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Review
. 2020 May;55(5):438-447.
doi: 10.4085/1062-6050-356-19. Epub 2020 Apr 8.

Current Clinical Concepts: Conservative Management of Achilles Tendinopathy

Karin Grävare Silbernagel  1 , Shawn Hanlon  1 , Andrew Sprague  1
Affiliations
Review

Current Clinical Concepts: Conservative Management of Achilles Tendinopathy

Karin Grävare Silbernagel et al. J Athl Train. 2020 May.

Abstract

Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports. In addition to pain, Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties, altered lower extremity function, and fear of movement. Cumulatively, these impairments limit sport participation and performance. A thorough evaluation and comprehensive treatment plan, centered on progressive tendon loading, is required to ensure full recovery of tendon health and to minimize the risk of reinjury. In this review, we will provide an update on the evidence-based evaluation, outcome assessment, treatment, and return-to-sport planning for Achilles tendinopathy. Furthermore, we will provide the strength of evidence for these recommendations using the Strength of Recommendation Taxonomy system.

Keywords: exercise therapy; loading; rehabilitation; tendinitis; tendon.

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Figures

Figure 1
Figure 1
Palpation of the A, midportion; B, insertion of the Achilles tendon; and C, the medial and lateral fat pad and bursa.
Figure 2
Figure 2
Domains of tendon health. Abbreviation: PROMs, patient-reported outcome measures.
Figure 3
Figure 3
A, Starting position, and B, elevated position for the heel-rise endurance test.
Figure 4
Figure 4
Extended field-of-view ultrasound images of A, midportion, and B, insertional Achilles tendinopathy with measures of tendon thickness at the symptomatic region and an unaffected region of the tendon (solid line). C, Psychometric properties of tendon thickness measures. Abbreviations: ICC, intraclass correlation coefficient; MDC, minimal detectable change; SEM, standard error of measure.
Figure 5
Figure 5
The pain-monitoring model. Reprinted with permission from Silbernagel KG, Crossley KM. A proposed return-to-sport program for patients with midportion Achilles tendinopathy: rationale and implementation. J Orthop Sports Phys Ther. 2015;45(11):876–886.
Figure 6
Figure 6
Commonly used Achilles tendon-loading exercises. A, Bilateral heel rise. B, Unilateral heel rise. C, Seated heel rise. D, Eccentric heel rise. E, Rebounding heel rise.
See this image and copyright information in PMC

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