A 35-year-old male was referred by his orthopaedic physician to an outpatient physical therapy clinic with a diagnosis of Achilles tendinosis on his right side. He has experienced a gradual increase in pain for 2 years. His worsening symptoms have limited his ability to run or play basketball. Previous therapies (nonsteroidal anti-inflammatories, ultrasound, manual therapy, custom orthotics) have failed to improve symptoms. His orthopedists has recommended surgery. However, the patient would like to try physical therapy again.