Achilles tendinopathy is an incredible painful, frustrating and long standing injury that often feels like it has no treatment. The good news is, research is showing us there is a way out of pain.
What is the Achilles tendon?
Your Achilles tendon is an incredibly strong, fibrous piece of connective tissue that connects your calf muscle to the calcaneus – or heel bone. It is the strongest and thickest tendon in the human body. In fact it is so strong it is believed to be able to cope with loads upwards of 8 times your bodyweight. It has am amazing ability to store and then release elastic energy back into the muscular system to allow for the propulsion experienced in activities such as walking, running, hopping and jumping.
Achilles tendinopthay (or tendonitis) is a term that commonly refers to an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.
Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendonitis out of habit.
Causes
Achilles tendinopathies are typically overuse or overload injuries. Put simply, the injury occurs after repeated stress and trauma happens at a rate that our body can’t tolerate. The stress is often caused by running and jumping and as such is seen frequently in athletes that play team sports such as AFL, or jumping sports such as volleyball. It is important to note that tendons have significantly less blood supply than that of a muscle, therefore they have a reduced capability to heal. Thus tendon healing times are rarely shorter than 3 months.
Achilles tendinopathies are common in middle aged adults, who are often under-conditioned, overweight, may have had an increased training load, and/or have decreased time between training sessions. They can occur secondary to poor foot and knee mechanics which increased load through the calf and therefore the Achilles tendon. They are also common in high-heel wearers.
Signs and symptoms of Achille tendinopathy
- Achilles pain may feel like a burning or deep ache pre-activity or first thing in the morning, making it difficult to walk without a painful limp
- Typically the pain will decrease during activity – only for it to come back a few hours later
- These injuries get progressively worse over time – can build up for weeks and months
- Pain in the back of the heel and up the back of the ankle
- In some cases there may be palpable nodules in and under the Achilles tendon itself
- Limited ankle flexibility particularly in dorsiflexion
- The area may be warm, tender and inflamed
- A feeling of stiffness in the Achilles
- Loss of strength.
What do I do with initial occurrence?
- If you suspect a tendinopathy it is important to not completely rest it. That being said rest, ice, compression and elevation can help reduce pain and inflammation immediately after activity
- Pain – free walking should be introduced as much as possible to keep some load coming through the tendon
- Book in with your osteopath ASAP for assessment and treatment
How is it diagnosed?
With thorough history taking and examination, your osteopath should be able to give a confident diagnosis of an Achilles tendinopathy. Imaging is rarely required, however an ultrasound or MRI may be warranted in severe cases where rupture might be a concern.
How long will it take to heal my Achilles tendinopathy?
Tendon recovery is typically quite difficult to judge healing time greatly varies based on the level of tissue damage, compliance with exercise and level of aggravating activities. Recovery isn’t typically a constant positive direction, there will be periods of flare up and discomfort that should get less severe and less frequent over time. Tendons can typically take anywhere from 4 weeks to 4 months, but severe cases may take longer. You can expect relief in the short term with treatment and pain management strategies.
Treatment
At Sports & Spinal Albury, our Osteopaths we are expertly trained to assess your biomechanics, both locally and throughout the rest of your body, then use some of our many manual therapy techniques to help address any causes or issues we find. We are passionate about helping you understand why the injury has occurred and what can be done to help it recover.
- The primary treatment plan involves a series of progressive exercise loading as we look to rebuild the strength of our tendon from the ground up.
- There are many phases of this, starting with pain-free tendon loading exercises such as isometric holds under a state on concentric tension before moving into pain free concentric repetitions and then building on eccentric control.
- We then look to restore your speed, power, proprioception and agility, aimed at reducing the risk of recurrence.
- Once we’re confident your tendon has the strength required we can tailor a return to sport or activity program to help prevent further aggravation in the future.
- Our clinic now has new radial shockwave technology which has shown high level evidence in pain reduction for Achilles and other tendinopathies. In fact, ours is the only machine with 27 level 1 studies completed on it. For more information visit our blog here ….
Dr. Cameron Bayliss
B Hlth Sc, B App Sc (Osteopathy)
