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The use of eccentric exercises and topical glyceryl trinitrate (GTN) in the treatment of midportion Achilles tendinopathy: a randomised placebo controlled trial

Tendinopathy is a challenging condition to treat and requires a multi-modal approach involving sports medicine doctors, physiotherapists, rheumatologists or general practitioners. One of the most common tendons affected is the Achilles tendon. Current treatment aims to restore the affected tendon to normal activity and ability to tolerate load without pain. Eccentric exercises have strong evidence of effectiveness in the treatment of this condition. Preliminary research has explored the use of topical glyceryl trinitrate (GTN) as an adjunct to exercise to enhance healing, but to date, the sample sizes have been small, the GTN dose may have been inadequate and results have been conflicting. The purpose of this placebo controlled double-blind randomized controlled trial is to investigate whether topical GTN when used in conjunction with an eccentric exercise program can improve clinical outcomes for individuals with Achilles Tendinopathy. Patients will be randomly allocated to one of two intervention groups. Group 1 will receive GTN for 6 months in combination with a supervised eccentric exercise programme delivered over 3 months. Group 2 will receive placebo GTN in addition to the same exercise programme. The target sample size is 76 patients, based on the primary outcome which is the VISA-A scale for Achilles tendinopathy. Other outcomes include pain severity using a visual analogue scale and pressure algometry, ultrasound examination of the tendon, the lower extremity functional scale and tests of proprioception. This study will follow the CONSORT guidelines to ensure scientific rigour and will aim to address the methodological limitations of previous studies in the field.