Tennis and Achillies Tendinopathy
Tennis is a non-contact sport which can be enjoyed by people of all ages in both a social and competitive manner. Due to the need for fast foot work and change of direction, ankle injuries; both serious and mild are very common within the tennis community. Continuous mild injuries and stress placed upon the achillies tendon, which crosses the ankle joint, can lead to overuse or chronic disability within the structure.
Achillies tendinopathy is a common degenerative injury among athletes who are involved in a lot of running. Development of the condition can occur due to a number of issues including; muscle power and tendon elasticity imbalance, a sudden increase in training intensity or duration and inadequate warm up or stretching before the completion of an explosive activity. Achillies tendinopathy in middle-long distance runners compared to both white collar and blue collar workers has been found to be statistically significant.
Diagnosing a suspected achillies tendinopathy, requires a full history covering past treatment, medication, medical conditions, training patterns, past training patterns and footwear use. Palpation of the achillies tendon at insertion mid portion, origin and surrounding tissues should be complete and in many circumstances the use of US or MRI may be appropriate to confirm the diagnosis.
It is suspected that tendon degeneration begins long before symptoms begin and may even remain asymptomatic in some cases. Early diagnosis is of practical relevance particularly in high performance sport. Despite popular belief found there to be no significant link between gender and achillies tendinopathy development.
It has been described tendinopathy to be on a continuum which incorporates 3 inter-weaving stages and suggests that each may be required to be managed differently depending where on the continuum the pathology resides.
Reactive Tendinopathy: Is a non-inflammatory response to compressive or acute tensile forces which develops a thickening and therefore increased cross section of the tendon, usually due a sudden increase in activity which an individual may not be used too. There is no change in the vascularity of the tendon matrix and collagen is mostly maintained at this point.
Tendon Disrepair: Is seen as a tendon which will make an attempt to repair, as seen in the reactive tendon but suffers from increase matrix breakdown and collagen separation. The placement of this within the spectrum will generally be associated with high intensity or repetitive load over a long duration. It is still somewhat possible to reverse anatomical and physiological changes at this point.
Tendon Degeneration: Is clearly identified by changes to the matrix and cells within the tendon. The ability of the tendon to reverse any possible pathology has diminished and some cell apoptosis has occurred. Through imaging these is visualization of extensive changes around the area of concern.