Bilateral Achilles tendinopathy: case report

Background and Purpose: Achilles tendinopathy is a pathology that is very common for runners. While this patient did have tendinopathy symptoms, some of the test results did not add up regarding how the tendon was loaded and his symptom provocation. With this, it was also discovered there were nerve-based symptoms present as well. The purpose of this paper is to highlight the investigation of his symptoms with testing, and the treatment for this atypical Achilles tendinopathy case. Case Description: The patient reported with chronic Achilles pain after running for 2 miles, onset one year prior to the evaluation. Clinically, he presented with bilateral plantarflexor weakness, pain limiting function and participation in running, and neural tension in the tibial nerve pattern. The majority of his treatments consisted of manual therapy, progressive bilateral tendon loading exercises, and nerve glides. Outcomes: Throughout the patient’s plan of care, his straight leg raise response had improved on both limbs (and finally became negative on the right halfway through the course of care). The patient demonstrated an increase in strength and tolerance to plyometric activity, and was even able to return back to running by the time his plan of care ended. Discussion: When performing an evaluation and examination, be mindful of how a pathology would typically present itself. If it present atypically, utilize other tests and measures to address the sources of the patient’s symptoms and to provide interventions that will address their impairments.