Electrical DN as an Adjunct to Eccentric Exercise, Stretching + MT for Achilles Tendinopathy

Patients with achilles tendinopathy will be randomized to receive 8-10 treatments (1-2 treatments per week) over 6 weeks (10 treatments max) of either: (1)Eccentric exercise, stretching, manual therapy and electrical dry needling or 2. eccentric exercise, stretching and manual therapy

Inclusion criteria

• Adult >18 years old that is able to speak English.
• Report of at least 3 months of Achilles pain clinically diagnosed as Achilles tendonitis or Achilles tendinopathy
• Patient has not had physical therapy, massage therapy, chiropractic treatment or injections for Achilles pain in the last 6 months:
• Diagnosis of noninsertional tendinopathy, defined as the following

• Subjective report of pain located 2-6 cm proximal to the insertion of Achilles tendon to the calcaneus, particularly with running or jumping
• Tenderness to palpation of the Achilles tendon while the clinician gently squeezes the tendon between the thumb and index finger in a proximal to distal direction
• Positive Arc Sign - Intratendinous swelling moves relative to the malleoli with the tendon during active dorsi/plantar Flexion
• Royal London Test - Tenderness to palpation decreases significantly or disappears with max dorsiflexion

Exclusion criteria

• Report of red flags to manual physical therapy to include: hypertension infection, diabetes, peripheral neuropathy, heart disease, stroke, chronic ischemia, edema, severe vascular disease, malignancy, etc.
• History of previous Achilles tendon surgery, ankle arthrodesis, hind foot fracture, or leg length discrepancy of more than one half inch.
• History of arthrosis or arthritis of the ankle and/or foot.
• History of significant ankle and/or foot instability
• Two or more positive neurologic signs consistent with nerve root compression, including any two of the following:

• Muscle weakness involving a major lower extremity muscle group
• Diminished lower extremity patella or Achilles tendon reflexes
• Diminished / absent sensation in any lower extremity dermatome
• Involvement in litigation or worker's compensation regarding foot pain
• Any condition that might contraindicate the use of electro-needling
• The patient is pregnant.