title: JOINT MOBILIZATION IN THE MANAGEMENT OF PERSISTENT INSERTIONAL ACHILLES TENDINOPATHY: A CASE REPORT.
abstract: OBJECTIVE
  Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise.
  
  
  METHODS
  A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms.
  
  
  RESULTS
  The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up.
  
  
  CONCLUSIONS
  Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function.
  
  
  METHODS
  Therapy, Level 4.
authors.affiliation: The George Washington University Program in Physical Therapy, Washington, DC, USA.
authors.forename: Dhinu J
authors.initials: DJ
authors.lastname: Jayaseelan
authors.affiliation: University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Post
authors.affiliation: University of Montana, School of Physical Therapy and Rehabilitation Sciences, Missoula, MT, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Mischke
authors.affiliation: University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors.forename: Josiah D
authors.initials: JD
authors.lastname: Sault
keywords: Achilles tendon; Ankle; manual therapy; pain