EFFECTS OF TENDON NEUROPLASTIC TRAINING VERSUS SLOW REVERSAL HOLD ON PAIN, FUNCTION, AND REARFOOT EVERSION DURING GAIT IN INDIVIDUALS WITH ACHILLES TENDINOPATHY

Abstract

Background: Achilles tendinopathy is a prevalent overuse disorder characterized by persistent tendon pain, impaired functional capacity, and biomechanical alterations that may affect lower-limb movement during gait. Although several rehabilitation approaches have demonstrated clinical benefits, comparative evidence regarding Tendon Neuroplastic Training and Slow Reversal Hold remains limited.

Objective: This study aimed to compare the effectiveness of Tendon Neuroplastic Training and Slow Reversal Hold in reducing pain, improving functional capacity, and correcting rearfoot eversion during gait in individuals with Achilles tendinopathy.

Methods: A randomized clinical trial was conducted over a period of 6 months among 42 individuals aged 30–60 years with clinically diagnosed Achilles tendinopathy. Participants were randomly allocated to either a Tendon Neuroplastic Training group or a Slow Reversal Hold group. Both groups received their respective interventions three times weekly for 12 weeks, with each session lasting 30–45 minutes. Tendon Neuroplastic Training focused on enhancing tendon load tolerance, neuromuscular control, and motor coordination, whereas Slow Reversal Hold was based on proprioceptive neuromuscular facilitation principles. Pain intensity, functional status, and rearfoot eversion during gait were assessed using the Numeric Pain Rating Scale, Victorian Institute of Sport Assessment–Achilles questionnaire, and video-based motion analysis, respectively. Data normality was examined using the Shapiro–Wilk test. Within-group differences were assessed using paired-samples t-tests or Wilcoxon signed-rank tests, while between-group differences were evaluated using independent-samples t-tests or Mann–Whitney U tests. Statistical significance was established at p < 0.05.

Results: Both interventions produced statistically significant improvements across the assessed outcomes (p < 0.001). Pain intensity decreased from 6.67 ± 1.39 to 2.62 ± 1.32 in the Tendon Neuroplastic Training group and from 7.52 ± 1.29 to 4.52 ± 1.40 in the Slow Reversal Hold group. Improvements in functional capacity and rearfoot eversion were also observed in both groups, with greater biomechanical correction demonstrated following Tendon Neuroplastic Training.

Conclusion: Both Tendon Neuroplastic Training and Slow Reversal Hold were effective rehabilitation approaches for Achilles tendinopathy. However, Tendon Neuroplastic Training demonstrated superior overall clinical effectiveness, particularly in pain reduction, functional improvement, and restoration of gait-related biomechanics