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Treatment of Achilles Tendinopathy

9/9/2012

3 Comments

 
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A stubborn injury that plagues many athletes, especially runners, is achilles tendinopathy. While rest may alleviate the pain in some individuals, as soon as activity is resumed, the symptoms often return.

As with many tendinopathy pathologies, achilles tendinopathy is often diagnosed as tendinitis and treated improperly. It has been shown that neovascularization is abundant in these structures and is not necessarily an inflammation issue (a topic we will examine more closely in the near future!). As with any other injured individual, they will present with many impairments that should be treated regularly (stretching, strengthening, etc.), but there are certain interventions that have been shown to have higher evidence.

Low-Level Laser Therapy (LLLT) is an intervention that is becoming more prominent today in treating many different pathologies, one of which is achilles tendinopathy. In the study we looked at, there was no difference between eccentric exercises + placebo and eccentric exercises + LLLT (actually the placebo group performed better in one of the outcomes!). Consider this evidence when choosing your interventions.

As you might have expected, eccentric exercises have been shown to be the best treatment method for patients with achilles tendinopathy. Even after 5 years of treatment, improvements were shown; although, some pain was still present in some individuals. One of the issues with using eccentric exercises for individuals with achilles tendinopathy that has become prevalent is the effectiveness for those with insertional vs. mid-portion achilles tendinopathy. Insertional achilles tendinopathy results in the tendon being most painful where it attaches to the calcaneus; mid-portion achilles tendinopathy is proximal to that. The studies have shown high evidence in regular eccentric exercises (loading into dorsiflexion) for mid-portion pain, but not insertional pain. However, there has been recent research that shows a modification of the exercise can improve the results of insertional pain. Perform the eccentric exercise the normal way, except do not load into dorsiflexion. Approximately 2/3 of the sample showed improvements!

Another alternative treatment method that is becoming more well-known involves using autologous-combined plasma injections combined with standard treatments-wearing a pneumatic boot, receiving ultrasound, and eccentric exercises. Occasionally, you hear about professional athletes receiving this type of treatment for other joints in Europe, since it is not usually performed in the U.S. While the study is still preliminary, it's still something to keep your eye on in the future!

References:
Deans VM, Miller A, Ramos J. "A Prospective Series of Patients with Chronic Achilles Tendinopathy Treated with Autologous-conditioned Plasma Injections Combined with Exercise and Therapeutic Ultrasonography." J Foot Ankle Surg. 2012 Jul 21. Web. 09/09/2012.

Fahlström M, Jonsson P, Lorentzon R, Alfredson H. "Chronic Achilles tendon pain treated with eccentric calf-muscle training." Knee Surg Sports Traumatol Arthrosc. 2003 Sep;11(5):327-33. Epub 2003 Aug 26. Web. 09/09/2012.

Jonsson P, Alfredson H, Sunding K, Fahlström M, Cook J. "New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study." Br J Sports Med. 2008 Sep;42(9):746-9. Epub 2008 Jan 9. Web. 09/09/2012.

Mafi N, Lorentzon R, Alfredson H. "Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis." Knee Surg Sports Traumatol Arthrosc. 2001;9(1):42-7. Web. 09/09/2012.

Tumilty S, McDonough S, Hurley DA, Baxter GD. "Clinical effectiveness of low-level laser therapy as an adjunct to eccentric exercise for the treatment of Achilles' tendinopathy: a randomized controlled trial." Arch Phys Med Rehabil. 2012 May;93(5):733-9. Web. 09/09/2012.

van der Plas A, de Jonge S, de Vos RJ, van der Heide HJ, Verhaar JA, Weir A, Tol JL. "A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy." Br J Sports Med. 2012 Mar;46(3):214-8. Epub 2011 Nov 10. Web. 09/09/2012.

Verrall G, Schofield S, Brustad T. "Chronic Achilles tendinopathy treated with eccentric stretching program." Foot Ankle Int. 2011 Sep;32(9):843-9. Web. 09/09/2012.

A more developed review of the research behind these and many more interventions is located in the practice guidelines below for achilles tendinopathy!

Carcia CR, Martin RL, Houck J, Wukich DK. "Achilles pain, stiffness, and muscle power deficits: achilles tendinitis." J Orthop Sports Phys Ther. 2010 Sep;40(9):A1-26. Web. 09/09/2012.

3 Comments
Download Software link
10/20/2013 08:31:59 am

Great info, thank you.

Reply
Spine & Sports Physiotherapy link
3/18/2019 01:49:05 am

Best of luck with the following!

Reply
Spine & Sports Physiotherapy link
3/18/2019 02:04:33 am

It is such a wonderful post to read.

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test