Achilles Tendinopathy
Author: Steph Vernon
Achilles tendinopathy is caused by an overload of the calf muscles and lower limb, often associated with an increase in activity that your body wasn’t ready for. This article will help you to understand your Achilles tendinopathy, why you have developed it, and why is it important to manage it correctly.
Essential anatomy
Your Achilles tendon is the thick, strong tendon at the back of your ankle and is the connection between your calf muscles (gastrocnemius and soleus) and your heel bone. When your calf muscles contract, the Achilles tendon pulls on your heel and causes your foot to point downwards, such as in a heel raise.
Tendons are thick and white in colour, and if you were to look at them under a microscope, they have a neat, parallel, linear structure. Tendons are made up of predominantly collagen fibers which give them great tensile strength, i.e. they can be stretched under great force without breaking. They also contain proteoglycans, which give them their viscoelastic properties, i.e. the ability to recoil and rebound like elastic that has been stretched.
Tendons have notoriously poor blood flow, but they do get some blood supplied from the bone and the muscle they attach to. This is important when considering the healing time for tendon injuries as it can be a slow process. If a tendinopathy does not adequately heal and recover full strength, further complications may arise, such as tendon ruptures or chronically degenerative tendons.
What Causes it
When training, most people have a goal of improvement; going faster, running further, lifting heavier, etc. In order to achieve this, the body needs to be progressively exposed to new challenges, or what physio’s refer to as “increased load”. This enables muscles, bones, joints, and the circulatory system to make the necessary adaptations to better tolerate this new load, and therefore improve performance.
But this can be a fine balance. We need to load enough to see improvements, yet not too much that it causes injury.
All tendinopathies are essentially caused by overload, when the training volume is increased too much or without adequate time for the body to recover and repair. Most commonly we see this in people who are either new to an activity or those who have a new goal. A common tendinopathy a physiotherapist will see is an “Achilles tendinopathy” where the back of the heel becomes sore, stiff, thickened and sometimes, red and inflamed.
Achilles tendinopathy is often seen in runners, particularly new runners, but it is also common in sportspeople and dancers, especially during the preseason. This is due to the rapid increase in training volume, often accompanied by new footwear and a reduction in muscle strength from a long period of rest.
Physiotherapy treatment
Physiotherapists can help in many ways when it comes to managing Achilles tendinopathy, and you’ll be glad to know that you don’t always have to stop doing your favourite activity. In most cases, we need to better manage your loading schedule to optimise recovery and work to improve the strength or capacity of the muscles involved. Combined with manual therapy, rehabilitation exercises, and appropriate self-treatment techniques, Achilles tendinopathy can often be effectively managed while you keep training. In actual fact, completely resting a tendinopathy can lead to further weakness and worsening of the underlying cause, so this is rarely the appropriate answer.
The key to improving a tendinopathy lies in the art of finding the appropriate balance between;
- The correct type of rehabilitation to increase muscle strength and tendon capacity
- Implementing an appropriate training schedule to maintain your current fitness, plus keep you exercising while you complete your rehab
- Scheduling adequate rest and recovery to allow the body time to heal between training sessions.
In the case of Achilles tendinopathy, it is important to enlist the help of a physiotherapist to help guide you through the appropriate management, as it can be tricky to get on track. Your physiotherapist will take a thorough history to work out exactly what factors are contributing to your unique presentation and what is the best course of action for you personally, as no two tendons are the same.
Mobility
Having a stiff ankle joint as well as the smaller joints in your feet can put more load on the Achilles tendon. However, stretching the Achilles is not always the answer, as for some people this can make their symptoms worse. Your physio will need to manually work on improving the stiffness, and teach you ways to continue this at home.
Control
Foot posture and ankle control are also very important in the development of Achilles tendinopathy and will need to be addressed to ensure adequate treatment. Your physio may give you exercises to improve your foot and ankle control, such as arch strengthening or balance exercises to help to offload your Achilles tendon.
Strength
Calf strength is super important for treating and preventing Achilles tendinopathies. Strengthening is usually eased into using isometric strength, eccentric strength, concentric strength, then fast and explosive strengthening. These steps are important to work through and you will be guided through each progression by your physiotherapist at the appropriate time.
Further management
In rare cases, further intervention may be required for those more suborn tendinopathies; such as Extracorporeal Shockwave Therapy, Platelet Rich Plasma injections, or orthotics. These can all be discussed with your physiotherapist during your consultation, but are usually only implemented if conservative treatments of load management and rehabilitation are not effective.
Summary
You will know if you have an Achilles tendinopathy if you experience pain at the back of your heel that is accompanied by morning stiffness. Sometimes your tendon will also feel thicker through the same region where it is sore and running or other exercises may make the pain worse, but often not until afterward, or even the following day. Treatment is complex and varied depending on the unique factors that have contributed to your overload, however, they can be worked through systematically with your physiotherapist to ensure the best outcomes for each individual.
Get in touch today if you think you may be experiencing Achilles tendinopathy, and our friendly physios will be able to help - BOOK NOW.
Don't forget to check out our Instagram for exercises for Achilles tendinopathy plus much more!