Achilies tendinopathy

Question 1

Which muscle makes up 2/3 of achillies tendon

Answer 1

soleus

Question 2

what is REACTIVE tendinopathy?

Answer 2

-temporary localised thickening of tendon in response to acute over load

Question 3

What is tendon dysrepair?

Answer 3

• tendon matrix breakdown?
• greater collagen production and separation
• matrix becomes disorganised
• disruption of matrix
• ingrowth of nervs and vessels

Question 4

What is degenerative tendinopathy?

Answer 4

• large areas of disordered matrix
• largely irreversible matrix breakdown
• absence of tenocytes and collagen
• neovascular infiltration ++

Question 5

Name the 8 symptoms

Answer 5

• onset of pain
• severity
• duration
• disability
• morning pain+ stiffness after increase in activity levels
• pain decrease with applying heat
• pain decrease during activity, returns hours later
• pain during activity

Question 6

Name 3 signs

Answer 6

• AT tenderness, thickening and crepitus
• assess any predisposing factors
• if tendon is in tact, tendon loading to provoke pain

Question 7

Wha predisposing factors would you assess

Answer 7

• ankle/subtalar joint stiffness
• calf stiffness
• Abnormal lower limb biomechanics

Question 8

how would you load the tendon to provoke pain

Answer 8

• heel raises
• hopping on spot or forward
• jumping

Question 9

What factors need to be considered

Answer 9

• years of running
• increase in activity, distance, speed, gradient
• decrease recovery time between training sessions
• change of surface
• change of footwear
• calf weakness
• restricted dorsiflexion
• poor muscle flexibility
• excessive pronation

Question 10

what investigation takes place?

Answer 10

• ultrasound
• MRI

imaging results should not dominate clinical decision making

Question 11

what treatment would you give?

Answer 11

• exercise therapy
• address and predisposing factors
• GTN patches - nitric oxide
• Sclerosing injections
• shock wave therapy

Question 12

what does shock wave therapy provide

Answer 12

shock waves have bioogical activating effect which regenerates hard + soft muscoskeletal tissue, such as tendon, bone and ligament

Question 13

what are the aims of shock wave therapy

Answer 13

convert chronic injury to acute

Question 14

What surgery procedures would take place

Answer 14

tenotmy - division of tendons

Arthroscopic shaving of neo vessels deep to ther surface of painful tendon

Question 15

What does research suggest in terms of exercise therapy

Answer 15

-muscle action type, eccentric v concentric

• load
• volume- high volumes of ecercise occludes the vessels

-pain provocation - exercise must be painful

ROM