Michelle Agliata, Amanda Bower, Joe Cappiello, Devin Schneider, & Jagoda Siembida
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1 Michelle Agliata, Amanda Bower, Joe Cappiello, Devin Schneider, & Jagoda Siembida
2
3 Origin and insertion Thickest and strongest longest tendon in human body Action Blood supply
4 Clinical condition tissue degeneration Signs and symptoms pain and stiffness Condition of all generation Examination Common in physical therapy
5 Common injury Effects both athletes and non-athletes
6 698 competitive and recreationally active patients 66% suffered from Achilles tendinopathy
7 July 10, 2013 The Institute for Health Metrics and Evaluation at the University of Washington Reported more people are Running Biking Other forms of exercise
8 NSAIDS Ice/Ice Massage Rest Stretching Exercise Taping Friction Massage Heel Lifts/Orthotics
9 Stretching ROM Strengthening Concentric muscle contractions are beneficial, but Eccentric, Eccentric, Eccentric provide best results
10 Stretching Gastrocnemius Stretch second hold Soleus Stretch Strengthening Seated Heel Raises Standing Heel Raises Heel Drops
11 Increasing weight on affected side SLS - Performing exercises only on affected leg Placing patient s toes on edge of step and following same progressions
12 12 week program (Alfredson, 2007) Eccentric and Concentric exercise groups Eccentric: 82% satisfied and back to previous activity level Concentric: only 36% satisfied and back to previous activity level Eccentric contractions Generate more tension = increased muscle strengthening Increased length of muscle-tendon unit = less strain during ankle joint movements
13
14 Topical glyceryl trinitrate (Skin patch) Decrease inflammation Extracorporeal shock wave therapy (ESWT) Increase blood flow Corticosteroid injection Decrease pain Electrophysical agents (Ultrasound) Increase protein synthesis Night splints Surgery recommended as last option
15 VISA-A Self-report questionnaire 8 questions - 3 domains Pain - questions 1-3 Function - questions 4-6 Activity - questions 7 and 8A, B, or C 1-7 scored scored 0-30 Asymptomatic = 100/100 Symptomatic > 100/100
16 12-week program (Alfredson, 2007) No concentric loading Complete exercises despite pain If no pain increase eccentric load Eccentric program 90% success rate in those who alternative treatments failed
17 Short-term pain relief Improved walking pain Reduced tendon diameter Best if used in correlation with exercise
18 Reduces strain on tendon Typically 0-5+ degrees DF Greater decrease in pain when combined with 12-week eccentric exercise program Used alone or with TE Helped decrease pain for 12 months (Alfredson, 2007)
19 Alfredson, H. and Cook, J. (2007). A treatment algorithm for managing Achilles tendinopathy: new treatment options. British Journal of Sports Medicine. (41) Jonsson, P. Eccentric training in the treatment of tendinopathy. Print & Media, Umeå University, Umeå (2009). Matt. Achilles Tendonitis. Your Guide to Wellness website. Published Accessed on 2/16/14. Obesity continues to rise in nearly all counties but Americans becoming more physically active, too. The Institute for Health Metrics and Evaluation website. release/obesity-continuesrise-nearly-all-counties-americans-becoming. Published 7/13/13. Accessed 2/20/14. Permanente Medical Group, The. (2011). Achilles tendonitis. Kaiser Permanente Quinn, E. Achilles tendon strengthening: Strengthen the Achilles tendon with eccentric exercise. About.com Sports Medicine. Published Accessed 2/16/14. Robinson, J. M. et al. (2001). The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. British Journal of Sports Medicine. (35), Rowe, V. et al. (2012). Conservative management of midportion Achilles tendinopathy. Sports Medicine. 42(11), Scott, A. et al (2011). Conservative treatment of chronic Achilles tendinopathy. Canadian Medical Association Journal. 183(10), van Dijk, C. N. et al. (2011). Terminology for Achilles tendon related disorders. Knee Surgery, Sports Traumatology, Arthroscopy. 19.5, Wood, S. (2009). Achilles tendinopathy: Advice and management. Nuffield Orthopaedic Center
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