What is Achilles Tendinopathy?

Description

• The Achilles tendon is the biggest and strongest tendon in the body. It is found at the back of the lower leg, just above the heel bone. It attaches your two calf muscles (gastrocnemius and soleus) the heel bone and helps you go up onto your toes.

• Injury to the Achilles tendon occurs when the load applied to the tendon, either in a single episode or, more often, over a period of time, exceeds the ability of the tendon to withstand that load. This excessive load leads to repeated small amounts of damage within the tendon fibres, and results in the tendon trying to heal itself in response to the strain.

• Achilles tendinopathy is a relatively common soft tissue injury that can affect both athletes and non-athletes. It is most common in people who that part in sports that involves running such as football, tennis, volleyball, badminton and middle to long distance tunning.

• Tendinopathy can occur at the midportion or the insertion of the Achilles tendon.

Presentation

• Morning stiffness: stiffness around the tendon when getting up in the morning which eases after a few minutes of walking.

• Onset of pain: may be sudden, gradual but noticeable or insidious.

• Severity of pain: may range from minor inconvenience to profound pain with activity.

• Duration of symptoms may range from days to years.

• Disability may be minimal, moderate, or severe.

• Swelling can range from being a major feature of the presentation to being absent.

• Tenderness may range from being pinpoint to extending throughout several centimeters of the tendon.

Tendinopathy progression

Stages of tendinopathy

• Reactive tendinopathy

  • Non-inflammatory response to acute overload due to burst of unaccustomed physical activity

  • Short-term adaptive thickening of tendon, reduced stress and increased stiffness

  • Potential to revert to normal if overload is reduced

• Tendon Disrepair

  • Attempt at tendon healing but with greater tendon matrix breakdown and neovascularisation.

  • Hard to distinguish clinically – thickened tendon.

  • Some reversibility with load management

• Degenerative Tendinopathy

  • Progression of tendon matrix and cell changes

  • Little capacity to reverse and can rupture.

Risk factors

• Age: most common from 30 onwards

• Gender: more common in men

• Weight: if you have a higher than average body weight you are more susceptible.

• Diabetes: increased risk of developing Achilles tendinopathy.

• Tight and/or weak calf muscles

• Poor endurance strength of the calf muscles.

• Poor core stability around the hip/knee

• Stiff ankle/foot joints.

Managing your Achilles Tendinopathy

Treatment

• Manual therapy:

  • Soft tissue massage

  • Dry needling

  • Joint mobilization

• Exercise program:

  • Calf eccentric exercise program: designed to gradually increase the stress going through the tendon in a controlled way. This gradually reduces swelling and pain.

  • Core stability, hip and knee exercise program.

• Stretches/foam roller muscle release exercises.

Prognosis: it may take a least 3 months to have significant improvement in symptoms.

If you have Achilles pain and need physiotherapy, book online today.

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