Achilles tendinopathy treatment - what is the latest research, and how can it help your treatment? What is the best way to treat Achilles tendinopathy (AT)?

Over the years our treatment of tendinopathy has evolved significantly. You may remember rubbing tendons with ultrasound or our thumbs in years gone past, and stretching the painful area or muscle-tendon complex. If you did, you may also remember the number of people that didn't really improve or develop the load tolerance to return to activity with this approach, supported by research demonstrating the lack of effectiveness of this approach.

We progressed to the golden era of loading, initially using eccentric training. Additional research emerged on the benefits of heavy slow resistance in tendinopathy treatment, closely followed by the importance of load management demonstrated in research on soft tissue injuries. In 2015 and 2016 Rio et al. released promising preliminary research utilising isometric holds in patellar tendinopathy patients, and we have extrapolated and used isometric holds with many different types of tendinopathy.

In Physio Edge podcast episode 82 with Dr Seth O'Neill, you will discover:

• Are isometric holds effective with Achilles tendinopathy patients?
• What is the most effective treatment for AT?
• What does the latest research on the treatment of AT reveal?
• Is relief of pain with isometric holds necessary to make a diagnosis of tendinopathy?
• What assessment tests can you perform to diagnose AT?
• How can you assess patient calf strength?
• How can you differentially diagnose other conditions including Plantaris involvement, insertional AT, talocrural impingement or neural irritation?
• How can you explain AT to your patients?
• What exercises can you include in your treatment?
• Exercise progressions you can use
• When are eccentrics a useful addition to a treatment program?
• When can patients start, continue or progress a walking or running program?
• How can you incorporate the biopsychosocial model into your treatment?
• Is dorsiflexion range of movement important?
• Is stretching an effective treatment for tendinopathy?
• Are ice, massage or ESWT useful?
• When is imaging useful?
• How can you treat insertional Achilles tendinopathy?

Dr Seth O'Neill completed a MSc in Musculoskeletal Physiotherapy, followed by a PhD focused on Achilles tendon disorders. Seth is a lecturer in Physiotherapy at the Universities of Leicester and Coventry, and has a Physio private practice in Nottingham, UK.

Links associated with this episode:

• Twitter - @Seth0Neill
• Let David Pope know what you liked about this podcast on Twitter
• Review the podcast on iTunes
• Like the podcast on Facebook
• Infographics by Clinical Edge

Articles associated with this episode:

• Beyer R, Kongsgaard M, Hougs Kjær B, Øhlenschlæger T, Kjær M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. The American journal of sports medicine. 2015 Jul;43(7):1704-11.

• O’Neill S, Radia J, Bird K, Rathleff MS, Bandholm T, Jorgensen M, Thorborg K. Acute sensory and motor response to 45-s heavy isometric holds for the plantar flexors in patients with Achilles tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy. 2018:1-9.

• Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, Cook J. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015 May 15:bjsports-2014.

Other episodes of interest:

• Physio Edge 068 Lower limb tendinopathy loading, running and rehab with Dr Peter Malliaras
• Physio Edge 075 Tendinopathy, imaging and diagnosis with Dr Sean Docking
• Physio Edge 042 Treatment of Plantaris & Achilles Tendinopathy with Dr Seth O'Neill
• Physio Edge 041 Plantaris Involvement In Achilles Tendinopathy With Dr Christoph Spang