Backward Running on a Negative Slope as a Treatment for Achilles Tendinopathy in Runners: A Feasibility Study

Background: Achilles tendinopathy (AT) is a common musculoskeletal injury among runners. Eccentric exercises are considered to be the first-line treatment. However, during the early stages of rehabilitation patients are usually instructed to stop running. Backward running (BR) on a negative slope provides a similar eccentric load while enabling ongoing physical-activity; thus, it may be suggested as an alternative treatment.

Aims: To determine the feasibility of a BR program as a treatment option for AT in runners.

Methods:

Design: Prospective, single-arm feasibility study.

Setting: Outpatient clinic.

Patients: Recreational runners diagnosed with AT and referred to the Meuchedet Health Services Physical Therapy Clinic in Givat Shaul, Israel from September 2019 to February 2020.

Intervention: Patients completed a 5-week (9 sessions) rehabilitation program of supervised BR on a negatively inclined treadmill.

Main Outcome Measures: Compliance with the program was evaluated by calculating the percentage of patients who completed the full protocol with no adverse events. Personal running-related goals were set before the program and were assessed following rehabilitation using the goal attainment scaling (GAS) method. Forward running time (FRT) until the onset of relevant Achilles tendon pain, and the Victorian Institute of Sports Assessment Scale-Achilles (VISA-A) were measured at baseline (T0), before treatment session six (T1), and after the last session (T2).

Results: Among the 15 patients recruited, 14 (93%), average age 48.8 [10.4] years (86% males) completed the full protocol with no adverse events. Almost all participants (85.7%) achieved their running-related functional goals. Post-intervention, FRT increased by 314% from 158.5 [251.7] sec to 656.4 [319.2] sec (p=0.008, effect size 0.858), and the VISA-A score improved by 24.1 points (p=0.003, effect size 0.881).

Conclusion: BR on a negative slope may be a feasible treatment method for runners suffering from AT. Future randomized control trials are required to further validate the efficacy of this method.