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Achilles Tendinopathy

The Achilles Tendon is a very common area of pain or discomfort. Going back, everything tendon related seemed to be considered “tendonitis” – ‘..itis’ being latin for inflammation. Often, we simply don’t know if the condition is inflammatory or not, and so it is considered a tendinopathy, where the suffix “…pathy” is derived from Greek, indicating a disorder,which is typically used to describe any problem involving a tendon.

The most common cause of Achilles tendinopathy is continually putting too much load on the tendon and not allowing enough time for the tendon to recover and adapt. This can be via;

Training Error – such as an increase in volume, frequency, intensity.

A Biomechanical issue – leg length difference, over pronation, or poor mobility in the foot, ankle and lower leg could be causal factors. Running “form” can also play a role here.

A flexibility issue – When your foot hits the ground the ankle moves the foot up – called dorsiflexion. Any loss of range can increase stress on the Achilles. Dorsiflexion range is commonly lost after ankle injury/sprain or due to calf muscle tightness

A strength discrepancy – Dr Ida Rolf once said where the pain is, the problem isn’t. Whilst the most common villains are usually the 2 calf muscles – gastrocnemius and soleus – something further up the kinetic chain could also be causing compensatory issues.

Symptoms usually begin gradually with onset of achilles pain during or after exercise/running. Over time, the pain becomes more frequent and can even begin to be a problem at rest. Usually the tendon itself is painful if you squeeze it, and you may become aware of swelling or thickening of the tendon. Some report pain first thing in the morning.

However, it can be aggravated by the simplest of things due to its weight-bearing location, and due to the various possible casues; using the stairs, walking uphill, squats, running fast or uphill, and lastly, some massage techniques and stretching! Yes, you read those last two correctly; if you have a tendinopathy that is compressive in nature, stretching will not help (Reference 1)… if you have an inflammatory response, having your sports masseur rub it/friction it for 30 minutes will not help.

Tendinopathy is usually divided into stages – reactive, disrepair, and degenerative.  Depending on which stage you are at, the most important treatment can be load management. This means reducing both tensile and compressive load on the tendon, much like proximal hamstring tendinopathy. Tendons connect muscle to bone and as a result are placed under a great deal of tension during activities that involve the muscle contracting or resisting a stretching force. Every time your foot contacts the ground during walking or running, the body has to deal with an impact force many times your body weight. Strength endurance seems key here (Ref 2).

The P.O.L.I.C.E protocol is useful, but as the condition can persist, ideally a structured, graded rehabilitation procedure of strengthening and stretching the relevant tissues will be discussed, with (potentially) a return-to-play plan put in place.

For particularly stubborn tendinopathies, Shockwave Therapy treatment is becoming a more widely used therapy, to enhance recovery.

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N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

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