Achilles tendinopathy is a common cause of heel pain and is common in running or jumping sports. The management of Achilles Tendinopathy is important to get right, and based on our clinical experience early treatment results in better outcomes and less recurrence.
The Achilles tendon is a strong, thick, fibrous band that connects the calf muscle to the calcaneus (heel bone). As with most other tendon injuries, they often get overloaded over a period of time (such as from excessive running or jumping, or sudden increase in intensity of walking or running) and the tissue fibres get disrupted. In the early stages, symptoms are mild, such as localised pain or stiffness in pert of the tendon or slight discomfort when first starting to run, but then eases off into the run. If the tendon overload is not addressed at this stage, the tendon disruption will worsen. Pain becomes more apparent, and the tendon may appear to be “lumpy” or swollen. Running or jumping (or even walking if severe) is affected and becomes harder to do.
The management of tendinopathy in all stages is LOAD MANAGEMENT. Contrary to what most people would assume, complete rest will worsen the condition and make is much harder to return to function later on. Tendons are structures that like load but the key to a healthy tendon is consistent and APPROPRIATE loading. In an acutely sore tendon, cutting back on load is essential and allows pain to go away and the tendon to heal. It may involve change in sport for a few weeks, cutting back on running and doing sports without running or jumping. Simple pain killers may help if the pain is quite severe, and given that there is very little inflammation in overload tendinopathy, anti-inflammatories are not usually effective.
Some other “Do Nots” if you do have acute Achilles Tendinopathy are calf stretching or massaging the tendon. When a tendon is unhappy, direct stretch or compression on the tendon will aggravate it. If tight calf muscles are contributing to the problem, massage or foam roll the calf muscle so that it stops tugging on the tendon. Isometric heel raises are “Panadol exercises” which can load the tendon in a healthy way, and to build up the healthy tendon structure around the disrupted tendon (think of the Donut analogy – unhealthy tendon is the hole, healthy tendon is the yummy donut bit!). Then, you will need a graduated rehabilitation program to increase load and types of load to the tendon to get you back to more function and eventually back to sport.
Apart from excessive external loading, the Achilles tendon can be overloaded due to issues internally in the body. For example, stiffness in the foot or ankle may lead to load being distributed unevenly within the tendon, causing one part of the tendon to get overloaded and hence disrupted. Further up, stiffness or weakness in the hip can also put unequal load on the tendon. As such, a full Physiotherapy assessment is required to work out what is the exact driver of the Achilles tendon. Tendon rehabilitation is also a process which requires time given the mechanism of injury (gradual overload rather than an acute one like an ankle sprain) so you will need to put in effort and patience to follow through with your program so that you can do sport safely and prevent recurrence.
**its important for your Physio to decide when you are ready to progress to stage 2 and 3
If you’d like to find out more, please drop me an email or book in with Denise