What is it?
The Achilles Tendon is named after the legendary warrior Achilles who was killed by an arrow that pierced his tendon. This tendon attaches the calf muscles (gastrocnemius and soleus) to the heel bone. This muscle-tendon unit works when we stand on our tip toes, hop or run. Achilles tendinopathy is associated with degenerative changes in the tendon following a failed healing response to loading. These changes can include growth or blood vessels and nerves into he region, making the area particularly sensitive.
Pain - local to the tendon itself which is associated with increased activity levels and is of gradual onset.
Morning stiffness - feeling stiff and sensitive in the tendon/lower leg when you take your first steps in the morning. This can last from minutes to hours.
Reduced symptoms with warm-up and return of symptoms following cool down
Tenderness and thickening of the tendon to touch
Pain on calf muscle activity e.g. heel raise, hopping
Tendinopathy generally arises from an increase in activity or training intensity and a lack of recovery time between sessions. Indirect changes in activity related to surface, footwear etc can also increase loading on the tendon. There are a number of factors that may predispose an individual to developing Achilles Tendinopathy:
Ankle Joint Stiffness
Biomechanics eg pronated foot posture
Bony Heel Spurs
Modify training - this does not mean total rest. This means change what you are doing e.g. reduce running for a period of time while you focus on strength of leg muscles.
Heel Raise - A small heel raise worn in the shoe will reduce the load on the tendon temporarily.
Physiotherapy - manual techniques such as soft tissue therapy, needling, joint mobilisation and taping can be very effective in offloading the tendon, allowing it to heal, while a structured exercise programme will rehabilitate you to full strength and performance.
Medical and Surgical Techniques - Various interventions such as Injection therapy, Shockwave therapy and Surgery may be appropriate, especially if symptoms persist with other treatments.
Podiatry - If biomechanics is one of the reasons why the tendon is being overloaded then it is important to wear suitable footwear. Alternatively an orthotic device worn in footwear can help improve biomechanics.
Exercise should target the tendon itself as well as other areas of weakness found on assessment. This may include strengthening the trunk and pelvis muscles which are key to hip and leg stability. Evidence has traditionally supported the use of eccentric strengthening exercises (loading the muscle as it lengthens) for the calf and achilles tendon. This is commonly carried out over the edge of a step. Loading the tendon without overloading is the key. It is normal to experience some low-grade pain with eccentric strengthening which may last into the following day. Isometric (sustained contraction) and concentric (contraction as the muscle shortens) strengthening options may also be employed depending on level of pathology and irritability of symptoms. If stiffness is a problem, then mobility and flexibility exercises should also be included your programme. A gradual return to sport or activity is advised once symptoms settle - if you back to doing exactly what you did before then the chances are your pain will return. For a specific and guided programme contact your physiotherapist.