Heel pain? Running and jumping irritating? You may be suffering from an Achilles tendinopathy. Read on to find out what Achilles tendinopathy is, what tendinopathy means, causes, symptoms, what to do right now, diagnosis, what physio/osteo treatment involves and how long until it gets better.
Not in the mood for reading? Watch this short video with Dr. Abbey Davidson (Osteopath) about Achilles Tendinopathy.
What is Achilles Tendinopathy?
The Achilles tendon is the biggest and strongest tendon in the body. This thick band of fibrous tissue connects the calf muscle (gastrocnemius + soleus) to the heel bone (calcaneus). This tendon allows you to point your toes (plantarflex), stand on the balls of your feet and walk/run.
Achilles tendinopathy occurs when there is injury or overuse of the Achilles tendon or its covering resulting in inflammation or micro-tears to tendon fibres. Achilles tendinopathy is a common injury for runners and jumpers. It is important to note that this injury used to be specifically an athlete’s injury but is becoming more common in sedentary occupations and non-athletic people.
What does tendinopathy mean?
Tendinopathy is a term used for any disease or injury of a tendon. This can mean tendonitis (acute inflammation), tendonosis (chronic inflammation) or paratenonitis (inflammation of the outer tendon layer). This is inclusive of both inflammatory and micro-tear type injuries.
Many practitioners still use the term Achilles tendonitis out of habit but there is a shift to using the term Achilles tendinopathy; unless medical testing specifies otherwise.
Causes of Achilles Tendinopathy:
Tendons are fibrous structures and pain usually come about due inflammation or micro-tears in the tendon. Common causes of achilles tendinopathy include:
- Over use/over training
- Transition in training surface (e.g. grass to concrete)
- Abnormal ankle joint range of motion
- Poor biomechanics (e.g. muscle tightness or weakness)
- Poor foot mechanics (e.g. flat or high arch feet)
- Direct trauma (e.g. getting kicked)
- Poor footwear (e.g. high heels)
- Secondary to another disease (e.g. rheumatoid arthritis)
Your physiotherapist, podiatrist or osteopath will identify, treat and educate you on these causes and how best to manage them to avoid re-injury.
Symptoms of Achilles Tendinopathy:
Some common sign and symptoms of Achilles tendinopathy include:
- Heel or calf pain
- Irritation with running/overuse/poor footwear
- Evening or waking pain
- Loss of strength
- Tender palpable lump within tendon
It is common with tendon injuries that you will feel discomfort before and after physical activity but not during. If you are concerned that you are suffering from an Achilles tendinopathy it is best to have it assessed by a professional (osteopath or physiotherapist).
What you can do right now for Achilles Tendinopathy?
For Achilles tendinopathy you can try resting, self massage, changing the surface you run on, using appropriate footwear, reducing inflammation and performing Achilles exercises. More information available on these modalities below.
Rest. If your Achilles tendon is inflamed it is important to allow opportunity for the structure to heal. Resting may mean stopping your current running or jumping activities to prevent aggravation. Once inflammation has decreased you can progressively recommence your physical activity. For those who choose not to rest consider decreasing the training intensity or frequency (how hard you are training or how often).
Self massage over the achilles tendon can help promote blood flow and healing at the region. This can be extremely tender initially but will improve as your tendinopathy improves. For a demonstration of this technique check out the video at the top of page.
The surface you train on has great impact on your body in particular your feet/ankle/legs. Alternating or changing the surface you train on can have positive impacts on your recovery. Consider training on softer surfaces (e.g. grass instead of concrete) or avoiding terrain which places your Achilles on stretch (e.g. hill running).
It is vital with an Achilles tendinopathy that your footwear is appropriate for the activity you are performing. Ensure your shoes are specific to your sport/training and the surface you’re training on. Make sure you are changing your shoes when appropriate; the more worn out a shoe is the less supportive it can be. It is important that your shoes are also appropriate for work or everyday wear (not just while participating in physical activity). If you have questions about your footwear approach your podiatrist, physiotherapist or osteopath for advice.
Tendon injuries involve inflammation. Inflammation can be responsible for a lot of the uncomfortable symptoms that have inspired you to read this article. Appropriate ice application (avoiding direct skin contact, 20 minutes on and 20 minutes off) and topical gel application can help reduce inflammation. This is important after the initial injury (within 24-48 hours) or after aggravation with physical activity. In some cases of achilles tendinopathy, anti-inflammatory medication can be beneficial. It is important to check with your doctor or pharmacists prior to taking anti-inflammatory medications.
Rehabilitation exercises or eccentric loading exercises as demonstrated at the top of page are showing promising results in Achilles tendinopathy recovery. It is important that these exercises be performed within pain limits. For any concerns regarding loading your Achilles tendinopathy ask your practitioner for further information.
How is Achilles Tendinopathy Diagnosed?
Your physiotherapist or osteopath will use information gathered in medical history and physical examination (range of motion testing, strength testing, palpation and orthopaedic testing) to diagnose you with achilles tendinopathy.
You may be sent far an ultrasound or MRI to confirm what your physiotherapist or osteopath is thinking. X-Rays are of little clinical value but can show calcification within the tendon (pictured right).
Physio and Osteo treatment for Achilles Tendinopathy:
Your physiotherapist and osteopath has spent multiple years at university learning how to diagnose and manage conditions like Achilles tendinopathy. They will first establish that you are in fact suffering from an Achilles tendinopathy by questioning the history of the injury, assessing the area and surrounding areas and using provocative orthopedic testing. They will then spend time explaining your diagnosis to you, how you are both going to manage it and how long until it will resolve.
Hands on therapy will involve relaxing tight muscles through the legs (especially the calf), decreasing inflammation and improving leg, ankle and foot mechanics. It is key that the cause of the stress on the Achilles is treated rather than just treating locally at the Achilles for symptoms. Sessions will also involve the prescription of specific rehabilitation exercises and management advice.
In long lasting (3+months) achilles tendinopathy there is strong research supporting the use of shockwave therapy in combination with your tailored exercise program. This should always be considered before more invasive options (like injections or surgery). For more information on shockwave therapy click here.
How long until Achilles Tendinopathy gets better?
How fast you recover from an Achilles tendinopathy will vary depending on the specific cause, your compliance to management protocol and how long your symptoms have been present. Generally, a tendinopathy will respond to conservative management with your physiotherapist or osteopath within 4-6 weeks.
If symptoms are present for more than 6 months’ of conservative management alternate therapies may be considered. This may involve Steroid injections, PRP injections or surgery.
Untreated Achilles tendinopathy can result in Achilles tendon rupture.
By Sydney CBD Osteopath Dr Abbey Davidson