You may or may not know of the legendary Greek warrior Achilles, who died as a result of an arrow that pierced the tendon in the back of his ankle. That is why we now refer to that tendon as the ‘Achilles’ tendon. Thankfully if you suffer from pain in this region, you will have a much better prognosis then he did.
The Achilles is a band of tissue that connects the calf muscle at the back of your lower leg to your heel bone. It is the thickest and strongest tendon in the human body; however, it is also the most common site to suffer irritation due to overuse. This is commonly known as Achilles Tendinopathy but has many other names too.
How does it present?
You might start by feeling mild pain in the back of the leg or above the heel after running or exercise, which may get worse over weeks or even months. You may also experience swelling or stiffness, especially in the morning. But you’ll probably feel better after the tendon warms up walking around.
Why does it happen?
Achilles tendinopathy is caused by repetitive strain, incorrect use or overuse of the tendon. The tendon is most commonly used for running, jumping or pushing up onto your toes. But if you use it in the wrong way, irritation occurs.
There are many things that can cause irritation of the tendon or make you more susceptible to this injury. Some things you can change/stop doing, others, unfortunately, you can’t do anything about – For example, as you age the structure weakens, which can make it more susceptible to injury.
In fact, runners have a 15 greater risk of Achilles tendon rupture and 3 times greater risk of tendinopathy. Other factors that may increase your risk of developing Achilles tendinopathy include:
Training choices
- A sudden increase in activity such as distance, speed, hills or reduced recovery time between training sessions can overload the tendon.
- Running on uneven surfaces (hilly terrain) or poor footwear (worn-out shoes) can also increase your risk of injury.
Foot posture
- A naturally flat arch (pronation) in your foot can put more strain on the tendon in some cases
Other factors
- Carrying more weight on your body, having tight calves and poor flexibility can also place increased strain on the tendon.
The stuff you can’t change
- Unfortunately, this condition is more common among men aged 30-50 years and there may also be a genetic predisposition. But there’s not much you can do about these.
Do I need to get a scan?
Not necessarily! Scanning, or ‘imaging’, of a tendon, can show varied results. We often see abnormal changes in someone who has absolutely no pain. Hence, a thorough history and physical assessment by a physiotherapist remains the key to diagnosis. However there are some cases in which we may require a scan – but don’t worry, we’ll tell you when!
How can I treat it?
The most effective first-line treatment is a step by step progressive loading and strengthening program. This means we start with a load that the tendon can handle comfortably and gradually increase this over time. But don’t get confused! This does not mean running and then increasing your running. There is a lot more that goes on behind the scenes.
We’ll also take a good look at your training schedule, lifestyle factors, and biomechanics (how your body lines up) to see why you might have developed the problem in the first place. Address these issues and you are much less likely to have the problem return in the future.
Other treatments can include massage, dry needling, non-steroidal anti-inflammatories, and more. We can discuss these options with you and the benefits.
Here are some preventative measures that you can do to reduce your risk:
- Avoid exercising whilst cold: Always warm up first by exercising at a slower pace.
- Gradually increase your activity level: When beginning an exercise program, start slow and gradually increase the intensity and duration. Don’t make sudden changes (either up or down) when on holidays. If you’re going to be doing a lot of walking, good to start building up your tolerance gradually before you leave home.
- Choose your footwear carefully: The shoes you wear while exercising should be comfortable and provide cushioning for your heel. They should also have a firm arch to help support your foot.
- Strengthen your calf muscles: This enables the calf and Achilles tendon to better handle the load they encounter with activity and exercise.
I don’t understand any of this…
Do not worry! At Back In Motion educating our clients is VITAL, not just something we rush through at the end of a consult. We’ll teach you all about your diagnosis, how you got the injury in the first place and why you’ll be doing some crazy looking exercises.
What should I do now?
The physiotherapists at Back in Motion Mentone can provide you with a FREE assessment to diagnose your Achilles pain. We not only aim to treat your pain but to identify factors which may contribute to the pain to provide you with long term management.
If you’re getting pain in your Achilles, call us now on 9583 1149 to book your free assessment or click here to book online.
Author: Nicholas Matkovic
Physiotherapist
Back in Motion Mentone