Achilles tendinopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon. This is the tendon that joins your heel bone to your calf muscles.
Tendinopathy is an umbrella term that indicates a non-rupture injury in the tendon that is aggravated by mechanical loading.
As many more people are now working from home, running has become the easiest and most efficient way to keep fit, while still staying safe in the current pandemic.
The increased frequency of running, combined with the hilly type of terrain in many London Parks, could play a contributing factor to this type of injury.
Parks and up hill terrain such as around Brockwell Park in Herne Hill and Sydenham Hill near Dulwich are prime examples of this type of environment.
What causes the pathology
Research has demonstrated that when tendons are exposed to volumes and magnitudes of loading (tension, compression, friction) that are beyond their physiological capacity they experience cumulative cycles of injury, inflammation, and repair, leading to pain and swelling (tendinopathy).
Without proper rehabilitation guidance to address potentially related pathomechanics, many individuals with tendinopathy are caught in a cycle of chronic and acute-on-chronic pain as they attempt to return to activity with a poorly healed and deconditioned tendon.
Achilles tendinopathy can be caused by several factors:
- Poor biomechanics
- Sudden changes to sports or training patterns
- Incorrect footwear
- Calf weakness or tightness
The effects of tendinopathy on the function of the tendon
Patients with tendinopathy display tendons that are thicker, but with reduced energy-storing capacity, meaning that for the same load, their tendons exhibit higher strains than those of healthy individuals.
Tendon Injury classification
Problems with the Achilles Tendon can be classified in 4 main categories:
- Acute on Chronic
What might Achilles Tendinopathy feel like
- Mild to moderate pain and stiffness around the back of the heel. This can be presents during a run or first thing in the morning.
- Swelling can be present after an acute injury and a small lump or thickening on the Achilles tendon may become noticeable in chronic injuries
- Tightness into the calf muscles.
Achilles Tendinopathy progression
- A mild Achilles tendinopathy can resolve itself with relative rest, ice, compression, and elevation.
- A more moderate strain that lasts more than a few weeks, usually needs some input to resolve, taking into account your biomechanics, training schedule=, flexibility and strength and conditioning.
- If left untreated, Achilles tendinopathies can become a chronic problem leading to long standing changes to the structure of the tendon, with scar tissue forming.
Diagnosis Achilles Tendinopathy
- A Physiotherapist will be able to diagnose an Achilles tendinopathy during a in depth assessment. This will include taking a full history to identify the potential cause of the problem, analysing muscle length and strength and looking at your biomechanics. Not only looking at your foot but all biomechanical factors including your knee, pelvis, and lower back.
How to treat Achilles Tendinopathy
- Biomechanical correction and training strategy errors: Moving more efficiently and not over training are key aspects of managing Achilles Tendinopathy. This will often involve a short period of rest combined with targeted physiotherapy exercises programme of flexibility and strengthening of the weak musculature identified after the biomechanical assessment. We often advise to continue your cardiovascular training by cycling, swimming, or cross trainer to maintain fitness but reduce the high impact on the tendon. The terrain you train on will also be key such as sticking to treadmill and flat terrain rather than uphill and uneven ground that can overload the tendon.
- Physiotherapy will help reduce the scar tissue formation and accelerate the rate of healing. It may involve soft tissue work, electrotherapy, acupuncture, and taping. We may also prescribe stretches, eccentric strengthening exercises and core stability to help balance the body. Preparing the tendon for the load, its key to succeed in the return to running. Understanding the stage of the tendon pathology is paramount to achieving a successful outcome. In simple terms understanding if the tendinopathy is acute, sub-acute, chronic, or acute on chronic, will dictate the type of management it requires. This may be complete rest, gentle exercises, or aggressive eccentric loading or plyometrics.
- Orthotics and heel lift: If foot biomechanics are contributing to your Achilles problems, orthotics can sometimes be helpful at reducing the load on the tendon. A heel raise may also be considered for those individuals that lack of foot flexibility has been identified as a key issue.
- Trainers: Ensuring you have the best trainer, is key in managing the injury. Lack of foot support or a very flexible trainer and cause additional eccentric load and torsional force on the tendon. There is no point fitting an insoles in a flexible not supportive shoe.
How to prevent developing Achilles Tendinopathy
Key factors include:
1-Maintaining general health and fitness, including strength and flexibility
2-Chage you trainers after 300 to 500 miles (very roughly) the distance you run to train for a marathon
3-Having a clear a structural running program with a variety of training strategies.
4-Do not increase your training frequency and intensity to aggressively and have some rest and non-high impact training days.
5-Make sure to combine some strength and conditioning and gentle Pilates exercises in your routine.