On initial presentation, the athlete was treated with anti-inflammatory drugs. Although the symptoms decreased, the Achilles tendinopathy was not resolved. Kader et al aintain that Achilles tendinitis is a degenerative, not an inflammatory, condition. Although the present case was an early stage of Achilles tendinopathy, it also was not an inflammatory condition. In our case study, a water based exercise programme was devised for the Achilles tendinopathy because it limits weight bearing using buoyancy. During the rehabilitation period, it is very important to protect the muscle-tendon unit from excessive torque or damaging vibrational forces. Premature loading of a damaged Achilles tendon can cause a number of adverse chemical, metabolic, and vascular changes. Rehabilitation progresses consistently when inflammation is kept to a minimum. Therefore, the aquatic rehabilitation programme provided the early initiation of specific exercises (strengthening, stretching, and balance exercises of the ankle joint) to prevent atrophy, motion loss, and abnormal movement pattern development. The cardiovascular swimming programme had two positive effects. Firstly, it maintained the athlete`s cardiovascular condition, which is also an important aspect of early intervention. Secondly, as supported by many studies it had positive effects on the healing tissues. These effects include increased blood flow and neurological stimulation, with minimisation of adjacent tissue weakness and adverse psychological effect. However, it is important that the athlete works within the constraints of his/her limitations. Passive and active (later) stretching exercises were necessary to maintain normal gait and facilitate normal anthropokinematics of the ankle and calf. Both types of stretching can be performed in or out of the water. The wobble board exercises are good for stimulating proprioception.15 Water is an ideal environment for proprioception training because of its viscosity. Viscosity provides a slow motion, three dimensional resistive environment which facilitates proprioceptive feedback through functional movement patterns. This proprioceptive activity enables the athlete to incorporate safely advanced levels of dynamic stabilisation earlier in the rehabilitation schedule by decreasing both the demands of deceleration and joint excursion. During the early phase (first week), static and isometric exercises were performed. Dynamic activity was contraindicated because of the joint compression, vibration, and torsional forces that accompany these techniques, resulting in increased pain and inflammation. The athlete in this study was able to perform mild dynamic exercises (second week) earlier in the pool because of minimisation of some of these forces in this environment. Concentric and eccentric loading in single and then multiple planes (late phase) encouraged normal gastrocnemius and soleus function. Aquatic rehabilitative exercises for Achilles tendinopathy provide an opportunity for the athlete to train in a gravity minimised environment while being immersed in a resistive medium. The unloading is critical as rehabilitation time can be minimised because safe and functional rehabilitation can be started immediately. This can minimise the injury and reduce recovery time. The aquatic and land based programme reported here offered an effective rehabilitation protocol for the female athlete. However, a case study does not allow generalisation of the conclusions. Further investigation is needed to estimate the effectiveness of this early intervention in achieving rapid return to unlimited activity.
© Copyright 2003 British Journal of Sports Medicine. BMJ Publishing Group Ltd of the BMA. Alle Rechte vorbehalten.