Achilles Tendinopathy

What is it, what can you do to self manage and what can we offer to help you?

Achilles tendinopathy is a common ankle condition that affects the strong band of tissue connecting the calf muscle to the heel bone. In fact, it is the strongest tendon in the body working when you walk, run, climb, and jump. It is one of the most common injuries seen in runners with about 10% having it at some stage. 

We also see it in our male 50 year+ golfers as a fairly common occurrence with varied reasons for why it presents in these populations. You may see it called Achilles tendonitis meaning inflammation but this is not always caused by an inflammatory response especially if you’ve had it for more than 3 months (chronic tendinopathy). Read on to find out more…

Signs of Achilles Tendinopathy

You may feel pain or tenderness in the back of the ankle, directly above the heel, (insertional tendinopathy) or higher in the main tendon (mid portion Achilles tendinopathy). We distinguish these 2 types on assessment as treatment is slightly different.

The area around the heel may feel warm when you touch it and may look swollen or thickened. You may notice limited range of motion flexing your foot with pain increasing during and after activity, and your foot and ankle may be stiff first thing in the morning or when you get up after prolonged sitting until it gets moving.

In severe injuries where the tendon completely ruptures you will feel a distinctive tear, pop, and commonly hear a loud noise, some say like a shotgun!

Causes of Achilles Tendinopathy

The most common cause of Achilles tendinopathy is overuse or repetitive stress due to a sudden increase in activity and excessive exercise, walking or sports activities. Cumulative micro trauma occurs with both intrinsic and extrinsic factors. Intrinsic factors are things like poor foot or lower limb biomechanics, tight calves, or obesity. Extrinsic factors are things like rheumatological diseases, a history of taking steroid medication or taking antibiotics called fluoroquinolones.

There is also a degenerative classification due to a ‘weakening’ over time which makes the structure more susceptible to injury. This typically affects men over the age of 50.

Other causes

~ Suddenly increasing the intensity of exercise without a proper warm-up

~ Playing sports that require swift or rapid movements

~ Not taking enough time to increase training progressively

~ Wearing ill-fitting footwear and using the wrong equipment

~ Using high heels for prolonged period or when you’re not used to them

~ Running on uneven surfaces

Self-Management Tips

1. Rest – Avoiding activities which make the pain worse.

2. Ice – Apply an ice pack to the painful area to reduce your symptoms

3. Stretching – Gently stretching the calf muscle can relieve some tightness around the tendon. See our suggestions below

4. Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) – These types of medication can help reduce the tenderness enough to perform and complete simple exercises and stretches in early rehabilitation

5. Always warm-up before beginning an exercise or training session

6. Increase the intensity of exercises gradually

7. Alternate between high and low-impact exercises

8. Use comfortable shoes that fit well and replace worn running shoes

9. Use supports or cushioning pads inside shoes (available from our clinic)

10. Use the right equipment

Further Investigation

An ultrasound scan can be used to assess the tendon structure using sound waves to give a picture a bit like in pregnancy scans. This form of assessment is completely painless and shows the severity and specific location of the injury. It’s often used if a rupture is suspected.  A treatment called extracorporeal shockwave has been found to be beneficial in stubborn unresolving cases of Achilles tendinopathy.

How Physical Therapy Can Help

We will thoroughly assess you for your individual presentation – no two Achilles problems are the same in our experience. We can explain what has happened, give advice, and provide manual therapy techniques and sports taping to improve the tissue and reduce pain. We may recommend a heel cushion or shoe insert which we can provide from our clinic. Most importantly, we give you a bespoke progressive exercise and strengthening programme which is best evidence for treatment and prevention of further episodes.We can also provide Laser Therapy in clinic which can assist with inflammation, reduce associated muscular spasm, increase blood flow to the area, and provide additional energy for repair. This works by directing laser light energy into the damaged tissue, causing an interaction with molecules within the cells. 

Did you know…. Almost all of the force you generate when pushing yourself forward goes through the Achilles tendon – when you run fast, this force can be six times your bodyweight!

Need help? Check out what we offer and give us a call … SERVICES – Amanda Marsh Physiotherapy

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