***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIM Despite the lateral epicondylitis or tennis elbow is a common cause of pain in orthopaedic and sports medicine , the results of the different modalities of conservative treatment are still contradictory . The pourpose of this study was to evaluate the efficacy of radial shock wave therapy ( RSWT ) in the treatment of tennis elbow . METHODS In a prospect i ve r and omized controlled single-blind study , of 75 eligible patients , 62 with tennis elbow were r and omly assigned to study group and control group . There were 31 patients in the study group and 31 patients in the control group . Both groups had received a treatment a week for 4 weeks ; the study group had received 2000 impulses of RSWT and the control group 20 impulses of RSWT . All patients were evaluated 3 times : before treatment , at the end of treatment and to 6 months follow-up . The evaluation consisted of assessment s of pain , pain-free grip strength test , and functional impairment . RESULTS Statistical analysis of visual analogue scale ( VAS ) , disabilities of the arm , shoulder , and h and ( DASH ) question naire and pain-free grip strength test scores has shown , both after treatment and to the follow-up at 6 months , significant difference comparing study group versus control group ( P < 0.001 ) . Statistical analysis within the groups , showed always statistically significant values for the study group . Also the control group showed statistically significant differences for some analyzed parameters . Nevertheless such differences result ed to be more statistics that not clinics as it showed the percentage of satisfied patients in the study group ( 87 % post-treatment ; 84 % follow-up ) in comparison with that of the control group ( 10 % post-treatment ; 3 % follow-up ) , and the number needed to treat ( NNT ) that is of 1.15 at post-treatment and of 1.25 to the 6 months follow-up . CONCLUSION The use of RSWT allowed a decrease of pain , and functional impairment , and an increase of the pain-free grip strength test , in patients with tennis elbow . The RSWT is safe and effective and must be considered as possible therapy for the treatment of patients with tennis elbow AIM Prognosis and treatment of Achilles tendon pain ( achillodynia ) has been insufficiently studied . The purpose of the present study was to examine the long-term effect of eccentric exercises compared with stretching exercises on patients with achillodynia . METHODS Patients with achillodynia for at least 3 months were r and omly allocated to one of two exercise regimens  . Exercise was performed daily for a 3-month period . Symptom severity was evaluated by tendon tenderness , ultrasonography , a question naire on pain and other symptoms , and a global assessment of improvement . Follow-up was performed at time points 3 , 6 , 9 , 12 weeks and 1 year . RESULTS Of 53 patients with achillodynia 45 patients were r and omized to either eccentric exercises or stretching exercises . Symptoms gradually improved during the 1-year follow-up period and were significantly better assessed by pain and symptoms after 3 weeks and all later visits . However , no significant differences could be observed between the two groups . Women and patients with symptoms from the distal part of the tendon had significantly less improvement . CONCLUSIONS Marked improvement in symptoms and findings could be gradually observed in both groups during the 1-year follow-up period . To that extent this is due to effect of both regimens or the spontaneous improvement is unsettled Injuries involving the Achilles tendon and manifested as chronic tendon pain are common , especially among recreational athletes . In a pilot study on a small group of patients with chronic painful mid-portion Achilles tendinosis , eccentric calf-muscle training was shown to give good clinical results . The aim of this prospect i ve study was to investigate if the previously achieved good clinical results could be reproduced in a larger group of patients , and also to investigate the effects of eccentric calf-muscle training in patients with chronic insertional Achilles tendon pain . Seventy-eight consecutive patients , having chronic painful Achilles tendinosis at the mid-portion ( 2–6 cm level ) in a total of 101 tendons ( 55 unilateral and 23 bilateral ) , and thirty consecutive patients with chronic insertional Achilles tendon pain in 31 tendons ( 29 unilateral and one bilateral ) were treated with eccentric calf-muscle training for 12 weeks . Most patients were recreational athletes . Evaluation of the amount of tendon pain during activity was recorded on a visual analogue scale ( VAS ) , before and after treatment . In 90 of the 101 Achilles tendons ( 89 % ) with chronic painful mid-portion Achilles tendinosis , treatment was satisfactory and the patients were back on their pre-injury activity level after the 12-week training regimen . In these patients , the amount of pain during activity , registered on the VAS-scale ( mean±SD ) , decreased significantly from 66.8±19.4 to 10.2±13.7 . On the contrary , in only ten of the tendons ( 32 % ) with chronic insertional Achilles tendon pain was treatment satisfactory , with a significant decrease on the VAS-scale ( mean±SD ) , from 68.3±7.0 to 13.3±13.2 . Our conclusion is that treatment with eccentric calf-muscle training produced good clinical results in patients with chronic painful mid-portion Achilles tendinosis , but not in patients with chronic insertional Achilles tendon pain 70 consecutive adult , nonrheumatic patients with a painful achilles tendinopathy were r and omized to treatment with either a nonsteroid antiinflammatory drug ( piroxicam ) or placebo . Both groups received adjunct treatment with a period of rest combined with stretching and strengthening exercises .  52/70 cases were engaged in various sports , notably running . All subjects were evaluated on days 3 , 7 , 14 , and 28 with respect to pain , tenderness , swelling , ankle joint movement and muscle strength . Results were judged from residual symptoms and an overall assessment of the efficacy . No differences were seen between the groups at any time during the study . The overall result was identical with a rate of success slightly better than 50 percent which corresponds to the placebo response reported in other studies Achilles tendinopathy is common and treatment with eccentric exercises seems promising . We design ed a prospect i ve r and omized clinical trial to test the hypothesis that eccentric calf muscle exercises reduce pain and improve function in patients with Achilles tendinopathy . Forty-four patients were recruited from primary care ( mean age : 45 years ; 23 women ; 65 % active in sports ) and r and omized to three treatment groups for 12 weeks :  eccentric exercises , a night splint or a combination of both treatments . Pain and function were evaluated at 6 , 12 , 26 and 52 weeks by the Foot and Ankle Outcome Score . At 6 weeks , the eccentric group reported a significant pain reduction ( 27 % compared with baseline , P = 0.007 ) which lasted for 1 year ( 42 % , P = 0.001 ) . The two groups treated with a night splint also reported significant but less pain reduction than the eccentric group . Differences between all the three groups were not significant . At 12 weeks , the eccentric group reported significantly less pain than the splint-only group ( P = 0.04 ) . More patients in the eccentric group than in the splint group returned to sport after 12 weeks . We conclude that eccentric exercises seem to reduce pain and improve function in patients with Achilles tendinopathy . Our results are in line with previous studies and strengthen the recommendation that patients should undergo an eccentric exercise program prior to considering other treatments such as surgery A double-blind , controlled study is presented on the effect of low-dosage heparin on acute calcaneal peritendinitis crepitans in young men . Treatment consisted in exemption from physical work and subcutaneous injection of heparin . 5000 I.U. , or placebo , once a day for 5 consecutive weekdays . During the first week the mean total symptom score showed a gradual fall to 32 and 34 % of the baseline values in the heparin ( n = 10 ) and the placebo group ( n = 10 ) , respectively . On day 15 the value was unchanged in the heparin group , whereas it had increased again to 45 % in the placebo group . However , the symptoms and signs recorded never differed significantly between the two groups . No adverse reactions were observed . Consequently , further studies are needed to show whether a treatment of acute peritendinitis can be obtained with heparin in a dosage with less risk of bleeding than that involved in the previously reported regimen A retrospective study is presented of 83 athletes with tendo Achillis pain ( TAP ) treated conservatively over a 12-year period from 1976 to 1988 .  Local steroid injections did not contribute to an earlier return to sport , though many individuals were improved symptomatically . Local steroids were not found to have a deleterious effect on outcome .  Steroids were used most frequently in the chronic cases that presented late and had been treated previously : this group had most recurrences and surgical intervention . One case of Achilles rupture ( 3 % ) occurred in the group treated with steroids . Early presentation for treatment led to an earlier return to sport and avoidance of recurrences . Recurrences were most frequent in athletes with bilateral Achilles tendinopathy . The tendo Achillis lesion may range from peritendinitis through a mixed lesion of the tendon and paratenon , to complete rupture . The management depends upon accurate diagnosis , its chronicity and the age and aspirations of the patient . Steroids are safe to use and further prospect i ve trials should note presentation time and disease staging accurately BACKGROUND Extracorporeal shock wave therapy ( ESWT ) is an increasingly popular therapeutic approach in the management of a number of tendinopathies . Benefit has been shown in calcific tendinitis of the rotator cuff , but evidence for its use in non-calcific disorders is limited . AIMS To perform a double blind r and omised controlled trial of moderate dose shock wave therapy in plantar fasciitis . METHODS Adults with plantar fasciitis for at least 3 months were r and omised to receive either active treatment ( 0.12 mJ/mm(2 ) ) or sham therapy , monthly for 3 months . Pain in the day , nocturnal pain and morning start-up pain were assessed at baseline , before each treatment and 1 and 3 months after completion of therapy . RESULTS Eighty-eight subjects participated and no differences existed between the groups at baseline . At 3 months , 37 % of the subjects in the ESWT group and 24 % in the sham group showed a positive response ( 50 % improvement from baseline ) with respect to pain . Positive responses in night pain occurred in 41 % and 31 % in the ESWT and sham groups , respectively . Positive responses in start-up pain occurred in 37 % and 36 % in the ESWT and sham groups , respectively . Both groups showed significant improvement over the course of the study , but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period . CONCLUSIONS There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis . Efficacy may be highly dependent upon machine types and treatment protocol s. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints Background : Low level laser therapy ( LLLT ) has gained increasing popularity in the management of tendinopathy and arthritis . Results from in vitro and in vivo studies have suggested that inflammatory modulation is one of several possible biological mechanisms of LLLT action . Objective : To investigate in situ if LLLT has an anti-inflammatory effect on activated tendinitis of the human Achilles tendon . Subjects : Seven patients with bilateral Achilles tendinitis ( 14 tendons ) who had aggravated symptoms produced by pain inducing activity immediately before the study . Method : Infrared ( 904 nm wavelength ) LLLT ( 5.4 J per point , power density 20 mW/cm2 ) and placebo LLLT ( 0 J ) were administered to both Achilles tendons in r and om blinded order . Results : Ultrasonography Doppler measurements at baseline showed minor inflammation through increased intratendinous blood flow in all 14 tendons and measurable resistive index in eight tendons of 0.91 ( 95 % confidence interval 0.87 to 0.95 ) . Prostagl and in E2 concentrations were significantly reduced 75 , 90 , and 105 minutes after active LLLT compared with concentrations before treatment ( p = 0.026 ) and after placebo LLLT ( p = 0.009 ) . Pressure pain threshold had increased significantly ( p = 0.012 ) after active LLLT compared with placebo LLLT : the mean difference in the change between the groups was 0.40 kg/cm2 ( 95 % confidence interval 0.10 to 0.70 ) . Conclusion : LLLT at a dose of 5.4 J per point can reduce inflammation and pain in activated Achilles tendinitis . LLLT may therefore have potential in the management of diseases with an inflammatory component In a previous uncontrolled pilot study we demonstrated very good clinical results with eccentric calf muscle training on patients with painful chronic Achilles tendinosis located at the 2–6 cm level in the tendon . In the present prospect i ve multicenter study ( Sundsvall and Umeå ) patients with painful chronic Achilles tendinosis at the 2–6 cm level in the tendon were r and omized to treatment with either an eccentric or a concentric training regimen for the calf muscles . The study 
    Output:
    
Eccentric exercises have the most evidence of effectiveness in treatment of midportion Achilles tendinopathy .