Runners are at a 30 times greater risk of tendinopathy as compared to sedentary controls
as stated by Kujala et al. in the Clinical Journal of Sports Medicine 2005.
Achilles Tendinosis Pain is mediated by ‘neurogenic inflammation’ in response to collagen
injury NOT traditional inflammation!! Therefore there is no prostaglandin release which is
what many NSAIDs target. There is speculation that local nerve fibres release
peptides which starts the pathophysiological painful process.
Collagen fibre disarray is typical of mid portion Achilles Tendinosis:
Typical clinical features include a gradual onset, morning pain and stiffness,
pain that decreases with activity and recurs several hours after activity.
Thickening of the tendon and ankle or subtalar joint stiffness is also common.
Mobilization of the subtalar or ankle joints are typical manual therapy treatment
strategies with this condition. Mechanotherapy or Mechanotransduction is another
option for treatment.
The process of Mechanotransduction promotes cells to convert mechanical stimuli into biochemical responses to repair tendon, muscle, cartilage and bone.
Mechanotherapy involves the use of eccentric training drills for increasing the tendon
strength which stimulates tenocytes to produce collagen, reversing the tendinosis cycle.
Here is a sample 12 week Heel Drop Program: (Fahlstrom et al. 2003)
3×15 reps twice daily, 7 days/ week for 12 weeks
Eccentric only Gastrocnemius Drop and Soleus Drop (knee flexed 45 degrees)
raise back onto toes using other leg or arms and progress until pain-free, then add load.
Collagen production is the key cellular phenomenon determining recovery from tendinosis
and one of the best ways to promote tissue repair is through exercise.
To Your Manual Therapy Success.
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