Achilles tendinopathy is a common issue for many people, especially those who are active or involved in sports. It causes pain and discomfort in the Achilles tendon, the large tendon that connects the calf muscle to the heel. A recent study explored the effectiveness of glyceryl trinitrate (GTN) ointment alongside eccentric exercises for treating chronic Achilles tendinopathy.
The study aimed to determine if daily treatment with GTN ointment, a topical medication commonly used for heart conditions, could improve outcomes when combined with a 12-week eccentric exercise program for Achilles tendinopathy. Eccentric exercises involve lengthening the muscle while it’s under tension, a technique known to help with tendon healing.
In this study, participants were randomly assigned to use either GTN ointment or a placebo ointment (a cream with no active ingredients) alongside following the same eccentric exercise program.
What Did They Do?
76 participants (a mix of men and women, mostly middle-aged) took part in the study. Half of them applied GTN ointment daily for 24 weeks, while the other half used a placebo ointment. Both groups followed the same eccentric exercise program for 12 weeks.
The study aimed to measure pain, function, and activity level over time, using a widely recognized questionnaire called the Victorian Institute of Sport Assessment–Achilles (VISA-A).
What Did The Study Show?
Both groups showed improvements in pain and function over the course of the study, as measured by the VISA-A questionnaire, which tracks pain levels, function, and physical activity. These improvements were seen at:
6 weeks
12 weeks
24 weeks
However, the results showed no significant difference between the group using GTN ointment and the group using the placebo. In other words, adding GTN ointment to the eccentric exercise program did not provide additional benefits for pain relief or improved function.
Key Takeaways
Both treatments (GTN and placebo) showed similar results: Using GTN ointment did not offer better outcomes than using a placebo cream alongside eccentric exercises.
Eccentric exercises are still effective: The exercise program itself helped reduce pain and improve function in both groups, meaning that these exercises remain one of the most effective treatments for Achilles tendinopathy.
GTN ointment didn’t provide added benefit: While GTN has shown effectiveness for other conditions, it didn’t provide extra help for Achilles tendinopathy in this study.
Eccentric Exercises for Achilles Tendinopathy
The Alfredson protocol includes two key eccentric calf exercises that target the Achilles tendon:
Eccentric Calf Raises with Straight Knee: Stand on a step with your knee straight, rise up onto both toes, and slowly lower your heel below the step level. Use your non-injured leg to return to the starting position. Perform 3 sets of 15 reps, twice a day.
Eccentric Calf Raises with Bent Knee: Stand on a step with your knees slightly bent, rise up on both toes, and slowly lower your heels below the step. Return to the starting position using your non-injured leg. Perform 3 sets of 15 reps, twice a day.
These exercises should be done consistently, with gradual load progression as pain allows. The goal is to strengthen the Achilles tendon and improve its function over time, supporting recovery from Achilles tendinopathy.
Reference:
Kirwan PD, Duffy T, French HP. Topical glyceryl trinitrate (GTN) and eccentric exercises in the treatment of mid-portion Achilles tendinopathy (the NEAT trial): a randomised double-blind placebo-controlled trial. British Journal of Sports Medicine. 2024;58:1035-1043.
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