What is Achilles Tendonopathy?
Achilles tendonopathy is pain and pathology within the thick tendon at the back of the ankle joint known as the Achilles' tendon.
Tendonopathy used to be termed tendinitis meaning inflammation in the tendon. Now research has shown that it is more of a pathology that affects the tendon - micro tears within the tendon associated with overload and sometimes in chronic cases there can be cellular changes as the body attempts to repair itself. Basically the tendon can change structure completely. A tendon should be made of only thick strong collagen fibres. With a degenerative tendonopathy when the tendon has been overloaded in some way for a prolonged period, there is matrix breakdown of the tendon and the tendon becomes composed of many different cells such as protein molecules, water, nerve and circulatory tissue rather than just strong collagen fibres. Therefore the tendon having a lower ratio of collagen fibres means that it becomes weakened. Nerve vessels in the tendon can mean it can become painful.
What causes Achilles Tendonopathy?
Tendonopathies normally occur when the tendon has been overloaded more than normal and then not had sufficient recovery. Overload is the main cause. E.g if you have increased your mileage too soon, or incorporated hills/speed work too fast. Typical sports include engaging in running, football, rugby and any other sports involving hopping or jumping activities which puts a lot of stress on the achilles tendon.
Achilles tendonopathy is not solely limited to sports, it can also develop from muscular weakness in the calf or kinetic chain, inflexibility in the posterior chain (calf and hamstring musculature), improper footwear, poor technique, high foot arches or low foot arches and over-pronation.
It can more commonly occur with runners in their 40's onwards when there is reduced flexibility in the tendon. It can also be associated with rheumatoid conditions or taking certain types of medication. If taking regular medication it is always best to check the side effects and inform a doctor if you develop Achilles pain.
Tendons are lazy structures that do not like sudden increases in loading/stress. They like to be GRADUALLY loaded. That's why there's the 10% rule with running (making no more than approx 10% increases in your weekly mileage per week). Even if you feel fit and mentally keen to increase your mileage/physical activity make sure that you still only increase very gradually as the tendon can't keep up with sudden changes!!!
What are the symptoms?
Symptoms include Pain, weakness, swelling, thickening, and tightness in the calf and Achilles. You may find pain and stiffness is worse first thing in the morning and at the start and end of exercise.
If there was a sudden pain associated with exercise, subsequent immediate swelling, and maybe a pop/tearing sensation or a feeling that you have been kicked in the back of your ankle then there may be a tear/rupture and you are best to seek immediate advice from a doctor.
What Treatment can help Achilles pain?
- Specific strengthening exercises for the Achilles depending on the stage of the tendonopathy and location (whether it be in the main portion of the Achilles or in the insertion). Exercises set by the physiotherapist during the initial assessment will determine the exact strengthening exercise for you and how many reps to do etc.
- Strengthening exercises for the kinetic chain- again specific exercises are set by a physiotherapist on your initial assessment for areas found to be weak higher up the leg. After all the body works as a team e.g when you land/load the load is not only taken from the calf/Achilles but also from the quadriceps and gluteal muscles therefore it is important to set a programme for all these areas particularly highlighting the weakened areas.
- Kinesiology Taping- This can offload the tendon significantly and allow it to calm down. A heel raise placed in your footwear can temporarily be used in the early stages additionally to offload the tendon.
- Soft tissue massage/mobilisation for the tightened structures that may be affecting the posterior chain and Achilles.
- Acupuncture- This therapy works well as an adjunct to the treatment to speed up healing and help improve pain. We have found from our clinical results for acupuncture to significantly reduce pain quickly in most cases.
- Ultrasound- ultrasound can also help to speed up the bodies healing process and reduce pain.
- Advice and education- Involves highlighting the cause of the tendonopathy, discussing treatment and advice regarding footwear, proper technique and foot posture.
- Ice application- can offer pain relief.