Achilles Tendinopathy

Question 1

Hx of mid portion achilles Tendinopathy

Answer 1

• gradual onset of pain around mid portion of achilles
• Assoc w inc load. volume. or intensity
• pain at start of activity and stiffness in morning

Question 2

obj ax

Answer 2

ask pt to point to area of pain
palpate around tendon for areas of tenderness
if rupture- swelling?
assess muscle wastage
loading- single leg raise, hopping, jumping etc
assess strength and endurance: PF
1st MPJ DF PF rule out FHL Tendinopathy
- unilateral calf tightness, reduced DF etc
-gait analysis

Question 3

+ signs

Answer 3

pain in worse in morning

morning stiffness

Question 4

predisposing factors

Answer 4

relative tendon overload- inc in distance, speed or frequency of training
sudden inc in activity involving high energy storage
new exercise regime
high bmi
T2DM

Question 5

Rx

Answer 5

manage tendon load- activity modification (control symptoms)
and then inc tendon load (improve tendon capacity)
address biomech abnormalities- restricted AJ DF or hallux rigidus
eccentric and concentric strength loading program 12 weeks
progressively loading the muscle tendon to promote effective stimulus

Question 6

exercise program

Answer 6

• isometric calf raise 15 x 3 daily

stage 2- when pain resolved
hold single calf raise 45s progress to weight

stage 3 - energy storage exercises
tendon to act as spring
fast stair climbing, slow skipping 3x a week

stage 4
running drills to prepare athlete to return sport

over 12 week period