The Pilates Method in the Rehabilitation of Achilles Tendinopathy - A Randomized Controlled Trial

This study was designed as a pragmatic, parallel-group randomized controlled trial in individuals with Achilles tendinopathy. Participants were randomly allocated to either a Pilates-based rehabilitation group (intervention group) or an Alfredson eccentric loading group (control group) using a computer-generated random allocation sequence and sealed, opaque, sequentially numbered envelopes prepared by an independent researcher. Due to the nature of the interventions, participant and therapist blinding was not feasible. However, outcome assessment was performed by an assessor blinded to group allocation.

Different members of the research team were responsible for participant recruitment, randomization, intervention delivery, and outcome assessment in order to minimize potential bias and ensure allocation concealment. Participants were instructed not to disclose details of their intervention during outcome assessments. Adherence monitoring differed between groups according to the nature of the interventions. In the control group, participants received weekly follow-up communication and were encouraged to maintain adherence logs. In the Pilates group, adherence was monitored through supervised session attendance and rescheduling procedures when necessary.

Participants were recruited through referrals from healthcare professionals and public invitations for voluntary participation. Eligible participants were adults over 18 years of age with clinically diagnosed Achilles tendinopathy. Written informed consent was obtained prior to participation, and all participant data were pseudonymized using unique identification codes.

The intervention group followed an 8-week supervised Pilates-based rehabilitation program using Reformer equipment, with two 60-minute sessions per week and a 12-week follow-up assessment. The intervention incorporated progressive and individualized loading principles, motor control training, core stabilization, controlled movement execution, and functional progression according to symptom tolerance and participant performance.

The control group followed a 12-week modified Alfredson eccentric loading protocol. Participants performed a progressive home-based eccentric loading program involving exercises with the knee extended and flexed, adapted according to pain tolerance and symptom behavior. Weekly communication and monitoring were performed to support adherence and progression.