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

Eligibility Criteria

• 1. Adult \>18 years old that is able to speak English.
• 2. Report of at least 3 months of Achilles pain clinically diagnosed as Achilles tendonitis or Achilles tendinopathy
• 3. Patient has not had physical therapy, massage therapy, chiropractic treatment or injections for Achilles pain in the last 6 months:
• 4. 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
• 1. 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.
• 2. History of previous Achilles tendon surgery, ankle arthrodesis, hind foot fracture, or leg length discrepancy of more than one half inch.
• 3. History of arthrosis or arthritis of the ankle and/or foot.
• 4. History of significant ankle and/or foot instability
• 5. Two or more positive neurologic signs consistent with nerve root compression, including any two of the following:
• 1. Muscle weakness involving a major lower extremity muscle group
• 2. Diminished lower extremity patella or Achilles tendon reflexes
• 3. Diminished / absent sensation in any lower extremity dermatome
• 6. Involvement in litigation or worker's compensation regarding foot pain
• 7. Any condition that might contraindicate the use of electro-needling
• 8. The patient is pregnant.