Prevalence
True or False: Only sedentary individuals are at risk of Midportion Achilles Tendinopathy
FALSE The prevalence of midportion Achilles tendinopathy occurs in older adults and those with higher athletic involvement
True or false: Training in cold weather is a risk factor for developing Achilles Tendinopathy
TRUE
Diagnosis of midportion Achilles tendinopathy is ______ centimeters distal to the Achilles tendon insertion
>2cm
True or false: Clinicians should counsel patients that they should stop all activity for 1-2 weeks when starting physical therapy treatment for midportion Achilles tendinopathy
False: Clinicians should advise that complete rest is not indicated for individuals with midportion Achilles tendinopathy and that they should continue with their activities within their pain tolerance (B-level evidence)
True or false? The first Thanksgiving feast was eaten outdoors
TRUE
What athletic population reportedly have a 40% to 52% chance (cumulative incidence) of having an Achilles tendon injury in their lifetime?
Runners reportedly have a 40% to 52% chance (cumulative incidence) of having an Achilles tendon injury in their lifetime.
Use of this type of antibiotic therapy is an increased risk factor for Achilles tendinopathy
Fluoroquinolone antibiotic therapy (-floxacine, "Spiro" medications)
What was an important addition to the diagnostic criteria of Achilles tendinopathy compared to the 2018 CPG?
Hint: the 2024 update placed emphasis on movement evoked pain
An important addition to the diagnostic criteria is that Achilles tendinopathy pain is provoked by tendon-loading activities, indicating an emphasis on movement-evoked pain
There is E-level evidence to suggest that patients should use tendon loading exercises at an intensity as high as tolerated for how many days per week?
Individuals using tendon loading exercise for man-aging their Achilles tendinopathy should exercise at least 3 times a week at an intensity as high as tolerated.
What country were the first pumpkin pies made?
Turkey
United States
Canada
England
The first pumpkin pies were made in England
Tenocyte proliferation and neovascularity leads to tendon thickening or thinning?
Tenocyte proliferation and neovascularity leads to tendon thickening
A 14 year old male who is otherwise healthy arrives to the clinic with complaints of pain in his posterior heel. He plays high school basketball and uses rigid insoles. He practices 5 days per week and has more pain about an hour after practice. He denies a specific MOI. What are two potential diagnoses based on this information?
Severs/Calcaneal Apophysitis, Achilles Tendinopathy, calcaneal stress fracture, Achilles tendon ossification
Demonstrate the Royal London Hospital Test which is C-level evidence for diagnosis of midportion Achilles Tendinopathy. Explain what a positive test would be.
Palpated tenderness during active end range PF and DF. A positive test is decreased or elimination of pain with active, end range DF.
Clinicians may use stretching of what muscle group and in what position to reduce pain and improve satisfaction with outcome in patients with midportion Achilles tendinopathy who exhibit limited ankle dorsiflexion range of motion?
Clinicians may use stretching of the ankle plantar flexors with the knee flexed and extended
When was the first Thanksgiving NFL football game?
1928
1936
1940
1945
The first Thanksgiving NFL football game was played between the Chicago Bears and Detroit Lions on November 29, 1936.
The Bears won 19-16.
True or false: A patient presents with a significant curve of their Achilles tendon secondary to rearfoot equinus. Since their tendon abnormality is severe, we can assume that their symptoms will also be severe.
False. The severity of tendon abnormalities are NOT consistently related to the severity of clinical presentation
A prospective study by Hanlon et al identified 4 clinical profiles based on identified impairments, including Activity-dominant, Function-dominant, Psychosocial-dominant, and Structure-dominant, that had different trajectories of recovery with rehabilitation over 6 months.
Which groups had greater functional recovery?
Activity and Function-dominant groups had greater functional recovery than the Psychosocial- and Structure-dominant groups
Localized thickening of the midportion Achilles tendon occurs in what percentage of patients with this diagnosis?
About 75% of patients have a thickening of the midportion Achilles tendon, but 25% of the patients may not have localized thickening
A patient arrives to the clinic with midportion Achilles tendinopathy which was confirmed with testing and palpation in your examination. She states her chiropractor advised her to wear heel lifts in her shoes temporarily help with her pelvic alignment. What does the CPG recommend for the use of heel lifts for midportion Achilles tendinopathy?
C-level evidence: Clinicians may use heel lifts as a therapeutic tool to temporarily reduce ankle dorsiflexion during activity for individuals with midportion Achilles tendinopathy
What causes male turkeys to gobble?
To communicate with other turkeys
To entice female turkeys
To clear their throats
To let others know they are in pain
Male turkeys gobble to entice female turkeys
In Achilles tendonitis, collagen fibril thinning and disorganization occurs which leads to an increase in non-collagen/ fibrocartilage matrix and fat deposition. This in turn leads to a _______ tendon and _______ load transfer.
(weaker/stronger AND decrease/increase/no change)
In Achilles tendonitis, collagen fibril thinning and disorganization occurs which leads to an increase in non-collagen/ fibrocartilage matrix and fat deposition. This in turn leads to a WEAKER tendon and DECREASED load transfer.
A 46 year old female presents to the clinic with pain in her R posterior heel. Her health history includes history of R fibula fracture 5 years ago, currently taking ofloxacin for a UTI, and her BMI is 30. She started playing 1-on-1 basketball with her teenage son last winter, and that is when the pain started.
During your exam, you note weakness in her peroneals and gastroc/soleus muscle groups. She has ankle dorsiflexion to 10 degrees on the involved side. When standing, her static foot posture is excessive pronation and rearfoot equinus. She demonstrates abnormal gait pattern with decreased forward progression of propulsion.
Name at least 2 parts of clinical presentation above that are NOT risk factors for Achilles Tendinopathy.
Risk factors: history of lower leg fracture, taking ofloxacin, training during cold weather, weakness in gastroc/soleus isokinetic strength, and abnormal gait with decreased forward progression of propulsion
NOT risk factors: BMI 30, ankle dorsiflexion 10 deg, weakness in his peroneal muscle group, static foot posture includes excessive pronation
Which of the following is NOT a criteria in the 2024 update for diagnosis of midportion Achilles Tendinopathy?
A. Symptoms are localized to the midportion of the Achilles tendon
B. Achilles tendon pain is provoked by tendon-loading activities
C. Recent increase in activities that involve a large amount of propulsion
D. Pain with palpation of the Achilles tendon midportion
E. Localized thickening of the Achilles in the midportion region of the tendon in more chronic conditions (may be absent)
C. Recent increase in activities that involve a large amount of propulsion
A patient arrives to the clinic with heel pain which started 3 weeks ago after starting his recreational basketball league. He denies a specific MOI but states he has the most pain when walking, running, and ascending stairs. He goes to the gym 4 times per week which includes running and weightlifting and plays on his recreational basketball team once per week. He is still able to play basketball but is concerned about injuring himself further. When ambulating, you note that he has excessive and uncontrolled pronation. What would be the most indicated treatment of the following?
A. Exercise focused on mechanical loading and shoe orthotics to correct overpronation during gait
B. Patient education about continuing activities to their pain tolerance and iontophoresis with dexamethasone
C. Exercise focused on mechanical loading and iontophoresis with dexamethasone
D. Exercise focused on mechanical loading and ultrasound
C. Exercise focused on mechanical loading (A) and iontophoresis with dexamethasone (B)
A-level evidence: exercise with mechanical loading
B-level evidence: patient education
B-level evidence: iontophoresis with dexamethasone
C-level evidence: should NOT use ultrasound
D-level evidence: no recommendation for foot orthoses
How many turkeys do Americans consume per year?
12 million
46 million
65 million
85 million
46 million turkeys