Essay: Physiotherapy on Sport Injury

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Physiotherapy on Sport Injury

ID# Case Management

Case Management Assignment

In this essay thought to be best evidence-based practices for tendinopathy of the Achilles tendon. Tendinopathy has been reported as one of the most common injuries encountered in sports and in the workplace (Woo, Renstrom, & Arnoczky, 2007).tendinopathy is the inability of the Achilles tendon to return to its homeostatic balance. Researchers have gone further to explain that effective treatment can be difficult and depends somewhat on the person giving therapy and treatment. Woo, Renstrom, & Arnoczky, (2007 ) discuss that tendinopathy is a major medical problem associated with sports and physical activity in active people over 25 years of age. They define it as a syndrome of tendon pain, localized tenderness, and swelling that impairs performance. This is diagnosed through taking a history of the patient, though it is also explained that there are no definitive correlations made between history and symptoms.

The Achilles tendon is the single tendon of the soleus and gastrocnemius muscles, inserting into the calcaneum. It has a highly structured peritendinous tissue with no synovial membrane. The blood supply to the tendon enters on the deep (anterior) surface, and appears to be similar in volume throughout its length (Beeton, 2003).

Houglum (2010) defines tendinopathy as an irritation of the tendon that is displayed as pain, swelling, and reduced function. Unless visualized in surgery, the precise structure involved is difficult to determine. The Achilles tendon (AT) is the largest and most powerful tendon in the body. It can be involved in a number of pathological conditions, and often represent the sole manifestation of an underlying ailment. The etiology, pathogenesis, and natural course of AT pathologies are largely unknown, and current management modalities vary considerably depending from the etiological factors. AT pathologies have been associated with a multitude of disorders, such as inflammatory and autoimmune conditions, genetically determined collagen abnormalities, infectious diseases, and neurological conditions . AT is frequently involved in rheumatic disorders, although its clinical recognition is often under-reported (Ames, Longo, Denaro & Maffulli 2008). It is estimated that Achilles tendonitis accounts for around 11% of all running injuries. ("Achilles Tendinitis ( Tendinopathy) what is Achilles Tendonitis?," 2010, p. 1)

Achilles tendinitis is a common problem that affects the ankle. The Achilles tendon, which attaches the calf muscles to the foot, is a thick, ropelike structure that can easily be felt just above the heel. When the tendon becomes degenerated or inflamed, it can cause pain in the back of the ankle; in some cases, it can severely limit the patient's mobility. In the most severe cases (when the tendon is very degenerated), it may lead to Achilles tendon rupture, which generally requires surgery for athletic individuals. Achilles tendinitis often occurs in patients who have tight calf muscles. When the gastrocnemius and soleus are tight, increased stress is placed on the Achilles tendon, which can lead to the onset of symptoms. Achilles tendinitis is also associated with overuse attributed to sports that require running or explosive activity (Robert, n.d)

Currently, there is lack of consensus on the best management of acute Achilles tendon ruptures. Management can be broadly classified into operative open or percutaneous and non-operative cast immobilization or functional bracing (Ebinesan, Sarai, Walley, & Maffulli 2008). Recovery time appears contingent upon the method used for repair as well as the length of time and practices associated with post op treatment. Muscle strain is the term used for a moderate amount of soft-tissue damage to muscle fibers, usually caused by sudden, strenuous movements. Limited bleeding inside the muscle causes tenderness and swelling, which may be accompanied by painful spasms or contractions. Visible bruising may follow. More serious damage, involving a larger number of torn or ruptured fibers, is called a muscle tear. A torn muscle causes severe pain and swelling. Following a medical check to gauge severity, the usual treatment is rest, anti-inflammatory medication, and perhaps physiotherapy. Rarely, surgery may be needed to repair a muscle that has been badly torn. The risk of muscle strains and tears can be reduced by warming-up adequately before exercise (Muscle and Tendon Disorders, n.d.).

Search Strategy: To determine what literature was relevant in this case study key words were utilized during the search.

Key words included, Achilles tendon surgery, post Operations Management, treatment, possible procedures, current methods of treatment, physiotherapy, sports injury and treatments, injury rehabilitation, and diagnosis and prerequisites for treatment. After EBSCO, BJSM, Medline, Cochrane Database, CINAHL Plus, ProQuest, PubMed, Health Source, and Academic Search Elite. A Google Scholar search was conducted, significant information was located regarding Achilles tendonopathy, however, there were no resources that appeared to relate specifically to the post-op treatment of tendonopathy, nor did they appear to address my case (a 28-year-old male suffering from Achilles tendonopathy). Exclusions occurred regarding research for several reasons, first there were articles that though they did discuss tendonopathy the content did not relate to the 28-year-old subject in this case study, secondly, some research and information was more than 15 years old, which in itself did not prove to be an up-to-date nor a reliable source for a current study. Cost was also an issue as there were articles that could have had pertinent information, but were not assessable due to cost restraint issues.

Etiology and Pathophysiology

Ajis, Maffulli, Alfredson, & Almekinders (2010), explain that in the past two to three decades, the incidents of Achilles tendinopathy has increased due to an increase in participation in sports both recreational and competitive. An increase in the reports of Achilles tendon injures by runners has more than doubled. The incidence of Achilles tendinopathy in top-level runners is estimated at around 7-9%. Tendon injuries can fall into two categories, acute or chronic; and the cause can be intrinsic or extrinsic factors. Woo, Renstrom, & Arnoczky,( 2007) explain that chronic tendinopathy includes an increased degree of degeneration with or without inflammation present. Age plays a significant role in the severity of this injury. Tendinopathy can be caused by an interaction of extrinsic factors including training errors, such as excessive distance, intensity, hill work etc. Environmental issues can also play a factor i.e. cold weather. In addition, footwear and equipment may also play a factor in Achilles tendinopathy.

Cook & Khan (2007) explain that understanding the etiology of tendinopathy is a critical aspect of improving knowledge in this area, as it would allow active intervention in athletes prior to the onset of debilitating symptoms or tendon rupture. The cause on tendinopathy is unknown at this time. Peers (2003) reports that Achilles tendinopathy typically presents as exercise induced pain 2 to 6 centimeters proximal to the tendon insertion. Pain most often occurs at the beginning and after exercise. When the pathology progresses, pain will continue during exercise and may interfere with daily activities. Patients with tendonopathy will usually complain of stiffness in the morning.

Hammer (2007) conducted research regarding the etiology of tendinopathy, he explains that overuse injuries can create excessive loading of tissue, especially when it is associated with extrinsic factors, such as biomedical faults and mal-alignments, such as hyperpronation, as in Achilles tendinopathy. As stated in other research hammer confirms that the pathology of tendinopathy is unclear at this time. Houglum (2010) discusses that tendinopathy can occur as a traumatic or an overused condition. The three prevalent theories regarding tendinopathy are a mechanical theory, vascular, and neural.

Case presentation and decision for Post-Operations Management of Achilles tendon

Narrative: Marco, a 28-year-old athlete ( hurdler) complained of pain in the area of his Achilles tendon and lower calf during a running exercise at practice. At the time of injury it was decided that there was evidence of a possible Achilles tendonitis. Immediate evidence was not given as to if this was acute or chronic at the time of initial assessment on the field. No initial assessment was made regarding the location of the injury i.e. At the attachment point to the heel or in the mid-portion of the tendon. It was concluded that Marco would need to have further assessment as well as a health history interview in order to determine the problem and possible treatments. Onsite cold therapy was applied to the area on the right leg.

Assessment was conducted on Marco; he was asked a series of questions regarding the injury and previous pains or issues associated with the affected area. Marco reported that that he has had gradual onset of pain over the past several weeks, on a scale of one to five, five being every time, one being seldom to never, Marco reported that he has had pain with all physical activities and exercises. He mentioned that there was a slight sharp pain in the area of the Achilles tendon while walking and running. Pain was assessed to occur in the morning and during times of rest. Lumps were evident in the area of the Achilles tendon; constant tenderness in the area of injury was also evident. Swelling has occurred over the Achilles tendon. No redness was evident in… [END OF PREVIEW]

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