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Mentoring Minutes: Achilles Tendinopathies
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.
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
Clin J Sport Med. 2009 Jan;19(1):54-64. doi: 10.1097/JSM.0b013e31818ef090.
Nonoperative treatment of midportion Achilles tendinopathy: a systematic review.
Magnussen RA1, Dunn WR, Thomson AB.
Eccentric exercises have the most evidence of effectiveness in treatment of midportion Achilles tendinopathy.
Sports Med. 2013 Apr;43(4):267-86. doi: 10.1007/s40279-013-0019-z.
Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness.
Malliaras P1, Barton CJ, Reeves ND, Langberg H.
- CONCLUSION: There is little clinical or mechanistic evidence for isolating the eccentric component,
- Concentric- eccentric loading better (3 sec up, 3 sec down)- time under tension- 3 sets of 10-20, enough load to be painful in third set
J Orthop Sports Phys Ther. 2016 Aug;46(8):664-72. doi: 10.2519/jospt.2016.6494. Epub 2016 May 12.
Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running.
Willy RW, Halsey L, Hayek A, Johnson H, Willson JD.
- Treadmill running resulted in greater achilles tendon loading compared with overground running ; peak concentric ankle power greater with Treadmill runnning
Am J Sports Med. 2015 Jul;43(7):1704-11. doi: 10.1177/0363546515584760. Epub 2015 May 27.
Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial.
Beyer R1, Kongsgaard M2, Hougs Kjær B3, Øhlenschlæger T2, Kjær M2, Magnusson SP4.
- chronic mid portion achilles tendinopathy;
- eccentric training 3x15 7x week, 12 weeks vs: Heavy slow resitance 3x week, knee flexed seated, and knee extended standing (15 rep max to 6 rep max);
- sports allowed if < 3; 4-5/10 while training if subsides next session
- Both groups: improved pain, and sports assessments, reduction in tendon thickness and neovascularization
- Patient satisfaction > in heavy slow resistnace group (96 vs 76%), with higher compliance (96% vs 76%))
Mentoring Minutes: Ulnar Nerve Entrapment
Welcome to PhysioU’s Mentoring Minutes! Each episode of Mentoring Minutes directly applies a clinical approach with relevant research for effective results.
Understanding peripheral nerve anatomy is critical in order to help maximize patient function and quality of life. In today’s episode of Mentoring Minutes, Dr. Michael Wong will be discussing the common entrapment sites of the Ulnar Nerve and how movement can contribute to this nerve problem.