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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.

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Based on the patient's diagnosis, what do you anticipate may be the contributing factors to his condition?

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What are the most appropriate physical therapy interventions?

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ECCENTRIC EXERCISE: Form of exercise in which the muscle(s) are allowed to lengthen gradually in the presence of an applied load

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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

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NEOVASCULARIZATION: Growth of new blood vessels

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TENDINOPATHY: General term for a diseased state of a tendon; tendinosis may be referred to as a chronic tendinopathy

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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)

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  1. Describe the differences between tendinitis and tendinosis.

  2. Describe the pathophysiology associated with Achilles tendinosis.

  3. Prescribe an evidence-based resistance training program for an individual with Achilles tendinosis.

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PT considerations during management of the individual with a diagnosis of Achilles tendinosis:

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  • 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

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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.

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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 ...

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