Achilles Tendinopathy and tendonitis like many tendon overuse injuries can be debilitating and frustrating if not managed appropriately. It usually presents with pain, swelling, and stiffness in the area between the bottom of your calf and top of your heel.
All tendon injuries have one main underlying cause overload. Overload is not when you physically can’t do an activity anymore. It occurs when certain muscles and tendons fail to control and stabilise the area as they are meant to.
Common factors to set off Achilles tendinopathy centres around sudden increases in load. Think when you have started off running. Many of us go from couch potato to trying to run distances that we did back in high school.
Others we see it in are those looking to get fit (usually around January the 2nd) same situation they go from nothing to working out 5+ days a week. Usually at high intensity to boot.
If your tendons aren’t adapted and are deconditioned to this amount of activity it will lead to overload and subsequent injury.
Tendons connect your muscle to bone. In this case your calf muscle to your heel. If your calf can’t handle the load this will mean more stress on the tendon, again leading to overload.
As this overload builds it causes micro tears in the tendon making it even weaker. Picture a rope that as more load is added progressively the strands start to fray. It gets weaker and weaker.
These tears trigger swelling, fluid retention and thickening of the tendon. Unfortunately, this thickening doesn’t strengthen the tendon.
It’s fairly common that patients present with a diagnosis of Achilles tendinopathy or Achilles tendonitis, but it actually falls under one of three more specific stages of tendinopathy.
- Reactive Phase (Tendonitis)
- Disrepair (Tendonitis)
- Degenerative (Tendinopathy)
The common presentation into the clinic is usually around 2-3 months, mainly because the pain /10 you experience is usually quite low and can for a period of time be pushed passed to allow you to keep being active.
It isn’t until people have tried a few things themselves and the pain hasn’t settled that they make their way in. This usually comes in the form of a week off the aggravating activity, then when they get back into activity it is still sore. They usually rest for 2 weeks and then a month all with the same result when they return to activity.
The amount of time off further leads to weakening of the tendon. Tendons don’t respond well to over or underloading.
So how do we manage this?
As a physiotherapist, we look to address three important things.
- How do we get you out of pain and back to full activity?
- How do we keep you injury free and performing to your full potential?
- How to manage load in rehab and resumption
The first two aspects aren’t independent of each other and often overlap.
Getting you out of pain usually involves a combination of treatment techniques including activity modification, taping, deep tissue release, joint mobilisation, orthotics and exercises.
It’s important we look at your actual technique we can see where the weaknesses are, and the subsequent overload is occurring. If it is purely a technique issue we will develop strategies to address this. More likely than not the technique issue has a muscular or stability issue.
The plan to keep you out of pain is where it takes some effort from both parties. Often it can be a case of two steps forward one step backwards. For example, winding back the distance or intensity of your workouts to allow you to keep active with minimal pain while we strengthen.
The Achilles can be a complex region due to the other contributing areas such as the hip, knee and load control but with a thorough assessment, tools and strategic plan we can give you the best options and path to get you back to your best.
To see one of our experienced Achilles Tendinopathy physio’s book an appointment below.