What is Achilles tendinopathy?
Achilles tendinopathy is an injury affecting the Achilles tendon, a thick band at the back of the ankle, connecting the calf muscles to the heel bone. Common symptoms of this injury are pain and swelling at the back of the ankle. It often starts off with pain during exercise but as the condition worsens, pain can be present even during daily activities such as walking.
Achilles tendinopathy can be further divided into 2 different types, insertional or mid-portion, with each having their own signs and symptoms.
Pain and swelling at the back of the heel bone where the tendon ends
Pain and swelling localised to the middle of the tendon
Pain typically occurs during dorsiflexion (pointing toes up)
Pain more often during plantarflexion (pointing toes down)
Usually worse in the morning
What causes Achilles tendinopathy?
The Achilles tendon is the toughest tendon in the body and goes through extreme loads every day through activities such as walking and running. Achilles tendinopathy occurs when there is overuse of the tendon and the calf muscles. This can either be through a sudden increase in the intensity of exercise or through repetitive action over a long period of time. Similar to how people can feel burnt out from too much work and stress, the Achilles tendon will break down if it cannot match the demands of the exercise.
Factors that can increase the risk of developing Achilles tendinopathy include:
- Previous history of lower limb tendinopathy
- Recent injuries
- Poor muscle power and strength
- Weight gain
- Sudden changes in training load or technique
- Returning to sport after a long period of rest
How long does Achilles tendinopathy last?
It can take up to 3 to 6 months to see improvement and recurrences during this period are common and expected.
However, this does not mean that you have to completely stop doing the activities you enjoy during this whole period. Instead, with the help of your trusty physiotherapist, you will be prescribed an exercise program to strengthen your tendon and enable you to return back to your sport in a safe way without aggravating your tendon pain.
How can I recover faster?
Activity modification is the first step to reducing symptoms of Achilles tendinopathy. This is especially important in the acute stage of Achilles tendinopathy, when the tendon needs more rest to recover. However, this does not mean complete rest from exercise. For tendons to heal, they actually need to be loaded appropriately. It is all about balancing the work to rest ratio so that the tendon has sufficient time to repair itself in between exercise sessions. This is where exercise selection is important. Knowing what exercises can be done and at what intensity for each stage can make your journey to recovery much easier and faster with a lower risk of flare-ups.
To optimise the healing process, it is also important to correct any factor that can perpetuate overuse of the tendon. One example is muscle imbalance at areas away from the ankle, which can lead to increased stress on the tendon during activities. This is common in people who suffered a prior injury on the same leg. Therefore, it is essential to incorporate exercises that can correct these muscle imbalances into your recovery programme. Your physiotherapist will be able to help you assess any muscle imbalances and devise an exercise programme to correct these.
Adjunct therapies such as manual therapy, dry needling and ultrasound are also useful in managing symptoms during the rehabilitation process. Pain and swelling can be huge deterrents to exercise, which slows down the recovery of the tendon. By reducing pain and swelling, you can exercise more and return to function faster.
Achilles tendinopathy is a painful condition and it often takes up to 3 to 6 months before improvement can be observed. However, you should not have to give up doing what you love because of it. At City Osteopathy and Physiotherapy, we have a team of experienced physiotherapists that you can count on to make your recovery journey faster and get you back on track to achieving your personal goals.
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From “9 tendinopathy truths you must know” by Dr. Peter Malliaras
- Tendinopathy does not improve with rest – does not increase tolerance of the tendon to load.
- Although there are some inflammatory biochemicals and cells involved in tendinopathy, it is not considered to be a classic inflammatory response. Anti-inflammatories may help if pain levels are high but unclear what effect they have on actual cells and pathology.
- Main risk factor is a sudden change in certain activities
- Those that require the tendon to store energy (walking/running/jumping)
- Loads that compress the tendon
- Some people are predisposed to tendon pain and may develop it even with subtle changes in their activity.
- Exercise is the most evidence based treatment for tendinopathy – tendons need to be loaded progressively so that they can develop greater tolerance to loads that an individual has to endure in their everyday life. Without this stimulus, most tendinopathies will not improve.
- Modifying load is important in settling tendon pain – often involves reducing (at least in the short-term) abusive tendon load that involves energy storage and compression.
- Pathology on imaging is not equal to pain. Additionally, most pathologies are unlikely to reverse with treatment – “target to improve function and pain instead”.
- Tendinopathy rarely improves long term with only passive treatments – they are adjuncts. Multiple injections should be avoided as it is associated with a poorer outcome.
- Exercise should be individualised – progressive increase in load.
- Tendinopathy responds very slowly to exercise – you need to have patience, ensure that exercise is correct and progressed appropriately.
From Achilles tendon loading during weight bearing exercises reviewed by Stephen King
- Achilles tendon injuries are common, particularly in male runners 30-50 years old
How long does Achilles tendinopathy take to get better? By Luke Nelson
- For a lot of those with Achilles tendinopathy, it can take 3-6 months to see improvement with full pain resolution sometimes taking over 1 year.
- However, while symptoms may persist for sometime, getting back to the things you love doing without pain impeding your performance will often take less time.
- It is important to stay the course and be consistent with following the advice of your health practitioner. It is rarely a condition where doing a couple of exercises for a few weeks will sort it out.
- Flare-ups will likely happen.
Is it time to put a hold on isometrics? By Tom Goom
- Good loading option if they are better tolerated than other forms of loading or if they cause an immediate reduction in pain.