EFFECTIVENESS OF ULTRASOUND GUIDED DEXTROSE PROLOTHERAPY INJECTION IN COMPARISON WITH EXTRACORPOREAL SHOCK WAVE THERAPY ON IMPROVING PAIN AND FUNCTION AMONG ATHLETES WITH ACHILLES TENDINOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Achilles tendinosis is a chronic, degenerative condition affecting both sedentary individuals and athletes of all abilities, with prevalence in running-based sports particularly high. Pain is considered to be the primary symptom of Achilles tendinosis, to the extent that it is suggested that a patients symptoms can reflect the severity of the condition. Several treatment modalities such as activity modification, heel lifts, arch supports, stretching exercises, nonsteroidal anti-inflammatories, and eccentric loading are known as standard treatment mostly without proven evidence. Objectives: To determine the effectiveness of ultrasound guided Dextrose prolotherapy injection in comparison with extracorporeal wave therapy on improving pain and function among athletes with Achilles tendinopathy Study Design: A Randomized controlled trial Methods: Fifty eight athletes with achilles tendinopathy meeting the inclusion and exclusion criteria were selected for this study and randomized into 2 treatment groups: dextrose prolotherapy injection under ultrasound guidance (prolotherapy group n = 29), and 3 sessions of focused extracorporeal shock wave therapy (ESWT group n = 29). The outcome measures were Victorian Institute of Sports Assessment–Achilles (VISA-A) questionnaire and pain visual analog scale (VAS). Both the groups underwent rehabilitation programs. For descriptive statistics mean, standard deviation and frequency were used. Continuous variables were analysed by students t-test. Categorical variables were analysed using Chi-square test. Within the group comparison (baseline and follow-up data of each group) was done by Repeated measures ANOVA. Between the groups comparison was analysed using students t-test. A p-value < 0.05 was taken as significant. Results: The 2 groups were homogeneous in terms of their baseline characteristics like age, gender, duration of symptoms and side of affection (p > 0.05). Within the group comparison showed significant improvement in outcome measures in both the groups at all follow ups (p = 0.00). Between the groups analysis found improvement in the VAS and VISA-A scores at all follow ups but the improvement was significantly more in the Prolotherapy group in comparison with the ESWT group (p = 0.00). Conclusion: Ultrasound guided injection of dextrose prolotherapy in combination with eccentric strengthening exercises lead to significant improvement in pain and function over the long term in comparison with focused ESWT among athletes with Achilles tendinosis and thereby enabling faster return to sports.