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Abstract
Achilles tendinopathy is a degenerative process due to excessive and cumulative use of microtrauma with internal and external risk factor. Approximately 52% of runners experience an Achilles tendinopathy (AT) injury during their lifetime. Achilles Tendinopathy can limit Indonesia's athletic performance due to pain on the side of the knee during running, walking and jumping. The aim of this study was to evaluate the physiotherapy management for Achilles Tendinopathy cases in Indonesian para-athletics. This research is a descriptive case studyinvolving one client with participatory observation. The physiotherapy intervention involved modality intervention using Eccentric exercises, ESWT, Stretching, Muscle release, Electrical Stimulation, and Cryotheraphy. The subject of the study was An. B, a 28 year old para athlete with height 182 cm, weight 77 kg, and BMI 23.3 in the ideal category. The patient came to the physiotherapy clinic of NPC Indonesia on 20 August 2023 with complaints of pain and burning in the left leg. Physical examination showed normal results except for pain examination using Numeric Rating Scale (NRS), where silent pain 0/10, tenderness 9/10, and motion pain 7/10 were found. The diagnosis of Achilles Tendinopathy sinistra was confirmed through specific examination. After four physiotherapy sessions Based on the results of studies that have been carried out, ESWT and Eccentric exercise can reduce pain, increase joint range of motion, increase muscle strength, increase ankle stability and improve functional abilities in Achilles tendinopathy patients.
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Copyright (c) 2023 Muhammad Raihan Maulidan, Suryo Saputra Perdana, Amalia Nur Azizah

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References
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- Cooper, K. (2023). Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. https://doi.org/https://doi.org/10.3310/tfws2748
- Garcia, C., Karri, J., & Zacharias, N. A. (2021). Use of Cryotherapy for Managing Chronic Pain : An Evidence-Based Narrative. Pain and Therapy, 10(1), 81–100. https://doi.org/10.1007/s40122-020-00225-w
- Giangarra, C., & Manske, R. (2019). Clinical orthopaedic rehabilitation a team approach. In Journal of Chemical Information and Modeling (Vol. 53, Issue 9).
- Gladman, D., Nash, P., Goto, H., Birt, J. A., Lin, Y., Orbai, A.-M., & Kvien, T. K. (2020). Fatigue numeric rating scale validity , discrimination and responder definition in patients with psoriatic arthritis. 1–8. https://doi.org/10.1136/rmdopen-2019-000928
- International Paralympic Committee. (2015). International Paralympic Committee Athlete Classification Code. November, 21. https://www.paralympic.org/sites/default/files/2020-05/170704160235698_2015_12_17%2BClassification%2BCode_FINAL2_0-1.pdf
- Kingma, J. J., de Knikker, R., Wittink, H. M., & Takken, T. (2007). Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. British Journal of Sports Medicine, 41(6), e3–e3. https://doi.org/10.1136/bjsm.2006.030916
- Kwiecien, S.Y., McHugh, M. P. (2021). The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. https://doi.org/https://doi.org/10.1007/s00421-021-04683-8
- Langberg, H. (2015). Eccentric or Concentric Exercises for the Treatment of Tendinopathies? 45(11), 853–863. https://doi.org/10.2519/jospt.2015.5910
- Maffulli, N., Longo, U. G., Kadakia, A., & Spiezia, F. (2020). Achilles tendinopathy. Foot and Ankle Surgery, 26(3), 240–249. https://doi.org/10.1016/j.fas.2019.03.009
- Malliaras, P. (2022). Physiotherapy management of Achilles tendinopathy. Journal of Physiotherapy, 68(4), 221–237. https://doi.org/10.1016/j.jphys.2022.09.010
- Millar N, Silbernagel K, T. K. et al. (2021). Tendinopathy. https://doi.org/10.1038/s41572-020-00234-1
- Miners, A. L., & Bougie, T. L. (2011). Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. The Journal of the Canadian Chiropractic Association, 55(4), 269–279. http://www.ncbi.nlm.nih.gov/pubmed/22131563%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3222702
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- Olagbegi, O. M., Adegoke, B. O., & Odole, A. C. (2017). Effectiveness of three modes of kinetic-chain exercises on quadriceps muscle strength and thigh girth among individuals with knee osteoarthritis. Archives of Physiotherapy, 7(1), 9. https://doi.org/10.1186/s40945-017-0036-6
- Riel, H., Lindstrøm, C. F., Rathleff, M. S., Jensen, M. B., & Olesen, J. L. (2019). Prevalence and incidence rate of lower- extremity tendinopathies in a Danish general practice : a registry-based study. 4–9.
- Schepsis, A. A., Jones, H., & Haas, A. L. (2002). Achilles Tendon Disorders in Athletes. The American Journal of Sports Medicine, 30(2), 287–305. https://doi.org/10.1177/03635465020300022501
- Silbernagel, K. G., & Crossley, K. M. (2015). A proposed return-to-sport program for patients with midportion achilles tendinopathy: Rationale and implementation. Journal of Orthopaedic and Sports Physical Therapy, 45(11), 876–886. https://doi.org/10.2519/jospt.2015.5885
- Silbernagel, K. G., Hanlon, S., & Sprague, A. (2020). Current clinical concepts: Conservative management of achilles tendinopathy. Journal of Athletic Training, 55(5), 438–447. https://doi.org/10.4085/1062-6050-356-19
- Stania, M., Juras, G., Chmielewska, D., Polak, A., Kucio, C., & Król, P. (2019). Extracorporeal Shock Wave Therapy for Achilles Tendinopathy. BioMed Research International, 2019. https://doi.org/10.1155/2019/3086910
- Utomo D.N. (2018). Cedera tendon achilles (Issue 1).
- van Sterkenburg, M. N., & van Dijk, C. N. (2011). Mid-portion Achilles tendinopathy: why painful? An evidence-based philosophy. Knee Surgery, Sports Traumatology, Arthroscopy, 19(8), 1367–1375. https://doi.org/10.1007/s00167-011-1535-8
- Vanlandewijck, Y. C., & Thompson, W. R. (Eds.). (2011). The Paralympic Athlete. Wiley. https://doi.org/10.1002/9781444328356
- Yoon, S. Y., Kim, Y. W., Shin, I. S., Kang, S., Moon, H. I., & Lee, S. C. (2021). The beneficial effects of eccentric exercise in the management of lateral elbow tendinopathy: A systematic review and meta-analysis. Journal of Clinical Medicine, 10(17). https://doi.org/10.3390/jcm10173968
References
Beyer, R., Kongsgaard, M., Hougs Kjær, B., Øhlenschlæger, T., Kjær, M., & Magnusson, S. P. (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy. The American Journal of Sports Medicine, 43(7), 1704–1711. https://doi.org/10.1177/0363546515584760
Cooper, K. (2023). Exercise therapy for tendinopathy: a mixed-methods evidence synthesis exploring feasibility, acceptability and effectiveness. https://doi.org/https://doi.org/10.3310/tfws2748
Garcia, C., Karri, J., & Zacharias, N. A. (2021). Use of Cryotherapy for Managing Chronic Pain : An Evidence-Based Narrative. Pain and Therapy, 10(1), 81–100. https://doi.org/10.1007/s40122-020-00225-w
Giangarra, C., & Manske, R. (2019). Clinical orthopaedic rehabilitation a team approach. In Journal of Chemical Information and Modeling (Vol. 53, Issue 9).
Gladman, D., Nash, P., Goto, H., Birt, J. A., Lin, Y., Orbai, A.-M., & Kvien, T. K. (2020). Fatigue numeric rating scale validity , discrimination and responder definition in patients with psoriatic arthritis. 1–8. https://doi.org/10.1136/rmdopen-2019-000928
International Paralympic Committee. (2015). International Paralympic Committee Athlete Classification Code. November, 21. https://www.paralympic.org/sites/default/files/2020-05/170704160235698_2015_12_17%2BClassification%2BCode_FINAL2_0-1.pdf
Kingma, J. J., de Knikker, R., Wittink, H. M., & Takken, T. (2007). Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. British Journal of Sports Medicine, 41(6), e3–e3. https://doi.org/10.1136/bjsm.2006.030916
Kwiecien, S.Y., McHugh, M. P. (2021). The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. https://doi.org/https://doi.org/10.1007/s00421-021-04683-8
Langberg, H. (2015). Eccentric or Concentric Exercises for the Treatment of Tendinopathies? 45(11), 853–863. https://doi.org/10.2519/jospt.2015.5910
Maffulli, N., Longo, U. G., Kadakia, A., & Spiezia, F. (2020). Achilles tendinopathy. Foot and Ankle Surgery, 26(3), 240–249. https://doi.org/10.1016/j.fas.2019.03.009
Malliaras, P. (2022). Physiotherapy management of Achilles tendinopathy. Journal of Physiotherapy, 68(4), 221–237. https://doi.org/10.1016/j.jphys.2022.09.010
Millar N, Silbernagel K, T. K. et al. (2021). Tendinopathy. https://doi.org/10.1038/s41572-020-00234-1
Miners, A. L., & Bougie, T. L. (2011). Chronic Achilles tendinopathy: a case study of treatment incorporating active and passive tissue warm-up, Graston Technique, ART, eccentric exercise, and cryotherapy. The Journal of the Canadian Chiropractic Association, 55(4), 269–279. http://www.ncbi.nlm.nih.gov/pubmed/22131563%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3222702
Myhrvold, S. B., Brouwer, E. F., Andresen, T. K. M., Rydevik, K., Amundsen, M., Grün, W., Butt, F., Valberg, M., Ulstein, S., & Hoelsbrekken, S. E. (2022). Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture. New England Journal of Medicine, 386(15), 1409–1420. https://doi.org/10.1056/nejmoa2108447
Nuraini, Y. N. (2018). Tendinitis Achilles Dextra Dengan Aplikasi Ultra Sound. 1–12.
Olagbegi, O. M., Adegoke, B. O., & Odole, A. C. (2017). Effectiveness of three modes of kinetic-chain exercises on quadriceps muscle strength and thigh girth among individuals with knee osteoarthritis. Archives of Physiotherapy, 7(1), 9. https://doi.org/10.1186/s40945-017-0036-6
Riel, H., Lindstrøm, C. F., Rathleff, M. S., Jensen, M. B., & Olesen, J. L. (2019). Prevalence and incidence rate of lower- extremity tendinopathies in a Danish general practice : a registry-based study. 4–9.
Schepsis, A. A., Jones, H., & Haas, A. L. (2002). Achilles Tendon Disorders in Athletes. The American Journal of Sports Medicine, 30(2), 287–305. https://doi.org/10.1177/03635465020300022501
Silbernagel, K. G., & Crossley, K. M. (2015). A proposed return-to-sport program for patients with midportion achilles tendinopathy: Rationale and implementation. Journal of Orthopaedic and Sports Physical Therapy, 45(11), 876–886. https://doi.org/10.2519/jospt.2015.5885
Silbernagel, K. G., Hanlon, S., & Sprague, A. (2020). Current clinical concepts: Conservative management of achilles tendinopathy. Journal of Athletic Training, 55(5), 438–447. https://doi.org/10.4085/1062-6050-356-19
Stania, M., Juras, G., Chmielewska, D., Polak, A., Kucio, C., & Król, P. (2019). Extracorporeal Shock Wave Therapy for Achilles Tendinopathy. BioMed Research International, 2019. https://doi.org/10.1155/2019/3086910
Utomo D.N. (2018). Cedera tendon achilles (Issue 1).
van Sterkenburg, M. N., & van Dijk, C. N. (2011). Mid-portion Achilles tendinopathy: why painful? An evidence-based philosophy. Knee Surgery, Sports Traumatology, Arthroscopy, 19(8), 1367–1375. https://doi.org/10.1007/s00167-011-1535-8
Vanlandewijck, Y. C., & Thompson, W. R. (Eds.). (2011). The Paralympic Athlete. Wiley. https://doi.org/10.1002/9781444328356
Yoon, S. Y., Kim, Y. W., Shin, I. S., Kang, S., Moon, H. I., & Lee, S. C. (2021). The beneficial effects of eccentric exercise in the management of lateral elbow tendinopathy: A systematic review and meta-analysis. Journal of Clinical Medicine, 10(17). https://doi.org/10.3390/jcm10173968