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I have a new patient with a 12 months history of achilles tendonopathy - she has significant thickening of the achilles/paratenon of the mid third of the tendon. The area is now only slightly tender (after treatment by a Physio) but the thickening has not significantly changed. She has been stretching appropriately. I am in the process of assessing her further regards her gait/mechanics etc but are there any other suggestions for reducing the swelling? I would imagine this has become a chronic, degenerative issue.

 

Cross-frictioning will help, as will activity once the area is asymptomatic. It can take years for a damaged TA to return to normal.

 

I would agree with David having dealt with a few of these. Part of the success lies in starting with the tissue relaxed and increasing tension on it as you progress with treatments. In the final treatment sessions an option is to do the same work with the patient weight bearing. Just my take on it mind.

 

It may not be swelling but fibrosis. Intratendinous pathology, such as fibrosis, is fairly common, particularly in the water shed area of the Achilles.

Steve