Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy

Abstract

Objective: To describe the subjective pain and functional improvements of a patient with chronic Achilles tendinopathy following a treatment plan incorporating active and passive tissue warm-up, followed respectively by soft tissue mobilization utilizing both Graston Technique(®) and Active Release Techniques(®), eccentric exercise, and static stretching in combination with cryotherapy.

Background: The primary characterization of chronic Achilles tendinopathy is gradual onset of pain and dysfunction focused in one or both Achilles tendons arising secondary to a history of repetitive use or excessive overload.

Intervention and outcome: Conservative treatment is commonly the initial strategy for patient management. Tissue heating, soft tissue mobilization, eccentric training, and static stretching with cryotherapy were implemented to reduce pain and improve function.

Summary: A specific protocol of heat, soft tissue mobilization, eccentric exercise, stretching, and cryotherapy appeared to facilitate a rapid and complete recovery from chronic Achilles tendinopathy.

Keywords: Achilles; Active Release Techniques; Graston Technique; cryotherapy; eccentric exercise; soft tissue therapy; tendinopathy; tendon pathology; thermotherapy.

Figures

Figure 1

Active and passive tissue warm-up utilizing a heat pack in combination with stationary cycling.

Figure 2

Graston Technique® performed on the Achilles tendon.

Figure 3

Active Release Techniques® performed on the gastrocnemius muscle.

Figure 4

Eccentric calf strengthening exercise. a) Start position, b) End Position.

Figure 5

Static stretching with ice pack application. a) Gastrocnemius stretch, b) Soleus stretch.