Biomechanical alterations in individuals with Achilles tendinopathy during running and hopping: A systematic review with meta-analysis

Introduction: Biomechanical alterations during running and hopping in people with Achilles tendinopathy (AT) may provide treatment and prevention targets. This review identifies and synthesises research evaluating biomechanical alterations among people with AT during running, jumping and hopping. Method: MEDLINE, EMBASE, CiNAHL and SPORTDiscus were searched in July 2018 for case control, cross-sectional and prospective studies investigating kinematics, kinetics, plantar pressures and neuromuscular activity in AT participants during running or hopping. Study quality was assessed with a modified version of the Downs and Black quality checklist, and evidence grading applied. Results: 16 studies reported 249 outcomes, of which 17% differed between groups. Reduced peroneus longus (standardized mean difference [95%CI]; −0.53 [−0.98, −0.09]) and medial gastrocnemius (−0.60 [−1.05, −0.15]) amplitude in AT runners versus control was found (limited evidence). Increased hip adduction impulse 1.62 [0.69, 2.54], hip peak external rotation moment (1.55 [0.63, 2.46] and hip external rotation impulse (1.45 [0.55, 2.35]) was found in AT runners versus control (limited evidence). Reduced anterior (−0.94 [−1.64, −0.24] and greater lateral (−0.92 [−1.61, −0.22]) displacement of plantar pressure preceded AT in runners (limited evidence). Delayed onsets of gluteus medius (1.95 [1.07, 2.83] and gluteus maximus (1.26 [0.48, 2.05] and shorter duration of gluteus maximus activation (−1.41 [−2.22, −0.61] was found during shod running in the AT group versus control (limited evidence). Earlier offset time of gluteus maximus (−1.03 [−1.79, −0.27] and shorter duration of activation of gluteus medius (−0.18 [−0.24, −0.12] during running in AT runners versus control was found (limited evidence). Reduced leg stiffness was found in the affected side during submaximal hopping (−0.39 [−0.79, −0.00]) (limited evidence). Conclusion: This review identified potential biomechanical treatment targets in people with AT. The efficacy of treatments targeting these biomechanics should be assessed. Systematic review registry: PROSPERO registration number: CRD42016048636.