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Physical Therapist Management of Fluoroquinolone-Induced Achilles Tendinopathy

BL Greene, PT, PhD, OCS, is Assistant Professor, Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, 1441 Clifton Rd, Rm 160, Atlanta, GA 30322 (USA) (bgree02{at}emory.edu)

Address all correspondence to Dr Greene at Emory University

Background and Purpose. Use of fluoroquinolone antibiotics is reported to be a cause of adverse musculoskeletal effects, such as tendinopathies and tendon ruptures. The purpose of this case report is to describe the management and outcomes of a patient with bilateral Achilles tendinopathy secondary to fluoroquinolone antibiotic use. Case Description. The patient was a 41-year-old man who developed bilateral Achilles tendon pain on the third day of levofloxacin use. The physical therapy intervention consisted of an initial phase to reduce stress on the tendon through the use of crutches and orthoses and a second phase to progressively stress the tendon through exercise and functional activities. Outcomes. After 11 weeks of physical therapy (14 treatments), the patient's pain decreased from 3/10 to 1/10 on a visual analog scale and his Lower Extremity Functional Scale score increased from 28/80 to 71/80. Discussion. An overlapping 2-phased intervention approach based on connective tissue remodeling principles may be effective in elimination of pain and restoration of function following fluoroquinolone-induced Achilles tendinopathy.

Key Words: Achilles tendon • Fluoroquinolons • Lower extremity • Musculoskeletal disorders • Physical therapy