A 35-year-old male was referred by his orthopaedic physician to an outpatient physical therapy clinic with a diagnosis of Achilles tendinosis on his right side. He has experienced a gradual increase in pain for 2 years. His worsening symptoms have limited his ability to run or play basketball. Previous therapies (nonsteroidal anti-inflammatories, ultrasound, manual therapy, custom orthotics) have failed to improve symptoms. His orthopaedist has recommended surgery. However, the patient would like to try physical therapy again.
Based on the patient's diagnosis, what do you anticipate may be the contributing factors to his condition?
What are the most appropriate physical therapy interventions?
ECCENTRIC EXERCISE: Form of exercise in which the muscle(s) are allowed to lengthen gradually in the presence of an applied load
MICRODIALYSIS: Laboratory technique in which a catheter is inserted into a tendon at the site of suspected degenerative changes in order to study metabolism within the tendon
NEOVASCULARIZATION: Growth of new blood vessels
TENDINOPATHY: General term for a diseased state of a tendon; tendinosis may be referred to as a chronic tendinopathy
TENDINOSIS: Chronic, painful degenerative condition of a tendon marked by absence of inflammation, a loss of function, and the presence of a thickened region (i.e., a painful nodule)
Describe the differences between tendinitis and tendinosis.
Describe the pathophysiology associated with Achilles tendinosis.
Prescribe an evidence-based resistance training program for an individual with Achilles tendinosis.
PT considerations during management of the individual with a diagnosis of Achilles tendinosis:
- General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility; increase active and/or passive range of motion; increase lower quadrant strength; prevent or minimize loss of aerobic fitness capacity
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; muscular flexibility exercises; resistance exercises to increase muscular strength of the gastrocnemius and soleus; aerobic exercise program
- Precautions during physical therapy: Monitor vital signs
- Complications interfering with physical therapy: Patient noncompliance with exercise program
The Achilles tendon is the strongest tendon in the human body; however, it is at risk for acute injury (tendinitis), degeneration (tendinosis), and/or rupture.1–3 The tendon is the distal extension of the gastrocnemius and soleus muscles and inserts into the calcaneus. A region of decreased blood supply is frequently found at the midportion of the tendon (2-6 cm proximal to its insertion site)—a location associated with Achilles tendon injuries.
Tendinosis is a chronic, painful state marked by a different pathophysiology than that associated with an acute tendon injury (tendinitis).4 Tendinosis is thought to be the result of overuse and age-related changes with a failure of proper tissue healing.2 In a study of ten adults undergoing surgery for Achilles tendinopathy, de Mos et al.5 found increased water content, matrix ...