So the thread - Is compressive load a factor in the development of tendinopathy? got me quite excited ( sad init) and though maybe we should discuss what treatement is optimal for why type of Achilles pain and maybe come up with some possible clinical tests where there is none available to help with a more specific diagnosis.
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So not so long ago - Achilles type pain was broken into 2 groups Achilles Tendonitis and Achilles Bursitis, then Tendonitis was out and Achilles Tendonopathy was where is at.
In fact articles were written about it -
Time to abandon the “tendinitis” myth. Yesterday I learnt a new word - enthesopathy to discribe pain at the insertion of the Achilles .
Why is all this important?
It is important because if we can work out the causative nature of the pain we can better decide a more appropriate treatment program.
So if we agree that at this moment most believe that increased tensile loads on the Achilles leads to pain.
Rather than too many words if we break it down like this feel free to add more if I missed something
Achilles Insertion related pain
1. Bursitis - compression of the Achilles Bursa which leads to pain and swelling
2. enthesopathy - compression of the tendon both internal and external which leads to pain
Mid tendon related pain
1. Tendonopathy - a breakdown in the micro cell structure taken from the above paper on tendinitis myth2. Compression tendon stress ( from the plantaris tendon) - The plantaris tendon and a potential role in mid-portion Achilles tendinopathy , outside of the tendons Physiologic window
3. Shear and friction stress, outside of the tendons Physiologic window
each of these should have different treatment programs. Infact some of the treatment programs will be contraindicated for some of the subsections of diagnosis.
ie eccentric train work well for those patients with mid tendon tendonopathy but will be contraindicated in patient with pain from Compression and shear/friction issues.
And there maybe evidence that orthotic intervention may again become standard 1st line of treatment for certain sub sections of Achilles Tendon treatment - where they had become not seen as a appropriate treatment measure by some. STJ Axis Variations and Achilles Tendonitis
I will leave it here see if anyone wants to bash this issue around and then I will update a post with a consensus of the overview when we are done- or this thread will go into the I thought this was a good idea at the time pile.
What I though we need is a for each of the subsections re Achilles Tendon pain.
diagnostic name
description
Etiological statement
Diagnostic method
Treatment plan
- Short
- Long
Contraindicated activities list.
Tags:
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Transverse plane motion at the ankle joint great than the sub-talar I think I can hear another parad
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Heel raise vs whole foot raise.
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Transverse plane motion at the ankle joint great than the sub-talar I think I can hear another parad
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Heel raise vs whole foot raise.
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