Notes & References
- wrong use vs over use - Not every tendon problem is the same; location matters
o Midsubstance- Most common: associated with over/wrong use; treat with load and reload;
-Most common (have ICF guidelines); goal is to stiffen it (so isometrics/eccentrics verse stretches)
-Can use tape, soft tissue, heel lifts, some modalities, all can help with pain (for the itis), but do not reload tendon, needed for Osis treatment
-Treatment: slow and controlled, involving cognition (think about it), need to exceed elongation than during walking (on step); high volume required, and overload it;
- Progression from flat ground to step to adding weight
- Goal with treatment is to make tendon more organized, thinner, faster reaction time;
-Palpation: if very localized, may more degeneration/thickening, verse entire tendon than more related to inflammation;
o Tenosseous junction (insertional)- associated with collagen disease, wide age range- teat surgery, casting, shockwave; Avoid resistive exercises, more to rest and boot/immobilize
-Running technique/skill training (change how they load the foot/calcaneus);
- Look at rear foot and mid foot mechanics.
Muscle Tendinous Junction: associated with immobilization (deprived loading); treat with progressive reloading- more rare, often inflammatory and need rest first
Sports Med. 2012 Nov 1;42(11):941-67. doi: 10.2165/11635410-000000000-00000.
Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning.
Rowe V1, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D.
MID PORTION ACHILLES
- Evidence was strong for eccentric loading exercises and extracorporeal shockwave therapy; moderate for splinting/bracing, active rest, low-level laser therapy and concentric exercises (i.e. inferior to eccentric exercise). In-shoe foot orthoses and therapeutic ultrasound had limited evidence.
J Orthop Sports Phys Ther. 2015 Nov;45(11):876-86. doi: 10.2519/jospt.2015.5885. Epub 2015 Sep 21.
A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation.
Silbernagel KG, Crossley KM.
Mid protion; 2-6 cm proximal to insertion (55-65%)
Eccentric protocol: 15x3, knee straight and 15x 3 knee bent; 2x a day, 7 days, no more than 5/10 during and after next day, slowly add load.
Return to sport: 3x15 with weight off step SL heel raises; 3x15 eccentric off step with weight, and 3x20 quick rebounding heel raises - 3 days recovery - need to load heavy, and speed
