Dry Needling and Exercise for Mid-portion Achilles Tendinopathy

The purpose of this study is to determine if adding ultrasound-guided tendon dry needling with mechanical needle stimulation to a standard heavy, slow resistance (HSR) exercise program improves outcomes for individuals with chronic midportion Achilles tendinopathy. Achilles tendinopathy is a common condition causing long-term pain and reduced function in the main heel tendon. All participants in this study will engage in a standardized 12-week physical therapy exercise program targeting the calf and Achilles tendon complex. Exercises are performed three times per week, combining supervised clinic sessions and home exercises, with the workload safely progressing over time based on individual performance and pain monitoring. In addition to the standard exercise program, participants will be randomly assigned to one of two groups to evaluate the effect of the dry needling procedure. The experimental group will receive 6 sessions of ultrasound-guided tendon dry needling over approximately 6 weeks, where fine needles are inserted into the affected area of the tendon and gently rotated under ultrasound visualization to stimulate tissue remodeling. The control group will receive an identical schedule of "sham" (placebo) needling, using a toothpick device inside a needle sheath to mimic the sensation without actually penetrating the skin. Improvements in pain, physical function, and physical performance (such as a heel-rise endurance test) will be recorded at baseline, 6 weeks, 12 weeks, and 26 weeks. Ultrasound imaging will also be used to evaluate structural changes inside the tendon, such as thickness and blood flow. The primary objective is to compare changes in Achilles-specific pain and function scores between the two groups at the conclusion of the 12-week intervention to determine if actual dry needling provides superior therapeutic benefits compared to exercise alone.

Inclusion Criteria: * Symptoms in one or both Achilles tendons * Pain reported in Achilles with running, jumping or walking * Symtom duration ≥ 6 weeks * Age 18-64 * English-speaking Exclusion Criteria: * Score \> 80 on VISA-A * Prior Achilles rupture or surgery * Pain reported in Achilles insertion to calcaneus only * Needle phobia * Self-reported pregnancy * Trainee status * Corticosteroid injection in the past 3 months into the Achilles tendon * Unable to participate in 12 week program * Taken Quinolone antibiotics past three months (e.g. Cipro, Levaquin, Floxin, Baxdela) * Currently undergoing separation from the military * Diagnosis of rheumatoid arthritis, systemic connective tissue disorder, or neurological disorder affecting the lower leg. * Symptoms in Achilles tendon are from another source (e.g. S1 radicular pain, referred pain, sural nerve entrapment) * Currently undergoing active physical therapy elsewhere for Achilles pain