Royal London Hospital Test

What is Achilles tendinopathy?

Achilles tendinopathy is characterized by pain, swelling, and impaired performance of the Achilles tendon, the thick band of tissue connecting the calf muscles to the heel bone. Due to repetitive strain and overuse, this condition commonly affects athletes, particularly those engaged in running and jumping sports.

Symptoms of this type of tendinopathy

Achilles tendinopathy manifests through various symptoms that affect the structure and function of the tendon. Individuals may experience markedly reduced flexibility and persistent local tenderness in the tendon sheath. During tendon palpation, thickening of the tendon might be noticed, which is a key indicator of the condition.

Symptoms often worsen with activities that stress the tendon, such as knee flexion or walking, leading to increased local tenderness in the tender portion of the Achilles tendon. As the tendinopathy progresses, these symptoms may become more pronounced, significantly impacting daily activities and mobility.

Causes of this type of tendinopathy

Achilles tendinopathy is primarily caused by repetitive microtrauma to the tendon fibers, often from activities involving excessive tendon loading, such as running or jumping. Contributing factors include improper footwear that fails to support the foot or distribute the load evenly and inadequate stretching, which leads to decreased tendon flexibility and resilience.

Additionally, biomechanical irregularities, such as flat feet, can exacerbate stress on the tendon, leading to changes in tendon thickness and palpation findings. Over time, these factors collectively contribute to the positive findings of tendinopathy, characterized by thickened tendons, local tenderness, and pain considered positive during clinical assessments.

What is the Royal London Hospital Test?

The Royal London Hospital Test is a specialized clinical evaluation designed to assess the condition of the Achilles tendon, particularly to detect the presence of tendinopathy. This test is valuable in the diagnostic process because it focuses on the mechanical and functional aspects of the tendon under stress.

The Royal London Hospital Test is a specialized clinical evaluation designed to assess the condition of the Achilles tendon, particularly to detect the presence of tendinopathy. This test is valuable in the diagnostic process because it focuses on the mechanical and functional aspects of the tendon under stress.

During the assessment, clinicians manually palpate the Achilles tendon to identify any areas of tenderness, which may indicate inflammation or damage. The patient is then asked to move their foot into maximum dorsiflexion and plantar flexion while the clinician re-palpates the tender spot. The change in pain level during these movements helps determine the presence or absence of Achilles tendinopathy.

The test is considered positive if the initial pain at the tender spot significantly decreases or disappears when the ankle is dorsiflexed. On the other hand, if the pain remains unchanged or worsens during dorsiflexion, it may indicate a negative result.

Common treatments for Achilles tendinopathy

The treatment of Achilles tendinopathy is aimed at alleviating pain and facilitating the tendon's recovery. Effective management strategies include:

• Physical therapy: Tailored exercises are crucial to strengthen the calf muscles and enhance tendon function and flexibility. This therapy also focuses on stretching exercises to increase tendon elasticity and reduce stiffness.
• Extracorporeal Shock Wave Therapy (ESWT): This non-invasive treatment uses shock waves to stimulate healing in the injured tendon. It's particularly useful for cases resistant to conventional treatments.
• Conservative management: The RICE protocol—Rest, Ice, Compression, and Elevation—is a foundational approach, especially soon after the injury. Additionally, over-the-counter or prescribed pain medications can effectively manage acute discomfort.
• Eccentric training: Gradual loading exercises that lengthen the tendon under tension can help remodel the tendon tissues and alleviate symptoms.
• Orthotic supports: Custom orthotics or heel lifts can reduce strain on the tendon by adjusting abnormal mechanics that contribute to tendon stress.

These therapies reduce immediate symptoms and implement long-term changes that prevent recurrence. Each patient's treatment plan may vary, often combining several options based on severity and specifics.