title: The EdUReP approach plus manual therapy for the management of insertional Achilles tendinopathy.
abstract: Insertional Achilles tendinopathy (IAT) is a challenging overuse disorder. The aim of this case report was to study the feasibility of a comprehensive rehabilitative approach according to the Education, Unloading, Reloading, and Prevention (EdUReP) framework combined with Instrument-Augmented Soft Tissue Mobilization (I-ASTM). An active 51-year-old man patient with chronic IAT was studied. Clinical assessment battery was composed by visual analogue scale for pain during the Achilles tendon palpation test, passive straight leg raise test, single leg hop test, Patient-Specific Functional Scale, and Foot and Ankle Ability Measure. The patient was treated over a 8 weeks period using the EdUReP guidelines plus 8 sessions of I-ASTM, applied with a solid instrument to the Achilles tendon and to the muscle fibrotic areas previously identified during evaluation. Clinically significant improvements were observed in all outcome measures, and a resume of patient's usual sports activities without pain or limitations was possible after treatment. Results lasted over a 6-month follow-up. To the best of our knowledge, this is the first study applying a comprehensive approach based on accurate physical assessment, and using the EdUReP theoretical model. The combination of the EdUReP model and manual therapy was effective in resolving the patient's symptoms and restore his usual sport activities. While these results cannot be generalized, the present findings could provide a valuable foundation for future researches.
authors.affiliation: Division of Physical Medicine and Rehabilitation, Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Istituti Clinici Scientifici Maugeri SpA-SB, Scientific Institute of Veruno, IRCCS, Veruno, Novara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sartorio
authors.affiliation: Private Practitioner, Nebbiuno, Novara, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Zanetta
authors.affiliation: Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri SpA-SB, Scientific Institute of Lissone, IRCCS, Lissone, Monza Brianza, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ferriero
authors.affiliation: Italian Society of Physiotherapy, Florence, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Bravini
authors.affiliation: Division of Physical Medicine and Rehabilitation, Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Istituti Clinici Scientifici Maugeri SpA-SB, Scientific Institute of Veruno, IRCCS, Veruno, Novara, Italy - stefano.vercelli@icsmaugeri.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Vercelli
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000503:physiopathology; D001265:Athletic Injuries; D001696:Biomechanical Phenomena; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000379:methods; D010146:Pain / Q000503:physiopathology; D010147:Pain Measurement; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D052256:Tendinopathy / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D064232:Visual Analog Scale