Effect of Symptom Duration on Injury Severity and Recovery in Patients With Achilles Tendinopathy

BACKGROUND: Achilles tendinopathy is a common overuse condition. Distinguishing between early- and late-stage tendinopathy may have implications on treatment decisions and recovery expectations. PURPOSE: To compare the effects of time and baseline measures of tendon health on outcomes among patients with varying symptom durations after 16 weeks of comprehensive exercise treatment. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Participants (N = 127) were categorized into 4 groups based on the number of months since symptom onset: ≤3 months (n = 24); between >3 and ≤6 months (n = 25); between >6 and ≤12 months (n = 18); or >12 months (n = 60). All participants received 16 weeks of standardized exercise therapy and pain-guided activity modification. Outcomes representing symptoms, lower extremity function, tendon structure, mechanical properties, psychological factors, and patient-related factors were assessed at baseline and at 8 and 16 weeks after the initiation of exercise therapy. Chi-square tests and 1-way analysis of variance were used to compare baseline measures between groups.Time, group, and interaction effects were evaluated using linear mixed models. RESULTS: The mean age of the participants was 47.8 ± 12.6 years, 62 participants were women, and symptoms ranged from 2 weeks to 274 months. No significant differences were found among symptom duration groups at baseline for any measure of tendon health. At 16 weeks, all groups demonstrated improvements in symptoms, psychological factors, lower extremity function, and tendon structure, with no significant differences among the groups (P > .05) CONCLUSION: Symptom duration did not influence baseline measures of tendon health. Additionally, no differences were observed among the different symptom duration groups in response to 16 weeks of exercise therapy and pain-guided activity modification.