ACHILLES TENDINOPATHY
What is Achilles tendinopathy?
The Achilles tendon is known as the largest and strongest tendon in human body and it is found at the back of the ankle. It connects the muscles of calf (Gastrocnemius and Soleus) to the heel and plays an important role in shock absorption and energy storage.
Achilles tendinopathy is the result of an overuse injury to the Achilles tendon due to excessive loading (such a dramatic increase in running distance or training time) over a short period of time.
Who gets it?
Runners and active individuals are most commonly affected by Achilles Tendinopathy but it is also prevalent in sedentary individuals especially if they have just commenced a new sport or had a drastic increase in training load / volume over a short period of time. Other risk factors include ill-fitting footwear, high BMI, decreased ankle range of motion, inadequate warm up or stretching and poor foot and lower limb biomechanics.
Signs and symptoms
In the early stages, Achilles tendinopathy is characterised by the localised pain often at the start and end of training sessions; however, as the condition progresses, everyday activities such as walking can become painful. Other signs and symptoms include pain or discomfort with touch, morning stiffness, swelling, tendon thickening and decreased calf strength.
It is very important to address tendinopathies early on before it progresses in severity to avoid dealing with factors such higher levels of pain and altered biomechanics.
How is Achilles tendinopathy treated?
Conservative management is the first line of treatment for Achilles tendinopathy. Your physiotherapist will be able to diagnose your pain, help you identify factors that are contributing to the problem and get you started on a treatment plan tailored to your stage of tendinopathy. Physiotherapy treatment for Achilles tendinopathy can include the following:
Modified rest – an initial period of low loading, not complete rest, is required to facilitate tendon healing.
Exercise – Your physiotherapist will provide you with a graded strengthening exercise program to promote long-term recovery.
Extracorporeal Shock Wave Therapy – Used in combination with exercise to effectively decrease pain and increase function in individuals with chronic Achilles tendinopathy.
Load management – Your physiotherapist will be able to help you manage your training load / exercise volume appropriately based on the severity of your condition. They can also offer advise on how to alter your biomechanics or training surface to decrease load on the tendon.
Manual therapy – Techniques such as soft tissue massage and ankle mobilisations are often used to improve contributing factors such as decreased ankle range of motion.
Orthotics – Often used to decrease tendon loading and improve foot biomechanics.
If you suspect that you might be experiencing symptoms of Achilles tendinopathy, please do not hesitate to call or book an appointment online with one of our physiotherapists here at Back in Motion, Point Cook. They will be able to assess you and then get you started on the appropriate treatment required for your stage of tendinopathy right away.
References:
Brukner, P. (2017). Brukner & Khan's Clinical Sports Medicine. McGraw-Hill Education.
Karlsson, J., Brorsson, A., Jónsdóttir, U., & Silbernagel, K. G. (2019). Treatment of Achilles Tendinopathies. In The Sports Medicine Physician (pp. 173-186). Springer, Cham.
Mascaró, A., Cos, M. À., Morral, A., Roig, A., Purdam, C., & Cook, J. (2018). Load management in tendinopathy: Clinical progression for Achilles and patellar tendinopathy. Apunts. Medicina de l'Esport, 53(197), 19-27.
Mani-Babu, S., Morrissey, D., Waugh, C., Screen, H., & Barton, C. (2015). The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. The American journal of sports medicine, 43(3), 752-761.
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Rio, E., Kidgell, D., Moseley, G. L., Gaida, J., Docking, S., Purdam, C., & Cook, J. (2016). Tendon neuroplastic training: changing the way we think about tendon rehabilitation: a narrative review. Br J Sports Med, 50(4), 209-215.
van der Vlist, A. C., Breda, S. J., Oei, E. H., Verhaar, J. A., & de Vos, R. J. (2019). Clinical risk factors for Achilles tendinopathy: a systematic review. Br J Sports Med, bjsports-2018.
Wilson, F., Walshe, M., O’dwyer, T., Bennett, K., Mockler, D., & Bleakley, C. (2018). Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis. Br J Sports Med, 52(24), 1564-1574.
Image of Achilles tendon pain: Shepes F. (2015). Achilles Pain and Tendinitis- The 3 F’s are the cause. Retrived from: https://thefreshfootcentre.wordpress.com/2015/07/26/achilles-pain-and-tendinitis-the-3-fs-are-the-cause/
Author: Heshani - Physiotherapist at Back in Motion Point Cook