{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T12:15:25Z","timestamp":1793967325745,"version":"4.8.0"},"reference-count":58,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:00:00Z","timestamp":1740528000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003441","name":"Universitair Ziekenhuis Gent","doi-asserted-by":"publisher","award":["FIKO21\/Type2\/013"],"award-info":[{"award-number":["FIKO21\/Type2\/013"]}],"id":[{"id":"10.13039\/501100003441","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2025,2,3]]},"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the effectiveness of low tendon compression rehabilitation (LTCR) versus high tendon compression rehabilitation (HTCR) for treating patients with insertional Achilles tendinopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In an investigator-blinded, stratified randomised trial, 42 sport-active patients (30 males and 12 females; age 45.8\u00b18.2 years) with chronic (&gt; 3 months) insertional Achilles tendinopathy were allocated in a 1:1 ratio to receive LTCR or HTCR. Both rehabilitation protocols consisted of a progressive 4-stage tendon-loading programme, including isometric, isotonic, energy-storage and release and sport-specific exercises. The LTCR programme was designed to control Achilles tendon compression by limiting ankle dorsiflexion during exercise, eliminating calf stretching and incorporating heel lifts. The primary outcome was the Victorian Institute of Sports Assessment-Achilles (VISA-A) score at 12 and 24 weeks, which measures tendon pain and function and was analysed on an intention-to-treat basis using a linear mixed model. Significance was accepted when p&lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>20 patients were randomised to the LTCR group and 22 to the HTCR group. Improvement in VISA-A score was significantly greater for LTCR compared with HTCR after 12 weeks (LTCR=24.4; HTCR=12.2; mean between-group difference=12.9 (95% CI: 6.2 to 19.6); p&lt;0.001) and after 24 weeks (LTCR=29.0; HTCR=19.3; mean between-group difference=10.4 (95% CI: 3.7 to 17.1); p&lt;0.001). These differences exceeded the minimal clinically important difference of 10.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In sport-active patients with insertional Achilles tendinopathy, LTCR was more effective than HTCR in improving tendon pain and function at 12 and 24 weeks. Consequently, LTCR should be considered in the treatment of insertional Achilles tendinopathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov (ID:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05456620\">NCT05456620<\/jats:ext-link>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjsports-2024-109138","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T13:20:22Z","timestamp":1740576022000},"page":"640-650","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Effectiveness of reducing tendon compression in the rehabilitation of insertional Achilles tendinopathy: a randomised clinical trial"],"prefix":"10.1136","volume":"59","clinical-trial-number":[{"clinical-trial-number":"nct05456620","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05456620","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05456620","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2005-4984","authenticated-orcid":false,"given":"Lauren","family":"Pringels","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2612-4196","authenticated-orcid":false,"given":"Robbe","family":"Capelleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A\u00e4ron","family":"Van den Abeele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8602-100X","authenticated-orcid":false,"given":"Arne","family":"Burssens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1589-0275","authenticated-orcid":false,"given":"Guillaume","family":"Planckaert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9303-6915","authenticated-orcid":false,"given":"Evi","family":"Wezenbeek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc","family":"Vanden Bossche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,26]]},"reference":[{"key":"2025042408500899000_59.9.640.1","doi-asserted-by":"publisher","DOI":"10.1097\/01.jsm.0000165347.55638.23"},{"key":"2025042408500899000_59.9.640.2","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-356-19"},{"key":"2025042408500899000_59.9.640.3","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2020-103867"},{"key":"2025042408500899000_59.9.640.4","doi-asserted-by":"publisher","DOI":"10.1177\/1071100717723127"},{"key":"2025042408500899000_59.9.640.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-003-0418-z"},{"key":"2025042408500899000_59.9.640.6","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.F.01494"},{"key":"2025042408500899000_59.9.640.7","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0838.2001.110402.x"},{"key":"2025042408500899000_59.9.640.8","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515584760"},{"key":"2025042408500899000_59.9.640.9","doi-asserted-by":"crossref","DOI":"10.1177\/23259671211031254","article-title":"No Difference in Clinical Effects When Comparing Alfredson Eccentric and Silbernagel Combined Concentric-Eccentric Loading in Achilles Tendinopathy: A Randomized Controlled Trial","volume":"9","author":"Habets","year":"2021","journal-title":"Orthop J Sports Med"},{"key":"2025042408500899000_59.9.640.10","doi-asserted-by":"publisher","DOI":"10.1111\/sms.14285"},{"key":"2025042408500899000_59.9.640.11","doi-asserted-by":"publisher","DOI":"10.1177\/0095399703258621"},{"key":"2025042408500899000_59.9.640.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2015.11.008"},{"key":"2025042408500899000_59.9.640.13","doi-asserted-by":"crossref","first-page":"7","DOI":"10.32098\/mltj.01.2013.03","article-title":"Relationship between compressive loading and ECM changes in tendons","volume":"3","author":"Docking","year":"2013","journal-title":"Muscles Ligaments Tendons J"},{"key":"2025042408500899000_59.9.640.14","doi-asserted-by":"publisher","DOI":"10.1177\/10711007211069570"},{"key":"2025042408500899000_59.9.640.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2024.04.004"},{"key":"2025042408500899000_59.9.640.16","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2011-090414"},{"key":"2025042408500899000_59.9.640.17","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.c869","article-title":"CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials","volume":"340","author":"Moher","year":"2010","journal-title":"BMJ"},{"key":"2025042408500899000_59.9.640.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g1687","article-title":"Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide","volume":"348","author":"Hoffmann","year":"2014","journal-title":"BMJ"},{"key":"2025042408500899000_59.9.640.19","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2016-096651"},{"key":"2025042408500899000_59.9.640.20","first-page":"1009","article-title":"A CHecklist for statistical Assessment of Medical Papers (the CHAMP statement): explanation and elaboration","volume":"55","author":"Mansournia","year":"2021","journal-title":"Br J Sports Med"},{"key":"2025042408500899000_59.9.640.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-021-04553-6","article-title":"A criteria-based rehabilitation program for chronic mid-portion Achilles tendinopathy: study protocol for a randomised controlled trial","volume":"22","author":"Griffin","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"key":"2025042408500899000_59.9.640.22","doi-asserted-by":"crossref","DOI":"10.1186\/s40798-022-00545-5","article-title":"Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial","volume":"8","author":"Radovanovi\u0107","year":"2022","journal-title":"Sports Med Open"},{"key":"2025042408500899000_59.9.640.23","doi-asserted-by":"publisher","DOI":"10.3113\/FAI.2012.0487"},{"key":"2025042408500899000_59.9.640.24","doi-asserted-by":"publisher","DOI":"10.26603\/ijspt20190761"},{"key":"2025042408500899000_59.9.640.25","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2020-000769","article-title":"Surgical treatment of insertional Achilles tendinopathy: results after removal of the subcutaneous bursa alone-a case series","volume":"6","author":"Alfredson","year":"2020","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025042408500899000_59.9.640.26","doi-asserted-by":"publisher","DOI":"10.1016\/S1067-2516(98)80089-6"},{"key":"2025042408500899000_59.9.640.27","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-010-1374-z"},{"key":"2025042408500899000_59.9.640.28","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s11420-005-0129-8","article-title":"Haglund\u2019s Syndrome: Diagnosis and Treatment Using Sonography","volume":"2","author":"Sofka","year":"2006","journal-title":"HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"},{"key":"2025042408500899000_59.9.640.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025042408500899000_59.9.640.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2025042408500899000_59.9.640.31","doi-asserted-by":"crossref","DOI":"10.1177\/2325967119898118","article-title":"Therapeutic Response of Extracorporeal Shock Wave Therapy for Insertional Achilles Tendinopathy Between Sports-Active and Nonsports-Active Patients With 5-Year Follow-up","volume":"8","author":"Zhang","year":"2020","journal-title":"Orthop J Sports Med"},{"key":"2025042408500899000_59.9.640.32","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.35.5.335"},{"key":"2025042408500899000_59.9.640.33","first-page":"76","article-title":"The victorian institute of sports assessment - achilles questionnaire (visa-a) - a reliable tool for measuring achilles tendinopathy","volume":"7","author":"Iversen","year":"2012","journal-title":"Int J Sports Phys Ther"},{"key":"2025042408500899000_59.9.640.34","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06261-9"},{"key":"2025042408500899000_59.9.640.35","doi-asserted-by":"publisher","DOI":"10.1177\/1941738119893996"},{"key":"2025042408500899000_59.9.640.36","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2009.057968"},{"key":"2025042408500899000_59.9.640.37","doi-asserted-by":"publisher","DOI":"10.2519\/jospt.2015.5885"},{"key":"2025042408500899000_59.9.640.38","doi-asserted-by":"publisher","DOI":"10.1054\/math.2002.0458"},{"key":"2025042408500899000_59.9.640.39","doi-asserted-by":"crossref","first-page":"e490","DOI":"10.1111\/sms.12341","article-title":"Massage induces an immediate, albeit short-term, reduction in muscle stiffness","volume":"25","author":"Eriksson Crommert","year":"2015","journal-title":"Scand J Med Sci Sports"},{"key":"2025042408500899000_59.9.640.40","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2014.03.024"},{"key":"2025042408500899000_59.9.640.41","doi-asserted-by":"publisher","DOI":"10.1016\/S0005-7916(00)00012-4"},{"key":"2025042408500899000_59.9.640.42","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100894"},{"key":"2025042408500899000_59.9.640.43","doi-asserted-by":"publisher","DOI":"10.11138\/mltj\/2017.7.1.192"},{"key":"2025042408500899000_59.9.640.44","doi-asserted-by":"crossref","DOI":"10.1177\/2325967120917271","article-title":"Tendon Morphology and Mechanical Properties Are Associated With the Recovery of Symptoms and Function in Patients With Achilles Tendinopathy","volume":"8","author":"Corrigan","year":"2020","journal-title":"Orthop J Sports Med"},{"key":"2025042408500899000_59.9.640.45","doi-asserted-by":"publisher","DOI":"10.32098\/mltj.02.2022.04"},{"key":"2025042408500899000_59.9.640.46","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1986"},{"key":"2025042408500899000_59.9.640.47","doi-asserted-by":"crossref","DOI":"10.1136\/bmjsem-2017-000298","article-title":"Sport and exercise medicine consultants are reliable in assessing tendon neovascularity using ultrasound Doppler","volume":"4","author":"Watson","year":"2018","journal-title":"BMJ Open Sport Exerc Med"},{"key":"2025042408500899000_59.9.640.48","doi-asserted-by":"crossref","DOI":"10.1002\/pri.1889","article-title":"Factors associated with outcome following exercise interventions for Achilles tendinopathy: A systematic review","volume":"26","author":"F\u00e4rnqvist","year":"2021","journal-title":"Physiother Res Int"},{"key":"2025042408500899000_59.9.640.49","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m3027","article-title":"Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial","volume":"370","author":"van der Vlist","year":"2020","journal-title":"BMJ"},{"key":"2025042408500899000_59.9.640.50","doi-asserted-by":"crossref","DOI":"10.1186\/s12874-017-0442-1","article-title":"When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guide with flowcharts","volume":"17","author":"Jakobsen","year":"2017","journal-title":"BMC Med Res Methodol"},{"key":"2025042408500899000_59.9.640.51","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2019.02.001"},{"key":"2025042408500899000_59.9.640.52","doi-asserted-by":"publisher","DOI":"10.1002\/jor.23338"},{"key":"2025042408500899000_59.9.640.53","first-page":"135","article-title":"Mechanobiology of tendon adaptation to compressive loading through fibrocartilaginous metaplasia","volume":"37","author":"Wren","year":"2000","journal-title":"J Rehabil Res Dev"},{"key":"2025042408500899000_59.9.640.54","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2022-106066"},{"key":"2025042408500899000_59.9.640.55","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2007.039545"},{"key":"2025042408500899000_59.9.640.56","doi-asserted-by":"crossref","DOI":"10.1177\/23259671231221583","article-title":"Immediate and Short-Term Effects of In-Shoe Heel-Lift Orthoses on Clinical and Biomechanical Outcomes in Patients With Insertional Achilles Tendinopathy","volume":"12","author":"Alghamdi","year":"2024","journal-title":"Orthop J Sports Med"},{"key":"2025042408500899000_59.9.640.57","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2023-107741"},{"key":"2025042408500899000_59.9.640.58","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000002720"}],"container-title":["British Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjsports-2024-109138","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T11:50:40Z","timestamp":1745495440000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjsm.bmj.com\/lookup\/doi\/10.1136\/bjsports-2024-109138"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,26]]},"references-count":58,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,4,24]]},"published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1136\/bjsports-2024-109138"],"URL":"https:\/\/doi.org\/10.1136\/bjsports-2024-109138","relation":{},"ISSN":["0306-3674","1473-0480"],"issn-type":[{"value":"0306-3674","type":"print"},{"value":"1473-0480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,26]]}}}