• Jillian Davison

    Evidence based practice is the cornerstone of treating patients in the medical Community. An article in JOSPT; Achilles Pain, Stillness, and  Muscle Power Deficits: Achilles Tendinitis helps to clarify what is the best way to treat this condition. Tendinopathy can and should be used as an umbrella term for tendinitis and tendinosis unless one has histological evidence of cells/tissue make up. Achilles tendinopathy is one of the top overuse injuries reported. More common in active adults 30-50 yrs old. These patients often have intermittent pain that is activity related, and or stillness alter prolonged rest.

    Intrinsic factors contributing to this condition are often, abnormal dorsiflexion range of motion (either in excess or deficit), abnormal subtalar range of motion (excess or deficit), decreased plantar flexion strength and overpronation of the feet. Runners are prone to extrinsic factors such as abrupt increase in mileage or intensity, hill training or return to sport alter a lag in training.
    This article recommends that therapists include functional measures into the patient exam in addition to traditional tests and measures (MMT/ROM).  For example gait observation, stair navigation, unilateral heel raises, unilateral hopping, and ability to participate in functional activities or sports.

    Research has shown that treatment through eccentric strengthening is primary followed by low level laser and iontophoresis with dexamethasone. A stretching component and possible orthotic use are listed as moderately supported interventions and should not be used as a sole treatment. Lastly the article describes how manual therapy (soft tissue work) and taping have little evidence

    In conclusion, studies are currently providing eccentric loading (various heel raise programs) for treatment of athletic individuals with mid-portion achilles tendinopathy to be most valid.  Being every patient is different and no treatment is ever ìblack and whiteî one should always treat their patient according to therir specific signs, symptoms and deficits.   Incorporation of high to moderately supported interventions may be used in conjunction for the best outcomes.

    For more information, references, or to learn how to prevent these injuries please contact our offices.