Understanding and Managing Achilles Tendinopathy
Achilles tendinopathy is a common condition that can affect anyone, from elite athletes to individuals simply going about their daily lives. It is a degenerative condition, often resulting from repetitive stress or overuse. Unlike acute injuries like tendon tears, tendinopathy is characterized by chronic pain and stiffness due to microscopic damage and impaired healing of the tendon tissue. It’s a spectrum of pathology, ranging from mild inflammation to more significant structural changes and degeneration.
The Anatomy of the Achilles Tendon
The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles—gastrocnemius and soleus—to the heel bone (calcaneus). It plays a vital role in activities that involve walking, running, jumping, and pushing off the ground. Despite its strength, the Achilles tendon is prone to overuse injuries due to the repetitive stresses it endures during physical activity.
Mechanism of Injury
Achilles tendinopathy usually develops over time, with repetitive microtrauma to the tendon outpacing the body’s ability to repair and strengthen it. Common mechanisms of injury include:
Sudden increases or change in activity: For example, ramping up running mileage or intensity too quickly.
Repetitive strain: Prolonged overuse, especially in sports like running, basketball, and tennis, can lead to wear and tear.
Poor biomechanics: Issues such as overpronation, tight calf muscles, or improper footwear can increase strain on the tendon.
Clinical Presentation
Symptoms of Achilles tendinopathy typically include:
Pain: Often located at the back of the heel or along the tendon, especially during or after activity. Morning pain and stiffness is a hallmark sign in Achilles tendinopathy.
Stiffness: Most noticeable in the morning or after periods of inactivity.
Swelling: May be present around the tendon but is a less common sign.
Weakness: Difficulty pushing off or performing activities that require calf strength.
Management Strategies in Physiotherapy
Effective management of Achilles tendinopathy requires a multifaceted approach, tailored to the individual. Below are key strategies commonly used by physiotherapists:
1. Load Modification
The most important part of Achilles tendinopathy management is adjusting the load on the tendon to allow it to heal while maintaining some level of activity to stimulate recovery. Strategies include:
Reducing or temporarily avoiding aggravating activities (e.g., running, jumping). It is important not to completely stop all activity.
Gradual reintroduction of loading through controlled exercises.
2. Controlled Tendon Loading
Specific exercise programs are crucial to stimulate tendon healing and improve its strength and resilience. These typically progress through:
Isometric exercises: Holding static contractions to reduce pain and build strength (e.g., heel raise hold).
Eccentric exercises: Slow, controlled lowering of the heel to build tendon capacity.
Heavy slow resistance training: Incorporating heavier loads to further strengthen the tendon.
3. Manual Therapy
Hands-on techniques can help improve mobility and reduce pain in the surrounding structures. These include:
Soft tissue massage to the calf or other muscles in the kinetic chain.
Mobilisation of the ankle joint to address stiffness and optimize biomechanics.
4. Addressing Biomechanics and Risk Factors
A physiotherapist can assess and address factors such as gait biomechanics, footwear, and training errors. Custom orthotics or supportive footwear may be recommended to correct overpronation or other biomechanical issues.
5. Other Modalities
Depending on the severity of symptoms, adjunct therapies such as shockwave therapy and taping techniques may also be used to manage pain and support the tendon.
Summary
Achilles tendinopathy, while common, doesn’t have to sideline you from the activities you love. With a clear understanding of the condition and a structured physiotherapy plan emphasising load management, controlled tendon loading, and adjunct strategies, recovery is within reach.
If you’re experiencing Achilles pain or stiffness, don’t wait for it to worsen. Book a consultation with one of our physiotherapists to develop a personalised treatment plan that gets you back on your feet—stronger and pain-free!