 4 female, Age = 31±2.6 years, DOS: 3.7±0.9 mths. | EE group: protocol outlined in another journal article, raised step exercise, eccentric only. | Concentric and eccentric plantarflexor average and peak torque, 30°/sec and 50°/sec. | ||
| CE = 9 | CE group: progressive concentric exercise programme on universal gym. | Pain: scale from 1–10. | ||
| 6 male, Age = 37.33±1.7 | Each group progressed weight as able. | |||
| 3 female, Age = 28.66±3.2 years. | Return to activity: scale from 1–10; 10 denoted full activity of pre‐injured level. | |||
| Roos 200450 | RCT. | Participants: 44: 21 male, 23 female. Age = mean 45 years. DOS: 5.5 (1–180) mths. | 12‐week intervention. | Length of follow‐up: 1 year. |
| Method of randomisation: envelope. | ||||
| EE = 16 | EE group: as described by Alfredson et al 1998. Straight and bend knee exercises. Day 1–2 1×15; day 3–4 2×15; day 5–7 3×15; then 3×15 from then on. Load added as tolerated. | Outcomes assessed: | ||
| 3 groups: EE, night splint or combination of both. | EE + Sp = 15 | Night splint group: anterior night splint, night‐time use only. | FAOS | |
| Sp = 13 | Combination group: a/a. | Return to sport: y/n. | ||
| Selvanetti 200363 | RCT | Participants: 60 patients. | 20–30 sessions. | Length of follow‐up: mean 11 months. |
| Method of randomisation: envelope numbered and sealed. | EE = 31: 17 males, 14 female, Age = 41.3 (33–54) years, DOS = 6.6 (2–10) mths. | EE group: 3 mins warm‐up, 4 PNF contract relax (10 sec contract, 2 sec rest, 30 sec stretch), 3 sets of 10 reps ecc. Exercises with theraband, 30 secs rest between sets, PNF stretches times 4 again then ice for 15 minutes. | Outcomes assessed: | |
| 2 groups: sham ultrasound and counselling, and EE, contract‐relax stretching and counselling. | US = 29: 15 males, 14 female, Age = 40.5 (32–52) years, DOS = 6.8 (3–11) mths. | US group: placebo US (20 sessions, 5/week). | Pain: VAS scale, but 0 = severe, 10 = no pain. | |
| Patient satisfaction: subjective general enhancement; 0–100% | ||||
| Silbernagel 200152 | RCT. | Participants: 40 (57 involved tendons) patients. | 12‐week intervention. | Length of follow‐up: 6 months. |
| EE = 30 tendons, 17 male, 5 female, Age = 47±14.7 years, DOS = 20±25.4 mths. | One‐year follow‐up for summary of questions to patient. | |||
| Method of randomisation: not stated. | EE group: extensive exercise programme split into 3 phases, including ROM exercises, concentric exercises and eccentric exercises. Pain allowed to reach 5 on VAS, no morning stiffness following, and decrease in VAS pain by morning. | |||
| 2 groups: EE and CE. | CE = 27 tendons, 14 male, 4 female, Age = 41±10.2 years, DOS = 41±55.9 mths. | CE group: a/a minus the eccentric exercises. Frequency of all exercises in all groups varied from week to week. | Outcomes assessed: | |
| Pain: VAS | ||||
| Function: plantarflexion, jumping test, toe raising test. | ||||
| Patient satisfaction: y/n. | ||||
| Stasinopoulos 200453 | RCT. | Participants: 30 patients, DOS = minimum 3 mths. | 4‐week intervention. | Length of follow‐up: 3 months. |
| Method of randomisation: drawing lots. | EE = 10: 7 male, 3 female, Age = 28.12±2.03 years. | All patients received 3 treatments per week. | Outcomes assessed: | |
| 3 groups: EE, pulsed US, and frictions (F). | US = 10: 6 males, 4 female, Age = 29.17±3.76 years. | EE group: static stretching exercises, 3 sets of 15 unilateral eccentric squats, load increased as able, 2 minute rest between sets. | Pain status: worse, no change, somewhat better, much better, no pain. | |
| F = 10: 5 male, 5 female, Age = 26.24±4.17 years. | US group: local pulsed US 0.4–0.8 W/cm2 ratio1:4, 2 ms pulse duration, frequency 1 MHz. ‐10 minutes. | |||
| Friction group: Cyriax and Cyriax technique for 10 minutes. | ||||
| Svernlov 200154 | RCT. | Participants: pilot study: 30 patients. | 12‐week intervention. | Length of follow‐up: 12 months for pilot, after 3 months training in clinical study. |
| Method of randomisation: not stated. | EE = 15: 13 male, 2 female, Age = 42.1 years, DOS = 10.7 (3–24) mths. | EE group: warm‐up ex. 2–3 mins, static stretch 3–5 times (15–30 secs), eccentric exercises, 3 sets of 5 with dumb‐bell 10 sec duration, static stretch as before, performed 1 time/day. | Outcomes assessed: | |
| 2 groups: EE and St. Both with use of brace. | St = 15: 6 male, 9 female, Age = 43 years, DOS = 8.4 (3–20) mths. | Stretching group: 10 secs of contractions of muscle, relaxation 2 secs, stretching 15–20 secs, repeated 3–5 times twice daily. | Pain: VAS | |
| Strength testing: using strain gauge device. | ||||
| Patient satisfaction: y/n. | ||||
| Visnes 200555 | RCT. | Participants: 29 male and female elite volleyball players (12 with bilateral symptoms) in Norway. | 12‐week intervention. | Length of Follow‐up: 6 months after end of intervention. |
| Method of randomisation: by statistician who was blinded to player identity. | EE = 13: 8 male, 5 female, Age = 26.8±4.6 years, DOS = 67±44 mths | EE group: twice daily, 3 sets of 15 reps, done without warming up. Decline squat exercise, eccentric loading only on affected leg, recommended to have 5/10 pain upon exercising. Load was increased as pain decreased. | Outcomes assessed: | |
| 2 groups: EE and control. | C = 16: 11 male, 5 female, Age = 26.4±3.4 years, DOS = 79±75 mths. | Control group: no intervention, trained as usual. | Function: VISA scores for knee function. | |
| Global evaluation score (pain and function) and jumping performance. |
AI, anti‐inflammatories; a/a, as above; C, control; CE, concentric exercise; DASH, disabilities of the arm, shoulder and hand; DOS, duration of symptoms; EE, eccentric exercise; F, frictions; FAOS, foot and ankle outcome score; RCT, randomised controlled trial; Sp, splint; St, stretching; US, ultrasound; VAS, visual analogue scale; VISA, Victorian Institute of Sport Assessment.