Achilles Tendinopathy Flashcards
Prevalence
Most frequently with ______/______
overuse/injury
Most common in…
- _______/_______ activities
- _________ > competition
- ___-____ year olds
10-20% of _______
recreational/competitive
training
30; 50
runners
Risk Factors and Etiology
- Limited calf ________
- Calf ________ could lead to under supply/overuse
- Biological _____ and family _____
- Excessive ________
flexibility
weakness
males; hx
pronation
Overuse may occcur with _____ ______ control, which includes ______ _______ deficits and ______ deficits
impaired LQ
hip neuromuscular
balance
Excessive Pronation is a earlier extended and or excessive combination of ____/_____/_____
DF; ABD; EV
Excessive pronation can become excessive if there is ______/_______ present
More commonly:
_______ or _________
Impaired ______ _____- top down influence
Less commonly: ______ or medial ______ hypermobility
hypermobility; instability
tibfib; talocrural
LQ control
subtalar; knee
Excessive pronation may become excessive if ______ ________ hypombility is present
Ex:
Limited ______ _______ may lead to midfoot and forefoot excessively EV and ABD
Limited _____ ______ may lead to excessive ankle DF
adjacent joint
talocrural DF
knee EXT
Risk Factors and Etilology
Abnormal _______ structure and prior _______
______ age (more plastic)
Also consider… _____ errors, _______ factors, and improper _________
________- overuse
Systemic dz with persistent _______ and poor _______ _______
tendon; injury
older
training; environmental; shoes
obesity
inflammation; blood supply
Pathomechanics
Repetitive ______ with _______ from limited ____ and or excessive _______
Collagen fibril ________/_________ and fibroblast death from altered fluid movement leads to _______, ________ nitric acid with persistent ___________
lengthening; compression
DF; EV
thinning; disorganization
overheating; increased; inflammation
Pathomechanics
Thickened but _______ tendon from:
increase of ____-______ matrix
fat _________
________ force transfer
Impaired _______ _________
weaker
non-collagen
deposition
ineffective
motor control
Symptoms
_______ onset that limits ______ activity
Localized _____ and _______
Particurarly after __________
Lessens with _____ bout of activity and increases with _____ to ______ activity
gradual; WB
pain; stiffness
inactivity
mild; moderate; severe
Signs
Observation- Achilles _______
Possibly impaired ____ _____ and or excessive _______
ROM- possible P! and limitation with ______
Resisted/MMT: Possible pain with _____, may be _____
possibly ____/______ weakness
Accessory Motion- possible _______ hypomobility for _______
Palpation- TTP 2-6 cm proximal to ______ (higher seas) area of less _____ ______
More _____ achilles P! indicates plantaris involved
Achilles _______ (high spec)
thickening
LQ control
pronation
DF
PF; weak
hip; knee
talar; DF
insertion; blood supply
medial
crepitus
Special Tests
- _____ ____ (high spec)
- _____ _____ Test (high spec)
- ________ Tests
- _______ _______ _______
- M. length- shortened ______
Arc Sign
Royal London
Stability
Single Heel Raise
Gastrocs
PT Rx
_______ NOT indicated
_______ stress is BEST within appropiate P! levels
______ management
______ wear
Timeline: ____-_____ wks
Prognosis: ______%
POLICED
Rest
Optimal
Weight
Shoe
8; 12
80
PT Rx
Modalities
LASER: ___________
Ionto: dexamethasone helpful for ____ function
Shockwave Therapy: support for P! relief with ADLs when added to ____ weeks of exercise
NO indication on ______ changes or return to sport
contradictory
P!
4
structure
PT Rx
Bracing: _______ sleeves on involved mm.- anecdotal
Night Splint: NOT _____ and NO ______
Neoprene
beneficial; support
PT Rx
Taping, including kinesiotape along tendon to reduce P! is found to be ______ and _______
Arch taping/foot orthotics- ______ evidence
- ______ taping may help predict orthotic benefit
- ______ absorbing orthotic decreases rate of injury
anecdotal ; conflicting
limited
arch; shock
PT Rx
Heel Lift
- _____ support
- both _______
mixed
shoes
PT Rx
Dry Needling can be helpful for _____ when added to ______
STM- mostly _______
Gentle Stretching: _____ and may be contraindicated due to ______/_______ on tendon
JMs for ______ and _______
pain; exercise
anecdotal
weak; compression; tendon
mobility; function
MET Purpose: ________ and ________ (hip and lumbar)
__-___ sets; ___-____ reps; _____ load
Varied _____ actions (BEST evidence) how may seconds?
proliferation; stabilization
2; 3
10; 15
heavy
muscle
3
Exercise progressions
- _______ loading w/o _______ from lengthening
- _______ loading w/o ________ from lengthening
- ________ loading with _______ from lengthening
- ________ loading in ______- (CC Hip ABD/ER/EXT)
- ________ loading
isometric; compression
isotonic; compression
isotonic; compression
isometric; WBing
Plyometric
Best exercises for achilles tendinopathy
Unilateral heel raises; 3x3 secs m. actions
With achilles tendionapthy, you want to progress _______ and activity with ≤ _____ symptoms for at least ___/wk and keep up for ____-_____ weeks
resistance; mild
2
6; 12
Prognosis
Mostly normalized tendon _____ and ______
Improved ______ proporties as well as cortical function
_____ weeks to recovery
____% fully recovered within ___-_____ months of progressive loading @ 5 year follow up
Eccentric exercises- 82-100% ___-____ tendinopathy in athletes
60%- _______ individuals
≤32%- _______ tendon
_______ P! may remain (20-45%)
structure; thickness
mechanical
12
80
3; 6
mid; portion
sedentary
insertional
mild
MD Rx
Injections
______-_______-: insufficient evidence for Cortisone
_______: guided Cortisone effective for P! and function (non-athletic population)
Achilles _______
Remove _______
mid- portion
insertional
debridement
plantaris
