Jayaseelan Dhinu J, Post Andrew A, Mischke John J, Sault Josiah D
The George Washington University Program in Physical Therapy, Washington, DC, USA.
University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
Int J Sports Phys Ther. 2017 Feb;12(1):133-143.
BACKGROUND & PURPOSE: Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise.
A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms.
The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up.
Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function.
Therapy, Level 4.
跟腱附着点肌腱病（IAT）保守治疗颇具挑战性。离心运动常用于慢性肌腱病的治疗；然而，相较于肌腱中部功能障碍，它对跟腱附着点问题的帮助可能没那么大。尽管目前关于IAT物理治疗管理的证据在不断发展，但最佳实践描述仍存在空白。本病例报告的目的是描述一名持续性IAT患者采用基于损伤的关节松动术、自我松动术和运动的治疗过程。
一名51岁男性因足跟后部疼痛和跑步能力下降前来接受物理治疗。他此前看过多位物理治疗师，但仍有持续的功能障碍和功能受限。进行了基于关节的非推力松动术和自我松动术练习，以提高他的跑步能力并减轻症状。
该患者在两个月内接受了4次治疗。他在足踝活动量表和维多利亚运动评估-跟腱量表上取得了具有临床意义的改善，无症状，并参加了多次马拉松比赛。一年随访时改善情况得以维持。
活动度不足可能导致肌腱病的发生，若不解决运动受限问题，与肌腱病相关的症状和功能下降可能会持续存在。在综合治疗方案中，针对关节的手法治疗可能是一种有益的干预措施，可使慢性肌腱改变的患者优化功能。
治疗，4级。
