PODCAST – Achilles Tendon Disorder


* This podcast is AI-generated. I offer it to you because it presents the content in a casual conversational way. I hope you enjoy listening to it… and learn. 😊
– Dr. Joe Muscolino .

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Study Guide

Short-Answer Quiz:

  1. What muscles make up the triceps surae group, and what is their primary action?
  2. Explain how both overuse and overstretching can contribute to Achilles tendinitis.
  3. What is the difference between Achilles tendinitis and Achilles tendinosus?
  4. Describe the location and function of the subcutaneous and subtendinous bursae in relation to the Achilles tendon.
  5. What factors increase the likelihood of an Achilles tendon rupture?
  6. Describe the signs and symptoms a patient might present with if they have Achilles tendinitis.
  7. Explain the Achilles tendon pinch test and what a positive result indicates.
  8. What does the triceps surae squeeze test (Thompson test) assess, and how is it performed?
  9. Summarize the manual therapy treatment protocol for Achilles tendinitis during the acute stage.
  10. What self-care advice should be given to a patient with Achilles tendinitis?

Short-Answer Quiz: Answer Key

  1. The triceps surae group consists of the gastrocnemius (with its medial and lateral heads) and the soleus muscles. Their primary action is plantarflexion of the foot at the ankle joint.
  2. Overuse, like excessive walking or running, causes repetitive micro-traumas to the tendon, leading to inflammation. Overstretching, particularly during activities like squatting with heavy weight, strains the tendon fibers.
  3. Achilles tendinitis is characterized by inflammation of the tendon, while Achilles tendinosus involves degeneration of the tendon’s collagen matrix without significant inflammation.
  4. The subcutaneous bursa lies between the skin and the Achilles tendon, while the subtendinous bursa sits between the tendon and the calcaneus. Both bursae reduce friction during movement.
  5. Factors include: Age (middle-aged individuals), lack of flexibility, inadequate warm-up, degenerated collagen (tendinosus), and a previous history of Achilles tendinitis or tendinosus.
  6. Pain at the Achilles tendon (especially during activity or palpation), swelling, warmth, crepitus, decreased dorsiflexion range of motion, pain with resisted plantarflexion, and potential antalgic gait.
  7. The therapist pinches the Achilles tendon above the bursae. Pain indicates a positive test, suggesting tendinitis, paratendinitis, or potentially bursitis if performed lower.
  8. It assesses for Achilles tendon rupture. With the patient prone and the foot relaxed, the therapist squeezes the calf muscles. Absence of plantarflexion suggests a rupture.
  9. The focus is on reducing inflammation: RICE (Rest, Ice, Compression, Elevation), gentle distal-to-proximal effleurage, and possibly light stretching depending on severity.
  10. RICE during the acute phase, gentle stretching of the calf muscles (both gastrocnemius and soleus), proper warm-up before activities, and gradual reintroduction of activity.

Essay Questions:

  1. Discuss the role of biomechanics in the development of Achilles tendon disorders, considering factors like gait cycle, footwear, and muscle imbalances.
  2. Compare and contrast the treatment approaches for Achilles tendinitis, tendinosus, and tendon rupture, highlighting the rationale behind each method.
  3. Explain the concept of neural cross-over and its application in the management of Achilles tendon disorders.
  4. Describe the importance of patient education in the prevention and management of Achilles tendon disorders, outlining key advice for activity modification, footwear, and self-care.
  5. Analyze the potential long-term consequences of untreated or poorly managed Achilles tendon disorders, considering the impact on mobility, function, and quality of life.

Glossary of Key Terms:

  • Achilles Tendinitis: Inflammation of the Achilles tendon, commonly caused by overuse or repetitive strain.
  • Achilles Tendinosus: Degenerative condition of the Achilles tendon, characterized by collagen breakdown and a lack of inflammation.
  • Achilles Tendon Rupture: Complete or partial tear of the Achilles tendon, often due to sudden, forceful contraction.
  • Antalgic Gait: Altered walking pattern to avoid pain, often characterized by a limp.
  • Bursa: Fluid-filled sac that reduces friction between tendons, muscles, and bones.
  • Calcaneus: Heel bone.
  • Collagen: A fibrous protein that provides strength and structure to connective tissues like tendons.
  • Crepitus: Grating, crackling, or popping sound and/or sensation felt during movement.
  • Dorsiflexion: Bending the foot upwards towards the shin.
  • Eccentric Contraction: Muscle lengthening under tension.
  • Effleurage: A type of massage involving long, gliding strokes.
  • Fibroblasts: Cells that produce collagen and other fibers, crucial for tissue repair.
  • Gastrocnemius: Calf muscle with two heads, responsible for plantarflexion and knee flexion.
  • Hypertonicity: Excessive muscle tension or tightness.
  • Inflammation: The body’s natural response to injury or irritation, characterized by redness, swelling, pain, and heat.
  • Joint Mobilization: Manual therapy techniques to restore joint movement and reduce pain.
  • Myofascial Trigger Point: Hyperirritable spot in a muscle that refers pain to other areas.
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Medications like ibuprofen that reduce pain and inflammation.
  • Paratenon: Connective tissue sheath surrounding the tendon.
  • Paratendinitis: Inflammation of the paratenon.
  • Plantarflexion: Pointing the foot downwards.
  • RICE (Rest, Ice, Compression, Elevation): Standard acute injury management protocol.
  • Soleus: Calf muscle located beneath the gastrocnemius, responsible for plantarflexion.
  • Subcutaneous: Located beneath the skin.
  • Subtendinous: Located beneath a tendon.
  • Tendon: A tough band of fibrous tissue that connects muscle to bone.
  • Triceps Surae: Collective term for the gastrocnemius and soleus muscles.
  • Triceps Surae Squeeze Test (Thompson Test): Test for Achilles tendon rupture.