Water and land based rehabilitation for Achilles tendinopathy in an elite female runner

A 17 year old female athlete presented with Achilles tendinopathy. A protocol of water and land based rehabilitation was designed to achieve non-weight bearing and pain free activity, so that she could rapidly return to her event (400 m hurdles). After three weeks, she returned to regular training, and after a further three weeks she successfully competed in a 400 m hurdle event. She has been able to compete at national level symptom free for the last 18 months. The Achilles tendon is the largest and strongest tendon in the human body and experiences high loads in all sporting activities. It has been shown to have a high capacity to withstand tensional forces.1 Chronic painful conditions located in the Achilles tendon are relatively common, especially in runners.2 The cause of such conditions is not known, but they are often associated with repetitive loading and overuse.3 Achilles tendinopathy is difficult to treat.1 Most recommend a conservative regimen as the initial strategy.4–6 Non-surgical treatments include a combination of rest, anti-inflammatory drugs, correction of malalignments, and stretching and strengthening exercises. There is sparse scientific evidence that these treatments are successful, and surgical treatment is required in about 25% of patients.1 In a recent prospective study, treatment with heavy load, eccentric calf muscle training showed very promising results and may reduce the need for surgical treatment of tendinopathy located in the mid-portion of the Achilles tendon.1 The short term results of surgery are often very good, but in the few studies with long term follow up there are signs of deterioration with time.1,7 In addition, over the last two decades there has been a considerable increase in the incidence of Achilles tendon rupture.8 Many athletic trainers propose an active land based rehabilitation training …