What is an Achilles Tendinopathy?
The Achilles tendon is the largest tendon in the body, it is a band of tissue attaching the calf muscle to the heel bone and it takes much of the load when walking, running, and jumping, acting like a spring when you push your foot off the floor.
Achilles injury can occur after a single mechanism or more often, due to repetitive microtrauma. A tendinopathy is an overuse condition in that the build-up of load has exceeded what the tendon can handle. Most individuals that suffer from Achilles Tendinopathy are active individuals, from the weekend warrior to the high-level athlete.
Symptoms include a pain behind the heel, swelling and calf stiffness, it can be quite crippling in the morning too. There are numerous ways to manage or treat this however being aggressive early on with load management strategies and exercises is key.
This is different to the more significant injury of an Achilles tendon rupture, a complete tear in the tendon. In this case, a popping or snapping sound may be heard, or feel like you have been kicked in the calf.
What does the evidence say about how to rehab Achilles Tendinopathy?
While it is a straight forward diagnoses, there can be numerous interventions to treat Achilles tendinopathy. These include; stretching, manual therapy, patient education, activity-modification, gait re-training, heel lifts, night splints, orthotics, taping, laser therapy, dry needling, and exercise.
The ONLY intervention that is backed up by strong evidence is EXERCISE!
Jill Cook, a specialist in Achilles tendons suggests it accounts for 70% of your recovery!
Evidence would suggest exercise should be the first intervention in patients with mid-portion Achilles Tendinopathy. Appropriate loading has been shown to decrease pain on Achilles tendinopathy. That is not to say there is no benefit with the alternative interventions when dealing with Achilles tendon pain; there is just less evidence to back them up.
What can I do to overcome Achilles tendinopathy?
FACT: Increased calf strength reduces the risk of an Achilles tendon injury.
(O’Neill, S., Watson, P. J., & Barry, S. (2016). A delphi study of risk factors for Achilles tendinopathy-opinions of world tendon experts. International journal of sports physical therapy, 11(5), 684.)
As we have learned exercise is the best treatment, but one size does not fit all!
Our knowledge and experience allow us to prescribe a program individualized to your injury. Following a diagnosis, we can assess your optimal load and begin a graduated strength program, think lots of heel raises! It is likely we will use adjuncts for optimal recovery too, such as needling etc.
TOP TIPS from Jill Cook a tendon researcher..
Tendon pain is the tendon telling you it is not happy with the loads. It needs time off and changes to the load. Act early and aggressively!
The old adage of use it or lose it applies to tendons, resting just decreases the ability of the tendon to take load.