High Volume Injection in Mid Portion AChilles Tendinopathy

Dynamic stiffness measured using the MyotonPRO at the middle part of the free tendon and over the soleus tendinous junction as identified by ultrasonography in both short and long axis.

The questionnaire encompasses three key domains: pain, functional capacity, and activity level, thereby providing a comprehensive assessment of the patient's condition from their perspective. The Victorian Institute of Sport Assessment - Achilles score ranges from 0 to 100, with 0 indicating no activity and maximum pain, while a score of 100 represents the highest level of activity with no pain experienced. A minimal detectable change of 12 points was considered for the change to be clinically significant (McCormack et al., 2015).

The single-leg heel raise test was utilised to assess the strength and endurance of the plantar flexor muscles. Participants were instructed to lift their heel to the maximum possible height for up to 25 repetitions or until the onset of discomfort or pain, whichever occurred first. A metronome was used to provide auditory feedback to help maintain a consistent pace throughout the test. A successful trial of the single-leg heel raise (SLHR) was recorded if the patient was able to maintain the set pace with the metronome (60 bpm/30 repetitions per minute) and demonstrated proper plantarflexion height and alignment. The trial was considered invalid if the patient compensated by:

• flexing the knee,
• using a hip propulsive strategy,
• or losing vertical displacement due to trunk flexion (Hébert-Losier et al., 2022; Hebert-Losier et al., 2017).

Ultrasonography was employed to assess secondary outcome measures, including cross-sectional area, tendon length, tendon thickness, and neovascularisation.

Tampa Scale of Kinesiophobia will be used to assess patients' perspectives on their condition and the avoidance and fear of movement.

The global rating of change consists of a single question addressing the overall change in Achilles tendon symptoms from the start of treatment to the follow-up appointment, focusing on the patient's self-perceived change in health status.

Patients were asked to report any co-interventions undertaken during the 3-month period

Participants self-reported their adherence using a 4-point Likert scale, which categorised adherence into four distinct levels: very good adherence, indicating consistent engagement with the prescribed exercise regimen; good adherence, reflecting regular participation but not on a daily basis; poor adherence, suggesting infrequent engagement; and very poor adherence, denoting minimal or no participation in the prescribed exercises. Participants were informed about the option to maintain a logbook of exercises performed; however, this was not mandatory.

An exiting satisfactory semi structured interview was conducted with willing participants to explore patients perspective on the effectiveness of their treatment and elaborate on their results.