achilles tendinopathy - final exam Flashcards
What is the most frequently reported overuse injury?
achilles tendinopathy
who is Achilles tendinopathy most common in?
recreational/competitive activities
training > competition
30-50 year olds
10-20% of runners
risk factors and etiology of achilles tendinopathy:
- reduced ____ ROM that limits PE of Achilles
- limited ______ flexibility
- ______ weakness
- _____ gender and ______ age
- abnormal _______
- what about weight?
- 3 things to consider:
- DF
- calf
- calf
- male and older
- tendon structure
- obesity
- training errors, environmental factors, improper shoes
risk factors of achilles tendinopathy : L4-S1 regional interdependence
– excessive _______ with tendinopathy origins due to Achilles attaching more ______ of calcaneus
– ____ neuromuscular deficits
– _______ deficits
EV/pronation; medial
hip
balance
pathomechanics of achilles tendinopathy:
- repetitive _______ with compression from limited _____ and/or excessive _______
- lack of PE with limited DF so ______
lengthening
DF
EV
overworked
achilles tendinopathy can occur from collagen fibril ______/________ and fibroblast _____ from:
- altered fluid movement leads to _____
- increased nitric acid with _______
thinning/disorganization
death
- overheating
- persistent inflammation
with achilles tendinopathy, you get a thickened but weaker tendon from:
increase of non-collagen matrix
fat deposition
achilles tendinopathy can result from ineffective ______ and impaired _______
force transfer
motor control
symptoms of achilles tendinopathy
gradual onset that limits WB activity
localized P! and stiffness
- particularly after inactivity
- lessens with mild bout of activity
- increase with moderate to severe activity
signs of achilles tendinopathy:
- observation:
- ROM:
- resisted:
- accessory motion
- achilles thickening. possible impaired LE control
- possible P! and limitation with DF
- possible P! with PF; may be weak. possibly hip and knee weakness of antigravity muscles
- possible talar hypomobility for DF
Achilles tendinopathy special tests:
palpate tender area; ask pt to DF/PF ankle
(+) = ?
arc sign
(+) = tender area moves with DF and PF
achilles tendinopathy special tests:
palpate tender area; ask pt to DF ankle
(+) ?
royal london
(+) = tender area less tender in DF
what are two other more functional tests for achilles tendinopathy?
single leg heel raise for endurance (if more P! on incline –> plantaris and insertional injury)
single leg hop
both (+) = less reps vs uninvolved side
muscle length test for achilles tendinopathy?
shortened gastrocs
where is TTP for achilles tendinopathy?
2-6 cm proximal to insertion
achilles pain would be more _____ indicating plantaris involved
medial
what are some differential dx at posterior ankle?
achilles/fascial tears
calcaneal bursitis
plantaris tendinopathy
posterior ankle impingement
what should you educate your patient on for PT Rx for achilles tendinopathy?
rest NOT indicated
optimal stress is best within appropriate P! levels
weight management
shoe wear
timeline (8-12 weeks)
prognosis (80% progress)
effectiveness of modalities for achilles tendinopathy?
- LASER
- Ionto
- shockwave therapy
- contradictory evidence
- dexamethasone helpful for P! and function
- more P! relief w ADLs when added to 4 weeks of exercise. no structural changes
PT Rx effectiveness for achilles tendinopathy: Bracing and taping
- neoprene sleeves:
- night splint:
- kinesiotape:
- anecdotal
- not beneficial and no support
- anecdotal and conflicting
arch taping for achilles tendinopathy may help predict ______
shock absorbing orthotic _______ rate of injury
heel lift support ?
orthotic benefit
decreased
mixed support
PT Rx effectiveness for achilles tendinopathy:
- dry needling:
- STM:
- gentle stretching:
- JMs:
- helpful for pain when added to exercise
- anecdotal. helpful for motion w exercise
- weak support. may be contraindicated due to higher tension/compression on tendon
- for mobility and function
primary purposes MET for achilles tendinopathy
tendon proliferation and stabilization
PT Rx MET muscle actions for achilles tendinopathy:
- ______ only
- _________ and ______ concentrics/eccentrics
eccentrics
heavy and slow
what exercises would you prescribe for someone with achilles tendinopathy?
PF w knee flexed
PF w knee ext
heel raises legs straight and bent
how do you progress resistance and activity for achilles tendinopathy?
add weight in hand or with loaded backpack
leg press or heel raise machine
sitting or standing heel raises
timeline for achilles tendinopathy Rx:
at least 2x/week, recommend every other day
6-12 weeks
may need more recovery time between heavy loading in a non-athletic/older patient
once symptoms return to normal P!, repeat exercises
recurrence rate for achilles tendinopathy:
27%
prognosis for achilles tendinopathy:
- mostly normalized ____ and _____
- improved:
- _____ weeks to recovery
- _____% recovered with ______ months of progressive loading at a 5 year follow up
tendon structure and thickness
mechanical properties as well as cortical function
12
80%; 3-6 months
with eccentric exercises,
______% success for mid portion tendinopathy in athletes
______% sedentary individuals
_____% insertional tendinopathy
82-100%
60%
< 32%
mild pain may remain in ____% with achilles tendinopathy
20-45%
MD Rx achilles tendinopathy:
- mid portion:
- insertional:
- insufficient evidence for cortisone
- guided cortisone effective for P! and function. recommended for non athletic pop.
calcaneal apophysitis or Sever’s Disease most common in:
9-12 year old boys
etiology of severs disease:
growth with high activity
pathomechanics of severs disease:
leg bone growth exceeds PF lengthening
increased tendon tension
growth plate is weak spot
mostly inflammation
complications: avulsion or premature closure
risk factors of severs disease
long or year round sports
poor fitting shoes that lack cushion
training errors
shortened PFs
foot dysfunction; pes planus/cavus
risk factors of severs disease
long or year round sports
poor fitting shoes that lack cushion
training errors
shortened PFs
foot dysfunction; pes planus/cavus
symptoms of severs disease
gradual onset of heel P! with overuse
bilateral (60%) because equally walking on feet
ROM for Severs disease:
limited DF leading to greater tensile forces on growth plate
special tests for severs disease:
squeeze test on heel
severs sign: P! with heel raise
m length: shortened gastroc
where would be TTP w severs disease
cap of calcaneus
PT Rx for severs disease:
patient education
policed
U shaped foam upside down on achilles w ankle sleeve
restore DF ROM/accessory motion
what stretching would you do for severs disease?
hamstring stretching due to fascial connections w gastroc
be careful with prolonged calf stretches
PT Rx severs disease: orthotics
- arch support for _____
- ______ > arch supports
– gel heel cups with a lift work __
- excessive pronation
- heel lifts
– best
MET Rx for severs disease
any impaired LQ control
caution with muscle/tendon attached to growth plate to avoid greater overuse
prognosis for severs disease:
- ___ resolved at 1 month; ___ at 3 months
- can be a ____ and/or ____ problem
- growth plate closes around _____
- 75%; 95%
- recurrent/persistent
- 14 years
achilles rupture prevalence:
men ages 20-50
where would the achilles typically rupture
3-4 cm proximal to calcaneal insertion
how would an achilles rupture typically happen
during a sudden eccentric activity
Signs of achilles rupture:
- ROM/resisted:
- special tests:
- limited if any PF/ weak PF
- Matle’s: prone, knee 90 deg flx, (+) = foot neutral or DF
- tendon gap palpation
- thompson: in supine squeeze calf
- Matle’s: prone, knee 90 deg flx, (+) = foot neutral or DF
PT Rx for achilles rupture:
POLICED
like achilles tendinopathy
early functional rehab and WB for achilles rupture:
- Week 0-2
- week 3-6
- week 7
- ROM: none
orthosis: fixed @ 30 deg PF - ROM: up to 30 deg DF; free PF
orthosis: 30 PF to 0 DF - normal
prognosis for achilles rupture:
many professional athletes don’t return to prior levels
