Exercise parameters to consider for Achilles tendinopathy: a modified Delphi study with international experts

To assess the level of agreement among experts on the heel raise exercise parameters that influence midportion and insertional Achilles tendinopathy (AT) rehabilitation outcomes.An international expert panel in AT rehabilitation was invited to complete a three-round Delphi survey. In the first two rounds, experts were asked to review a pregenerated list of exercise parameters (based on the heel raise exercise) and rate their perceived influence on rehabilitation outcome, using a 5-point Likert scale. For each parameter, consensus criteria for major influence on rehabilitation were (a) median≥4, (b) ≥75% of scoring 4 or 5 and (c) IQR≤1. The third round aimed to rank the exercise parameters according to importance (from most to least important) during rehabilitation.17 experts participated in the entire Delphi process. A total of 16 exercise parameters were assessed, of which 4 (intensity of contraction, total time under tension, number of repetitions and sets, type of contraction) reached consensus as having a major influence on rehabilitation for midportion AT and 3 reached consensus for insertional AT (range of ankle dorsiflexion during the exercise, intensity of contraction, number of repetitions and sets). The rankings of parameters that reached consensus showed that contraction intensity was perceived as the most important variable for midportion AT rehabilitation, while range of ankle dorsiflexion was deemed the most important variable for insertional AT rehabilitation.This study identified key exercise parameters for mid-portion and insertional AT rehabilitation based on expert opinion. This information should assist practitioners in optimising their approach to deliver more effective, patient-specific exercises for AT rehabilitation.

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Publication Details

Journal
British Journal of Sports Medicine
Published
2025-08-28
DOI
https://doi.org/10.1136/bjsports-2025-110183
Citations
2
Primary Topic
Tendon Structure and Treatment
Type
article
Field-Weighted Citation Impact
3.44
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article

Exercise parameters to consider for Achilles tendinopathy: a modified Delphi study with international experts

Kenneth Färnqvist, Adrián Escriche-Escuder, Vincent Grémeaux, Robert‐Jan de Vos et al.
2 citations
British Journal of Sports Medicine
Tendon Structure and Treatment
3.44
article

Exercise parameters to consider for Achilles tendinopathy: a modified Delphi study with international experts

Kenneth Färnqvist, Adrián Escriche-Escuder, Vincent Grémeaux, Robert‐Jan de Vos, A. Rapin, Igor Sancho, Seth O’Neill, S. Peter Magnusson, Redha Taı̈ar, Alex Scott, Peter Malliaras, Nicola Maffulli, Yoann Demangeot, Umer Asgher, Ruth L. Chimenti, Ebonie Rio, Myles Murphy, Rachel Chester, F. Boyer, Craig Purdam, Karin Grävare Silbernagel, Håkan Alfredson, Bas Habets, Jonathan D Rees, Francis Degache
article en
2 citations

Abstract

To assess the level of agreement among experts on the heel raise exercise parameters that influence midportion and insertional Achilles tendinopathy (AT) rehabilitation outcomes.An international expert panel in AT rehabilitation was invited to complete a three-round Delphi survey. In the first two rounds, experts were asked to review a pregenerated list of exercise parameters (based on the heel raise exercise) and rate their perceived influence on rehabilitation outcome, using a 5-point Likert scale. For each parameter, consensus criteria for major influence on rehabilitation were (a) median≥4, (b) ≥75% of scoring 4 or 5 and (c) IQR≤1. The third round aimed to rank the exercise parameters according to importance (from most to least important) during rehabilitation.17 experts participated in the entire Delphi process. A total of 16 exercise parameters were assessed, of which 4 (intensity of contraction, total time under tension, number of repetitions and sets, type of contraction) reached consensus as having a major influence on rehabilitation for midportion AT and 3 reached consensus for insertional AT (range of ankle dorsiflexion during the exercise, intensity of contraction, number of repetitions and sets). The rankings of parameters that reached consensus showed that contraction intensity was perceived as the most important variable for midportion AT rehabilitation, while range of ankle dorsiflexion was deemed the most important variable for insertional AT rehabilitation.This study identified key exercise parameters for mid-portion and insertional AT rehabilitation based on expert opinion. This information should assist practitioners in optimising their approach to deliver more effective, patient-specific exercises for AT rehabilitation.

British Journal of Sports MedicineVol. 59(19)
University of East Anglia (GB), Edith Cowan University (AU), University of Iowa (US), Universidad de Deusto (ES), University of British Columbia (CA), University of Leicester (GB), Universitat de València (ES), La Trobe University (AU), Frederiksberg Hospital (DK), Erasmus MC (NL), Karolinska Institutet (SE), University Medical Center Utrecht (NL), Centre Hospitalier Universitaire de Reims (FR), National University of Technology (PK), Fortius Clinic (GB), Czech Technical University in Prague (CZ), Monash University (AU), Sapienza University of Rome (IT), University of Delaware (US), Umeå University (SE), National University of Sciences and Technology (PK), Université de Reims Champagne-Ardenne (FR), University of Lausanne (CH)
Openalex Percentile: Top 8%
Tendon Structure and Treatment
3.44
DOIOpen Access PDFOpenAlex
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