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Treatment of Achilles Tendinopathies

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Abstract

Achilles tendinopathy is a common problem and often difficult to treat. The best-known and best-researched treatment is mechanical loading, either with eccentric or concentric-eccentric exercises or with a heavy-load, slow-speed (concentric-eccentric) rehabilitation program. To experience a favorable outcome from exercise, the exercises are allowed to cause pain. Therefore, the use of a pain-monitoring model together with a training log will help the patient and the clinician in the balance between overloading and loading enough to achieve a positive response to the exercises. The exercise program needs to continue for at least 12 weeks, and often it needs to be continued for up to a year. It might also be beneficial to combine the exercise treatment with other treatments, such as shock wave therapy, laser therapy, and the use of orthotics. Surgery is considered to be the last option. Patients with insertional Achilles tendinopathy are more likely to need surgery compared with patients with midportion Achilles tendinopathy.

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References

  1. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med. 1992;11:533–78.

    CAS  PubMed  Google Scholar 

  2. Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg. 2014;20:154–9.

    Article  PubMed  Google Scholar 

  3. el Hawary R, Stanish WD, Curwin SL. Rehabilitation of tendon injuries in sport. Sports Med. 1997;24:347–58.

    Article  PubMed  Google Scholar 

  4. Angermann P, Hovgaard D. Chronic Achilles tendinopathy in athletic individuals: results of nonsurgical treatment. Foot Ankle Int. 1999;20:304–6.

    Article  CAS  PubMed  Google Scholar 

  5. Mafi N, Lorentzon R, Alfredson H. Superior short-term results with eccentric calf muscle training compared to concentric training in a randomized prospective multicenter study on patients with chronic Achilles tendinosis. Knee Surg Sports Traumatol Arthrosc. 2001;9:42–7.

    Article  CAS  PubMed  Google Scholar 

  6. Roos EM, Engström M, Lagerquist A, Söderberg B. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy—a randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004;14:286–95.

    Article  PubMed  Google Scholar 

  7. Kujala UM, Sarna S, Kaprio J. Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005;15:133–5.

    Article  PubMed  Google Scholar 

  8. Nielsen RO, Ronnow L, Rasmussen S, Lind M. A prospective study on time to recovery in 254 injured novice runners. PLoS One. 2014;9:e99877.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. Holmes GB, Lin J. Etiologic factors associated with symptomatic Achilles tendinopathy. Foot Ankle Int. 2006;27:952–9.

    Article  PubMed  Google Scholar 

  10. Dowling GJ, Murley GS, Munteanu SE, et al. Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review. J Foot Ankle Res. 2014;7:53.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Jhingan S, Perry M, O’Driscoll G, et al. Thicker Achilles tendons are a risk factor to develop Achilles tendinopathy in elite professional soccer players. Musc Ligam Tendons J. 2011;1:51–6.

    Google Scholar 

  12. Klein EE, Weil L Jr, Weil LS Sr, Fleischer AE. Body mass index and Achilles tendonitis: a 10-year retrospective analysis. Foot Ankle Spec. 2013;6:276–82.

    Article  PubMed  Google Scholar 

  13. Astrom M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop Relat Res. 1995:151–64.

    Google Scholar 

  14. Józsa L, Kannus P. Human tendons. Anatomy, physiology and pathology. Champaign, IL: Human Kinetics; 1997. p. ix, 574 p.

    Google Scholar 

  15. Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22:675–92.

    Article  PubMed  Google Scholar 

  16. Heales LJ, Lim EC, Hodges PW, Vicenzino B. Sensory and motor deficits exist on the non-injured side of patients with unilateral tendon pain and disability—implications for central nervous system involvement: a systematic review with meta-analysis. Br J Sports Med. 2014;48:1400–6.

    Article  CAS  PubMed  Google Scholar 

  17. Tompra N, van Dieen JH, Coppieters MW. Central pain processing is altered in people with Achilles tendinopathy. Br J Sports Med. 2016;50:1004–7.

    Article  PubMed  Google Scholar 

  18. Hutchison AM, Evans R, Bodger O, et al. What is the best clinical test for Achilles tendinopathy? Foot Ankle Surg. 2013;19:112–7.

    Article  PubMed  Google Scholar 

  19. Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22:727–41.

    Article  PubMed  Google Scholar 

  20. Kader D, Saxena A, Movin T, Maffulli N. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. 2002;36:239–49.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Paavola M, Kannus P, Järvinen TA, Khan K, Jozsa L, Järvinen M. Achilles tendinopathy. J Bone Joint Surg Am. 2002;84-A:2062–76.

    Article  Google Scholar 

  22. Järvinen M. Epidemiology of tendon injuries in sports. Clin Sports Med. 1992;11:493–504.

    PubMed  Google Scholar 

  23. Jarvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10:255–66.

    Article  PubMed  Google Scholar 

  24. Kvist M. Achilles tendon injuries in athletes. Sports Med. 1994;18:173–201.

    Article  CAS  PubMed  Google Scholar 

  25. Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol. 1991;80:188–201.

    CAS  PubMed  Google Scholar 

  26. Vora AM, Myerson MS, Oliva F, Maffulli N. Tendinopathy of the main body of the Achilles tendon. Foot Ankle Clin. 2005;10:293–308.

    Article  PubMed  Google Scholar 

  27. Sandmeier R, Renström PA. Diagnosis and treatment of chronic tendon disorders in sports. Scand J Med Sci Sports. 1997;7:96–106.

    Article  CAS  PubMed  Google Scholar 

  28. Maffulli N, Kenward MG, Testa V, Capasso G, Regine R, King JB. Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med. 2003;13:11–5.

    Article  PubMed  Google Scholar 

  29. Pain A. Stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2018: using the evidence to guide physical therapist practice. J Orthop Sports Phys Ther. 2018;48:425–6.

    Article  Google Scholar 

  30. Pollock N, Dijkstra P, Calder J, Chakraverty R. Plantaris injuries in elite UK track and field athletes over a 4-year period: a retrospective cohort study. Knee Surg Sports Traumatol Arthrosc. 2016;24:2287–92.

    Article  PubMed  Google Scholar 

  31. Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007;41:211–6.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Chan O, Morton S, Pritchard M, et al. Intratendinous tears of the Achilles tendon—a new pathology? Analysis of a large 4-year cohort. Musc Ligam Tendons J. 2017;7:53–61.

    Article  Google Scholar 

  33. Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician. 2011;84:909–16.

    PubMed  Google Scholar 

  34. Luck MD, Gordon AG, Blebea JS, Dalinka MK. High association between accessory soleus muscle and Achilles tendonopathy. Skeletal Radiol. 2008;37:1129–33.

    Article  PubMed  Google Scholar 

  35. van Dijk CN, van Sterkenburg MN, Wiegerinck JI, Karlsson J, Maffulli N. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19:835–41.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Chimenti RL, Chimenti PC, Buckley MR, Houck JR, Flemister AS. Utility of ultrasound for imaging osteophytes in patients with insertional Achilles tendinopathy. Arch Phys Med Rehabil. 2016;97:1206–9.

    Article  PubMed  Google Scholar 

  37. Chimenti RL, Cychosz CC, Hall MM, Phisitkul P. Current concepts review update: insertional Achilles tendinopathy. Foot Ankle Int. 2017;38:1160–9.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, Warden SJ, Crossley KM. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. J Foot Ankle Res. 2012;5:15.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med. 2009;19:54–64.

    Article  PubMed  Google Scholar 

  40. Couppe C, Svensson RB, Silbernagel KG, Langberg H, Magnusson SP. Eccentric or concentric exercises for the treatment of tendinopathies? J Orthop Sports Phys Ther. 2015;45:853–63.

    Article  PubMed  Google Scholar 

  41. Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med. 2013;43:267–86.

    Article  PubMed  Google Scholar 

  42. Jonsson P, Alfredson H, Sunding K, Fahlstrom M, Cook J. New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. Br J Sports Med. 2008;42:746–9.

    Article  CAS  PubMed  Google Scholar 

  43. Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26:360–6.

    Article  CAS  PubMed  Google Scholar 

  44. Silbernagel KG, Thomee R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35:897–906.

    Article  PubMed  Google Scholar 

  45. van der Plas A, de Jonge S, de Vos RJ, et al. A 5-year follow-up study of Alfredson’s heel-drop exercise programme in chronic midportion Achilles tendinopathy. Br J Sports Med. 2012;46:214–8.

    Article  PubMed  Google Scholar 

  46. Silbernagel KG, Brorsson A, Lundberg M. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up. Am J Sports Med. 2011;39:607–13.

    Article  PubMed  Google Scholar 

  47. Beyer R, Kongsgaard M, Hougs Kjaer B, Ohlenschlaeger T, Kjaer M, Magnusson SP. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2015;43:1704–11.

    Article  PubMed  Google Scholar 

  48. Silbernagel KG, Gustavsson A, Thomee R, Karlsson J. Evaluation of lower leg function in patients with Achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2006;14:1207–17.

    Article  PubMed  Google Scholar 

  49. Thomee R. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Phys Ther. 1997;77:1690–703.

    Article  CAS  PubMed  Google Scholar 

  50. Silbernagel KG, Thomee R, Thomee P, Karlsson J. Eccentric overload training for patients with chronic Achilles tendon pain—a randomised controlled study with reliability testing of the evaluation methods. Scand J Med Sci Sports. 2001;11:197–206.

    Article  CAS  PubMed  Google Scholar 

  51. Verrall G, Schofield S, Brustad T. Chronic Achilles tendinopathy treated with eccentric stretching program. Foot Ankle Int. 2011;32:843–9.

    Article  PubMed  Google Scholar 

  52. Franettovich Smith MM, Honeywill C, Wyndow N, Crossley KM, Creaby MW. Neuromotor control of gluteal muscles in runners with Achilles tendinopathy. Med Sci Sports Exerc. 2014;46:594–9.

    Article  PubMed  Google Scholar 

  53. Chang YJ, Kulig K. The neuromechanical adaptations to Achilles tendinosis. J Physiol. 2015;593:3373–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Cheatham SW, Lee M, Cain M, Baker R. The efficacy of instrument assisted soft tissue mobilization: a systematic review. J Can Chiropr Assoc. 2016;60:200–11.

    PubMed  PubMed Central  Google Scholar 

  55. Munteanu SE, Scott LA, Bonanno DR, et al. Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2015;49:989–94.

    Article  PubMed  Google Scholar 

  56. Rowe V, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D. Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning. Sports Med. 2012;42:941–67.

    Article  PubMed  Google Scholar 

  57. Firth BL, Dingley P, Davies ER, Lewis JS, Alexander CM. The effect of kinesiotape on function, pain, and motoneuronal excitability in healthy people and people with Achilles tendinopathy. Clin J Sport Med. 2010;20:416–21.

    Article  PubMed  Google Scholar 

  58. Khan KM, Cook JL, Bonar F, Harcourt P, Åstrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999;27:393–408.

    Article  CAS  PubMed  Google Scholar 

  59. Alfredson H, Thorsen K, Lorentzon R. In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain. Knee Surg Sports Traumatol Arthrosc. 1999;7:378–81.

    Article  CAS  PubMed  Google Scholar 

  60. Åström M, Westlin N. No effect of piroxicam on achilles tendinopathy. A randomized study of 70 patients. Acta Orthop Scand. 1992;63:631–4.

    PubMed  Google Scholar 

  61. Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc. 1998;30:1183–90.

    Article  CAS  PubMed  Google Scholar 

  62. Maffulli N, Papalia R, D’Adamio S, Diaz Balzani L, Denaro V. Pharmacological interventions for the treatment of Achilles tendinopathy: a systematic review of randomized controlled trials. Br Med Bull. 2015;113:101–15.

    Article  CAS  PubMed  Google Scholar 

  63. Alfredson H. Conservative management of Achilles tendinopathy: new ideas. Foot Ankle Clin. 2005;10:321–9.

    Article  PubMed  Google Scholar 

  64. Kearney RS, Parsons N, Metcalfe D, Costa ML. Injection therapies for Achilles tendinopathy. Cochrane Database Syst Rev. 2015:CD010960.

    Google Scholar 

  65. Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion Achilles tendinopathy: a randomized double-blinded prospective study. Am J Sports Med. 2017;45:2034–43.

    Article  PubMed  Google Scholar 

  66. Lin MT, Chiang CF, Wu CH, Hsu HH, Tu YK. Meta-analysis comparing autologous blood-derived products (including platelet-rich plasma) injection versus placebo in patients with Achilles tendinopathy. Arthroscopy. 2018;34:1966–75.e5.

    Article  PubMed  Google Scholar 

  67. Zhang YJ, Xu SZ, Gu PC, et al. Is platelet-rich plasma injection effective for chronic Achilles tendinopathy? A meta-analysis. Clin Orthop Relat Res. 2018;476:1633–41.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Maffulli N, Spiezia F, Longo UG, Denaro V, Maffulli GD. High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon. Phys Ther Sport. 2013;14:163–7.

    Article  PubMed  Google Scholar 

  69. Wheeler PC, Tattersall C. Novel interventions for recalcitrant Achilles tendinopathy: benefits seen following high-volume image-guided injection or extracorporeal shockwave therapy—a prospective cohort study. Clin J Sport Med. 2018.

    Google Scholar 

  70. Chaudhry FA. Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review. Eur J Orthop Surg Traumatol. 2017;27:441–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Alfredson H, Ohberg L. Sclerosing injections to areas of neo-vascularisation reduce pain in chronic Achilles tendinopathy: a double-blind randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2005;13:338–44.

    Article  PubMed  Google Scholar 

  72. Ebbesen BH, Molgaard CM, Olesen JL, Gregersen HE, Simonsen O. No beneficial effect of Polidocanol treatment in Achilles tendinopathy: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc. 2018;26:2038–44.

    Article  CAS  PubMed  Google Scholar 

  73. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010;376:1751–67.

    Article  CAS  PubMed  Google Scholar 

  74. Wetke E, Johannsen F, Langberg H. Achilles tendinopathy: a prospective study on the effect of active rehabilitation and steroid injections in a clinical setting. Scand J Med Sci Sports. 2015;25:e392–9.

    Article  CAS  PubMed  Google Scholar 

  75. Rompe JD, Nafe B, Furia JP, Maffulli N. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of tendo Achillis: a randomized controlled trial. Am J Sports Med. 2007;35:374–83.

    Article  PubMed  Google Scholar 

  76. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37:463–70.

    Article  PubMed  Google Scholar 

  77. Furia JP, Rompe JD, Cacchio A, Del Buono A, Maffulli N. A single application of low-energy radial extracorporeal shock wave therapy is effective for the management of chronic patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2013;21:346–50.

    Article  PubMed  Google Scholar 

  78. Haake M, Konig IR, Decker T, Riedel C, Buch M, Muller HH. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis: a randomized multicenter trial. J Bone Joint Surg Am. 2002;84-A:1982–91.

    Article  CAS  Google Scholar 

  79. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med. 2006;34:733–40.

    Article  PubMed  Google Scholar 

  80. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. Am J Sports Med. 2015;43:752–61.

    Article  PubMed  Google Scholar 

  81. Bjordal JM, Lopes-Martins RA, Iversen VV. A randomised, placebo controlled trial of low level laser therapy for activated Achilles tendinitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med. 2006;40:76–80.. discussion 76-80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Salate AC, Barbosa G, Gaspar P, et al. Effect of In-Ga-Al-P diode laser irradiation on angiogenesis in partial ruptures of Achilles tendon in rats. Photomed Laser Surg. 2005;23:470–5.

    Article  PubMed  Google Scholar 

  83. Reddy GK, Stehno-Bittel L, Enwemeka CS. Laser photostimulation of collagen production in healing rabbit Achilles tendons. Lasers Surg Med. 1998;22:281–7.

    Article  CAS  PubMed  Google Scholar 

  84. Tumilty S, Munn J, McDonough S, Hurley DA, Basford JR, Baxter GD. Low level laser treatment of tendinopathy: a systematic review with meta-analysis. Photomed Laser Surg. 2010;28:3–16.

    Article  PubMed  Google Scholar 

  85. Hutchison AM, Pallister I, Evans RM, et al. Intense pulsed light treatment of chronic mid-body Achilles tendinopathy: a double blind randomised placebo-controlled trial. Bone Joint J. 2013;95-b:504–9.

    Article  CAS  PubMed  Google Scholar 

  86. Tumilty S, Mani R, Baxter GD. Photobiomodulation and eccentric exercise for Achilles tendinopathy: a randomized controlled trial. Lasers Med Sci. 2016;31:127–35.

    Article  PubMed  Google Scholar 

  87. Enwemeka CS. The effects of therapeutic ultrasound on tendon healing. A biomechanical study. Am J Phys Med Rehabil. 1989;68:283–7.

    Article  CAS  PubMed  Google Scholar 

  88. Chester R, Costa ML, Shepstone L, Cooper A, Donell ST. Eccentric calf muscle training compared with therapeutic ultrasound for chronic Achilles tendon pain—a pilot study. Man Ther. 2008;13:484–91.

    Article  PubMed  Google Scholar 

  89. Robertson VJ, Baker KG. A review of therapeutic ultrasound: effectiveness studies. Phys Ther. 2001;81:1339–50.

    CAS  PubMed  Google Scholar 

  90. Wilson JJ, Best TM. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician. 2005;72:811–8.

    PubMed  Google Scholar 

  91. Lohrer H, David S, Nauck T. Surgical treatment for achilles tendinopathy—a systematic review. BMC Musculoskelet Disord. 2016;17:207.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Tallon C, Coleman BD, Khan KM, Maffulli N. Outcome of surgery for chronic Achilles tendinopathy. A critical review. Am J Sports Med. 2001;29:315–20.

    Article  CAS  PubMed  Google Scholar 

  93. Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports. 2000;10:2–11.

    Article  CAS  PubMed  Google Scholar 

  94. Yuan J, Murrell GA, Wei AQ, Appleyard RC, Del Soldato P, Wang MX. Addition of nitric oxide via nitroflurbiprofen enhances the material properties of early healing of young rat Achilles tendons. Inflamm Res. 2003;52:230–7.

    Article  CAS  PubMed  Google Scholar 

  95. Paoloni JA, Appleyard RC, Nelson J, Murrell GA. Topical glyceryl trinitrate treatment of chronic noninsertional achilles tendinopathy. A randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2004;86-A:916–22.

    Article  Google Scholar 

  96. Paoloni JA, Murrell GA. Three-year followup study of topical glyceryl trinitrate treatment of chronic noninsertional Achilles tendinopathy. Foot Ankle Int. 2007;28:1064–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden

    Jon Karlsson, Annelie Brorsson & Unnur Jónsdóttir

  2. Department of Physical Therapy, University of Delaware, Newark, DE, USA

    Karin Grävare Silbernagel

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  1. Jon Karlsson
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  2. Annelie Brorsson
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  3. Unnur Jónsdóttir
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  4. Karin Grävare Silbernagel
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Correspondence to Jon Karlsson .

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Editors and Affiliations

  1. Orthopedics and Traumatology, State University of Campinas – UNICAMP, Campinas / Sao Paulo, Brazil

    Sérgio Rocha Piedade

  2. Orthopaedic Sports Medicine, University of Munich (TUM), München, Bayern, Germany

    Andreas B. Imhoff

  3. Ascot Hospital, Auckland, New Zealand

    Mark Clatworthy

  4. Department of Orthopedics & Traumatology, Federal University of São Paulo, Vila Clementino - São Paulo, São Paulo, Brazil

    Moises Cohen

  5. Espregueira-Mendes Sports Centre, Clínica do Dragão, Porto, Portugal

    João Espregueira-Mendes

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Karlsson, J., Brorsson, A., Jónsdóttir, U., Silbernagel, K.G. (2019). Treatment of Achilles Tendinopathies. In: Rocha Piedade, S., Imhoff, A., Clatworthy, M., Cohen, M., Espregueira-Mendes, J. (eds) The Sports Medicine Physician. Springer, Cham. https://doi.org/10.1007/978-3-030-10433-7_13

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