EVIDENCE INFORMED PRACTICE


Initial scan – May


Follow-up scan – June


Follow-up scan – July


1cm proximinal


1cm proximinal


TAKE-HOME POINTS The following list provides key points for you to bear in mind when diagnosing and treating tendon injuries: n Diagnosis is key: be specific and consider all differentials (Table 1)


2cm proximinal 2cm proximinal


n Carry out a detailed examination with a thorough history. For example, does the patient remember a specific incident when they felt the pain? This will help to rule in/out a tear.


n How long do they experience morning stiffness in the tendon?


4cm proximinal 4cm proximinal


n Palpate the tendon carefully and be specific – where is the pain? Is the pain on the mid portion, the enthesis or the medial or lateral side of the tendon?


Figure 6: Scans showing injury and follow-up. Healing can be seen as the damaged (red) tissue becomes healthier (green). (J. Antflick, Tendon Performance, 2013)


programmes in pathological tendons are currently unknown. It would appear the key goal of an exercise programme is to increase the load tolerance and energy absorption of the tendon. Tendons are very slow to adapt and this process is likely to take several months (10).


ONE-STOP MULTIDISCIPLINARY TENDON CLINIC USING UTC IMAGING Tendon Performance and Fortius Clinic have teamed up in London to provide a multidisciplinary one-stop shop


(a) (b)


for tendon-related issues designed for elite athletes and recreational sportsmen and sportswomen. The clinic utilises UTC imaging to provide detailed analysis of the tendon to ensure it results in the most effective management plan. The multidisciplinary team consists of leading foot and ankle consultants, specialist physiotherapists, sports doctors and interventional radiologists (Box 1, 2).


n Before commencing a loading programme, consider the irritability of the tendon: eg. how long does it take for the pain to go away once they have aggravated it?


n Eccentric loading may be effective but consider other types of loading as well: eg. moderate and heavy isometric exercises. n Soleus rehabilitation.


Approximately 2/3 of the calf complex is soleus and it plays a very important role in the overall strength endurance of the calf – don’t forget it!


n Beware loading into end-of-range


BOX 1: TENDON PERFORMANCE Tendon Performance is a clinical consultancy, led by physiotherapists Jarrod Antflick and Chris Myers, specialising in musculoskeletal services for recreational sportsmen and women, and elite level human and equine athletes.


(c)


Figure 7: Serial scanning of the repair of a complete Achilles rupture at: (a) 4 weeks, (b) 12 weeks and (c) 7 months post- surgery. Tissue repair can be seen as the damaged (red) tissue is replaced by healthy (green) tissue. (J. Antflick, Tendon Performance, 2013)


BOX 2: FORTIUS CLINIC Fortius Clinic provides leading orthopaedic and sports injury treatment, specialising in integrated musculoskeletal care. Our Consultant Foot and Ankle specialists are recognised as leaders in the field of foot and ankle disorders, with particular expertise in arthroscopic treatment. We also offer many non-surgical therapies including the latest evidence-based techniques optimising treatment for Achilles tendon disorders (extra-corporeal shockwave therapy) and Achilles tendon rupture. Mr James Calder, Consultant Orthopaedic Foot and Ankle Surgeon and Dr Jeremiah Healy, Consultant Radiologist are closely involved with the tendinopathy clinic. Both have particular expertise in sports injury.


www.sportEX.net


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