Achilles TendInopathy
What is Achilles Tendinopathy?
Achilles Tendinopathy is a commonly used term to describe load related pain arising from the achilles tendon. It is comonly referred to ‘tendinitis’ however, our understanding of the injury suggests that inflammation is less likely to be the key driver and it is more related to overuse or overload. Thus, the term tendinopathy better reflects this and has been commonly used within medical practice - more info on this can be found here.
Who does Achilles Tendinopathy affect?
Typically 150,000 people within the UK experience Achilles tendinopathy every year, with people ages 30-50yrs the most common age groups as well as being more common in males. When we look at the research of who suffers Achilles tendon pain, it has the highest occurrence in those that complete middle to long distance running, track and field, racket sports, volley ball and football.
Sadly if you have already had achilles tendinopathy the chances of reoccurrence in the same and opposite side are increased.
How do we diagnose it?
The diagnosis of Achilles tendinopathy is a clinical diagnosis that requires an experienced clinician to take a detailed history and accurate assessment. There is very little need for imaging to help in this process and it is common to find changes within tendons on individuals who experience no pain!
Some key factors we see on assessment is localised pain and increased discomfort with plyometric (jumping) exercises. It must be noted there are a number of possible other structures that live close to the Achilles so ruling these out is essential.
How do we rehabilitate Achilles Tendinopathy?
We have some good news, Achilles tendinopathy responds very well to progressive rehabilitation! In fact, we love treating it and enjoy the challenge it can pose. It is important to consider that this process can and does take time. Tendons take a long time to lay down new tissues and we think this process of remodelling can take three months plus, so persistent is important here, as well as setting realistic expectations. We get asked a lot if we can still do our activity and when we can we will always try and keep you doing what you enjoy, there might be some key restrictions in order to not irritate the tendon.
We tend to take an individualised approach to treating it as every patients story is different. The principles of rehabilitation include a period of de-load to calm the tendon down and then we create a progressive re-loading of the tendon including all contraction types, focusing initially on heavy slow loading and progressing to faster more rapid contractions. It is also important to consider the rest of body and often deficits arise if other muscles groups that assist the calf muscles in force production.
Calf Function
Restoring or increasing the ability to lift the heel off the floor (also known as a calf raise) is a key aspect of Achilles Tendon rehab. There are two main muscles in the calf (Gastrocnemius and Soleus) and focusing of both is really important. During running up to 8 x your body weight is loaded through the calf so we need to prepare it for these kind of loads. At Winchester Health Clinic, we emphasise the importance of understanding YOUR function and hobbies so we aim to tailor the rehabilitation to the demands you need the calf complex to get back to. Generally, just doing body weight calf raises is not enough to rehabilitate this.
Achilles Tendinopathy rehab - examples of double leg calf raises over a step.
How to get help?
IF you have been struggling with Achilles Tendon pain for a while and don’t feel like it is getting better, why not book a physiotherapy session with us and get a plan in place to help you get back to doing the things you love. You can book an appointment here
Thanks,
Winchester Health Clinic Team