positions initially, especially if the tendon is irritable or you suspect the plantaris to be involved, ie. medial Achilles pain.

n Monitor overall load on the tendon. Stopping all tendon load, ie. complete rest, is unlikely to solve the problem but load modification is important.

References 1. De Jonge S, Warnaars JLF et al. Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements. Scandinavian Journal of Medicine & Science in Sports 2013;doi:10.1111/sms.12072 2. van Schie HTM, de Vos RJ, et al. Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non- invasive approach. British Journal of Sports Medicine 2010;44(16):1153–1159 3. Kountouris A, Cook J. Rehabilitation of Achilles and patellar tendinopathies. Best Practice & Research Clinical Rheumatology 2007;21:295–316 4. Rosengarten S, Docking S I, et al. Tendon response in Achilles tendon of Australian football players using ultrasound tissue characterisation. British Journal of Sports Medicine 2014;doi:10.1136/ bjsports-2013-092459.30 5. Docking S, Daffy J, et al. Tendon structure changes after maximal exercise in the thoroughbred horse: use of ultrasound tissue characterisation to detect in vivo tendon response. The Veterinary Journal 2012;194:338–342 6. Kubo K, Akima H, et al. Effects of 20 days of bed rest on the viscoelastic properties of tendon structures in lower limb muscles. British Journal of Sports Medicine 2004;38:324–330 7. Ohberg L, Lorentzon R, Alfredson H. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. British Journal of Sports Medicine 2004;38:8–11 8. Fredberg U, Bolvig L, Andersen NT. Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in l and patellar tendons— the Danish Super League Study. American Journal of Sports Medicine 2008;36:451–460 9. Visnes H, Hoksrud A, et al. No effect of eccentric training on jumper’s knee in volleyball players during the competitive season: a randomized clinical trial. Clinical Journals of Sport Medicine 2005;15:227–234 10. Cook JL, Purdham CR. The challenge of managing tendinopathy in competing athletes. British Journal of Sports

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Medicine 2014;48(7):506–509 11. Rio E, Kidgell D, et al. Exercise to reduce tendon pain: a comparison of isometric and isotonic muscle contractions and effects on pain, cortical inhibition and muscle strength Journal of Science and Medicine in Sport 2013;16(Suppl 1):e28 12. Kosek E, Lundberg L. Segmental and plurisegmental modulation of pressure pain thresholds during static muscle contractions in healthy individuals. European Journal of Pain 2003;7:251–258.

FURTHER RESOURCES 1. UTCimaging website. www.utcimaging.com 2. Follow Jarrod Antflick on twitter: tendonexperts@jarrodantflick 3. van Schie HTM, de Vos RJ, et al. Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. British Journal of Sports Medicine 2010;44(16):1153–1159 4. Cook JL, Purdham CR. The challenge of managing tendinopathy in competing athletes. British Journal of Sports Medicine 2014;48(7):506–509.

KEY POINTS n Achilles tendon complaints are very common in recreational and elite sportsmen and women.

n Tendinopathy is characterised by matrix disintegration as a consequence of overstraining, ageing, degeneration and/or partial ruptures.

n The differential diagnosis of Achilles tendon complaints is paramount to implementing the most effective treatment plan.

n Ultrasound tissue characterisation (UTC™) provides a detailed image of the tendon, producing transverse, coronal and sagittal images as well as a 3D coronal view.

n UTC scans are coloured according to echo type, which reflects the current health of the tendon tissue.

n Successive UTC scans are useful for monitoring tendon health/rehabilitation.

n Eccentric exercises have been the focus of rehabilitation for the last 10 years, but is one loading strategy, there are many more depending on the diagnosis.

n Isometric exercises are useful for treating pre- season and in-season reactive tendinopathy.

THE AUTHORS

TH J

JARROD ANTFLICK BAPP BHSC PGCERT Jarrod is consultant physiotherapist with British Athletics sharing his time between

DISCUSSIONS

n What are the different diagnoses that can be made for the different regions of the Achilles tendon?

n What kind of imaging technology does UTC use and what do the different colours on a UTC scan indicate?

n What are the key points to think about in an Achilles tendinopathy rehabilitation programme? Would you do things differently for in- season/off-season athletes?

clinical work (at Tendon Performance, Complete Physio and The Fortius Clinic in London, UK) and attending major championships. He is currently undertaking field research into the effect of tendinopathy on performance utilising UTC. Jarrod was a consulting physiotherapist for members of the US Track and Field Team in preparation for the London 2012 Olympics. C

CHRIS MYERS BSC MSC PGCERT

Chris is a physiotherapist, osteopath and MSK sonographer. He runs a group of private clinics in London called Complete Physio. He has a

special interest in tendons and is especially interested in how imaging findings relate to pain and prognosis. He uses UTC as part of his daily practice in the clinic and treats many elite and recreational athletes from a variety of sports.

For further information please contact: 1. Tendon Performance (www.tendonperformance.com); Email: info@tendonperformance.com; Twitter: tendon experts. 2. The Fortius Clinic (www.fortiusclinic.com); Email: info@fortiusclinic.com; Tel: +44 203 1952442. 3. Complete Physio (www.complete-physio.co.uk); Email: chris@complete-physio.co.uk; Tel: +44 207 482387.

sportEX medicine 2014;61(July):26-30