Achilles tendinopathy is a common condition characterized by pain, stiffness, and swelling in the Achilles tendon, typically resulting from overuse, poor biomechanics, or inadequate recovery following physical activity. The condition can be classified into two types: insertional tendinopathy (where the tendon attaches to the heel bone) and mid-portion tendinopathy (occurring higher up the tendon). Achilles tendinopathy affects approximately 2-3 per 1,000 people annually in the general population. It is a significant issue among athletes, particularly those involved in activities that require running and jumping.

Symptoms include:

• Pain and stiffness in the Achilles tendon, particularly in the morning or after periods of inactivity.
• Swelling and thickening of the tendon.
• Pain that worsens with activity, especially running or jumping.
• Limited range of motion in the ankle.

Causes of Achilles Tendinopathy

Achilles tendinopathy is primarily a result of mechanical overload or repetitive microtrauma to the Achilles tendon. Several factors contribute to the onset and progression of this condition, including intrinsic tendon-related factors, extrinsic factors related to activity and training, and systemic conditions:

• Repetitive Overuse and Mechanical Load, such as Chronic overload or sudden increase in activity
• Biomechanical Abnormalities, including abnormal foot mechanics, leg length discrepancies and poor ankle dorsiflexion
• Age-related degeneration including tendon degeneration or creased healing capacity
• Training Errors and Inappropriate footwear
• Previous Injury and Tendon Weakness

Interventions

Rotator cuff tendinopathy is a common condition affecting the shoulder, especially in individuals who perform repetitive overhead movements or participate in activities that place stress on the shoulder joint. It is a type of rotator cuff injury that involves inflammation, degeneration, or tearing of the tendons in the rotator cuff, a group of four muscles and their associated tendons that stabilize the shoulder. In contrast a frozen shoulder (also known as adhesive capsulitis) is a condition characterised by a dull or aching pain with limited range of motion (ROM).

Symptoms include:

• A dull deep shoulder ache
• Pain that disturbs sleep
• Swelling in the shoulder area
• Limitation or discomfort with overhead movement and with moving the arm behind the back
• Arm weakness
• If left untreated, rotator cuff tendinitis can worsen and lead to a partially or completely torn tendon

Causes of Rotator Cuff Tendinopathy

• Repetitive overhead movements making rotator cuff injuries common across a diverse patient population.
• Trauma such as falls, rapid humeral deceleration with throwers, or high resistive forces applied through the shoulder.
• Individuals over the age of 60 are more prone to rotator cuff injury.
• Subacromial bone spurs can contribute to impingement, leading to an increased likelihood of rotator cuff pathology.
• Weakness or imbalance of muscles surrounding the shoulder joint.

Interventions

Plantar fasciitis is a common condition that causes heel pain due to inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes. Plantar fasciitis is one of the most common causes of heel pain. It is estimated to affect about 1 in 10 people at some point during their lifetime. It is common in athletes, particular runners, due to repetitive stress on the feet. Obesity is a significant risk factor because excess weight increases stress on the plantar fascia.

Symptoms include:

Symptoms include sharp, stabbing pain in the heel, particularly with the first steps in the morning, pain that worsens after long periods of standing or rising for sitting, or pain that typically decreases with activity (but may return after prolonged standing or exercise).

Plantar fasciitis is primarily caused by repetitive mechanical stress on the plantar fascia, leading to microtears and inflammation. Key etiological factors include:

• Overuse and Repetitive Strain: Activities that place excessive stress on the plantar fascia, such as running, dancing, or prolonged standing, can overload the tissue.
• Foot Biomechanics: Abnormal foot mechanics, including overpronation (excessive inward rolling of the foot), flat feet, or high arches, can alter the distribution of force across the foot, increasing strain on the plantar fascia.
• Age-Related Changes: Degenerative changes in the plantar fascia with aging, particularly in individuals over 40, can contribute to a decreased ability to absorb shock, making the fascia more susceptible to injury.
• Obesity: Increased body mass puts additional stress on the plantar fascia, increasing the risk of developing inflammation and pain, especially in individuals with underlying structural abnormalities.
• Improper Footwear: Shoes lacking proper arch support, cushioning, or flexibility, especially when worn for long periods, can exacerbate the strain on the plantar fascia. Heel height and shoe design also play a role in altering foot mechanics.
• Tightness of Adjacent Structures: Tight calf muscles, Achilles tendinopathy, or limited ankle dorsiflexion can increase tension on the plantar fascia, further exacerbating the condition.
• Occupational Factors: Jobs that require standing for prolonged periods or involve repetitive impact (e.g., factory workers, teachers, retail workers) are associated with higher risk due to prolonged loading of the foot.
• Inflammatory or Systemic Conditions:Conditions such as rheumatoid arthritis, ankylosing spondylitis, and reactive arthritis can predispose individuals to plantar fasciitis through inflammation and altered biomechanics.

Interventions

Osteoarthritis (OA) is the most common form of arthritis, characterized by the progressive degeneration of joint cartilage and underlying bone. It commonly affects weight-bearing joints such as the knees, hips, and spine, but can also affect the hands, wrists, and other joints. It's estimated that around 10% of men and 18% of women aged 60 years and older have symptomatic osteoarthritis. By age 65, nearly 30% of people have osteoarthritis, and by age 85, the prevalence increases to around 80%.

The clinical presentation of OA varies depending on the joint involved and the severity of cartilage damage.

Symptoms include:

The primary signs and symptoms of OA include:

• Pain: Joint pain is the hallmark of OA, typically exacerbated by activity or weight-bearing and relieved by rest.
• Stiffness: Can occur in a morning or after periods of inactivity and improves with activity. Stiffness often results in reduced ROM (range of motion).
• Swelling: May occur due to synovial fluid accumulation or inflammation around the joint.
• Crepitus: The sensation or audible sound of grating or crunching (known as crepitus), is commonly felt or heard during movement of the affected joint.
• Joint Instability: Related to functional impairment (a feeling of joint instability or “giving way”) or muscle weakness.
• Decreased Function: OA can cause significant interference with daily activities. Pain, stiffness and weakness all contribute to decreased function.

Risk Factors include age, gender, obesity, joint injuries, genetics and occupational hazards.

Interventions