Pulsed Electro-Magnetic Field Therapy for Treatment of Midportion Achilles Tendinopathy

The PEMF will be delivered using a BIXEPS device (Quantum Tx, Singapore) ; It is utilised by the patient placing the leg into the machine. This device is operated by participant individualized NFC cards, which will be centrally programmed to deliver either active PEMF (uniform 1mT, 50Hz) or sham PEMF (0mT, 0Hz) for 30 minutes. Because this biophysical intervention is non-invasive, and the electromagnetic fields emitted into the legs do not generate any sensation (e.g. heat, sound), participants will be blinded to the treatment. The protocol will be 180 minutes of PEMF therapy, performed in six 30-minute sessions 3 times a week and completed in 2 weeks.

All participants will be subject to a standardised rehabilitation exercise region consisting of stretching and eccentric exercises following the Alfredson protocol. The 12-week program will be taught by a physiotherapist or athletic trainer and supplemented by video tutorials. The regime begins with three 30-second static stretches for the gastrocnemius (knee extension) and soleus (knee flexion) muscles with 1-minute rest between each stretch. The 2nd part is eccentric exercises to the calves following the Alfredson protocol. This will be three sets of eccentric exercises lasting 12 weeks, with 15 sets twice a day. If participants are unable to complete three sets of 15 repetitions, they can start with fewer repetitions and sets (at least 2 sets of 10 repetitions each) and gradually increase to the total number of sets. Participants will perform the static stretching exercises from Step 1 at the end of each session