Achilles Tendonitis and the Impact of an Integrated Rehabilitation Program (Eccentric Exercises + Ultrasound) on Pain, Physical Capabilities, and Biomechanics in Futsal Players

Abstract

Abstract

Objective: To evaluate the effectiveness of a combined rehabilitation program integrating eccentric exercises (Alfredson protocol) with therapeutic ultrasound and cryotherapy in treating Achilles Tendinopathy in futsal players, and to assess its impact on pain, explosive strength, and ankle kinematic variables.

Methods: A pilot randomized controlled trial (Pilot RCT) was conducted on 12 futsal players (aged 20–24 years) from Dhi Qar governorate clubs, randomly assigned into two equal groups (n=6 each): an experimental group receiving a 6-week combined program (Alfredson eccentric exercises – two phases: knee straight and knee bent – 3 sessions/week, plus 3 MHz ultrasound once weekly in weeks 1, 3, and 5, and daily ice packs), and a control group receiving conventional treatment (rest, analgesics, basic stretching). Pre- and post-intervention measurements included the Visual Analog Scale (VAS) for pain, the Sargent Jump test for explosive strength, and ankle dorsiflexion range of motion using a goniometer. Data were analyzed using non-parametric statistical tests (Wilcoxon and Mann-Whitney U tests) due to the small sample size.

Results: The experimental group showed statistically significant improvements (p < 0.05) with a very large clinical effect size (r > 0.60) compared to the control group across all variables. Pain decreased by 61.8% in the experimental group (from 7.9 ± 0.8 to 3.0 ± 0.6) versus 11.5% in the control group (from 7.8 ± 0.9 to 6.9 ± 0.8). Explosive strength (vertical jump) improved by 23.5% in the experimental group (from 42.3 ± 4.1 cm to 52.2 ± 3.8 cm) versus 2.1% in the control group. Ankle dorsiflexion range increased by 27.8% in the experimental group (from 8.5° ± 1.2 to 10.9° ± 1.1), while no significant change was observed in the control group.

Conclusion: The combined rehabilitation program based on the Alfredson eccentric protocol and ultrasound provides promising pilot evidence as a highly effective intervention compared to conventional treatment for reducing pain, improving explosive strength, and restoring ankle range of motion in futsal players with Achilles Tendinopathy. This protocol is recommended for initial adoption in sports rehabilitation centers, encouraging future large-scale investigations.