Provocation With Progressive Loading Is the Most Common Diagnostic Method for Achilles Tendinopathy: An International Cross-Sectional Study of 1048 Physiotherapists

OBJECTIVE: To explore and define the diagnostic criteria and practices employed by physiotherapists worldwide for Achilles tendinopathy. DESIGN: A cross-sectional study using an anonymous online survey distributed to physiotherapists internationally. The survey captured diagnostic criteria, use of objective tests, and imaging techniques in the management of Achilles tendinopathy. METHODS: The survey, collaboratively designed by experts in Achilles tendinopathy, comprised 27 questions covering demographic information, diagnostic practices, and the use of imaging. The survey was disseminated through various social media platforms and professional events. All data were collected via REDCap. RESULTS: One thousand and forty-eight physiotherapists completed the survey. Physiotherapists reported that symptom response to a series of progressive Achilles loadings tests (92%), pain tolerance palpating the Achilles tendon (79.8%) and visual comparison of the Achilles tendon (63.8%) were helpful objective tests to establish a diagnosis of Achilles tendinopathy. The most commonly referred form of imaging was ultrasound at radiology clinics (n = 460, 63.3%). CONCLUSION: This global survey provides clinical perspective of physiotherapists diagnosing Achilles tendinopathy Although using a progressive loading protocol to form a clinical diagnosis, physiotherapists were also using pain elicited on palpation to further establish diagnosis of Achilles tendinopathy, despite recent studies that have demonstrated Achilles palpation pain is present in a variety of posterior ankle conditions and that there is no standardized pressure for palpation. JOSPT Open 2025;3(1):93-98. Epub 2 October 2024. doi:10.2519/josptopen.2024.0080