In today’s blog, we are going to talk about a runner’s worst nightmare… Achilles’ tendinopathy (previously known as Achilles’ tendinitis). Yes, this condition generally creeps up on you and has the uncanny ability to cause you pain at the most inconvenient times, like just before a major game or event! Unfortunately, ignoring the pain and hoping for it to just go away, or waiting for it to get really bad, is an all too common story. The good news is that physiotherapy management of Achilles’ tendinopathy can be incredibly successful, without the need for painful, ineffective, and expensive injection therapies. And if actioned early, you can be back running or training without pain in no time!
What is Achilles’ Tendinopathy?
Achilles’ tendinopathy (AT) is a condition of painful tendon changes in the Achilles’ tendon. This is the biggest and strongest tendon in the human body, and attaches you calf to the back of your heel. As the Achilles tendon connects the leg muscles to the foot, it gives you the ability to push off during walking and running.
Image credit: Coastal Sport
Patients with this condition often present with localised pain in the Achilles’ tendon. While it can lessen as the tendon warms up with activity, it’ll typically return afterwards, often lasting for several days. Morning pain with stiffness in the Achilles’ tendon is a very common symptom.
Although it’s often quick to be aggravated, tendon pain can take quite a while to settle and will require strengthening and modified training. The good news is that tendons are strong and adaptable and rehabilitation is supported by good quality evidence.
Why are the causes?
Causes can be extrinsic and/or intrinsic. Intrinsic risk factors are the things we can’t change – the more risk factors we have, the greater the impact! These include: increasing age, genetics and family history, as well as the impact of hormonal changes at menopause, some auto immune conditions and diabetes.
Extrinsic risk factors are modifiable, and when it comes to activities and training, a clear load-pain relationship is seen. Your poor biomechanics or training errors can include:
- an increase in hill running
- an increase in sprinting or speed work
- running on hard surfaces
- extra training sessions, with less rest and recovery
- an increase in overall running volume or distance
- commencing unaccustomed power walking, especially in the older population
- sudden addition of deep and heavy squats, dead-lifts
- prolonged sitting, e.g. sitting more at work, or a driving holiday
- wearing inadequate or incorrect footwear
- excessive pronation
- poor calf muscle flexibility and stiff ankle or toe joints
- weak calf muscles
Treatment – Can it be fixed?
A lot of research has been done and continues to come out to guide best treatment practice. Many treatments once popular 10-15 years ago are known to be (much) less effective than once thought. Happily (especially for those who are active and love training), EXERCISE is the best medicine when it comes to treating AT!
Researchers in the field agree on several key points for treatment of AT:
- a short amount of rest MAY be required to settle your pain levels. But too much rest actually decreases the ability of the tendon to cope with load and make getting going again more difficult
- use of heel raise/wedge MAY help in the initial stages to reduce your pain
- orthotics MAY also help address biomechanical issues of your foot and ankle that may be causing excessive load/strain on your Achilles’
- running/walking modification. Try reducing your running speed, shortening your stride length and avoiding of hills
- if doing weights at the gym, reduce the depth and weight of squats and dead lifts
- REFRAIN from ALL calf stretches. Whilst the Achilles’ feels like its tight and needs a stretch, the compression caused by stretching can actually aggravate your symptoms and increase your pain
- avoid training into significant pain, a 3-4/10 pain MAX
- closely monitor symptoms for any aggravation, and train at a level where you have an increase in pain for no longer than 24 hours post exercise
- allow yourself as much as 48 hours between training sessions, as tendons require loading – and then a recovery period – to repair
- exercise is the BEST treatment for tendon pain
- isometric strengthening is often a good way to start the rehabilitation process, to help relieve your pain, and start increasing the load tolerance of your Achilles’ to prepare for isotonic exercises
- common isometric exercises prescribed include seated or standing calf raises, either double or single leg
Image credit: RunSmart Online
- when suitable, isotonic exercises will further help strengthen your calf and improve the load tolerance of your Achilles’ tendon. Examples of suitable exercises may include weighted calf raises (seated and standing)
Image credit: KinX Learning
- a progressive hopping program may be prescribed, especially if running and sprinting are still causing pain
What to do now?
Treatment for AT is very personalised and not a recipe. What works for one person won’t work for the next. As mentioned above, there are many factors to consider when prescribing a treatment plan to address AT. The keys for success include early intervention, compliance to you rehab and PATIENCE, as tendon rehab will take months, not weeks to be remedied!
The team at Revive Physiotherapy and Pilates, have completed extra training in tendinopathies, to help ensure you are back doing what you love as quick as possible. Call us on 93912600 or book online to get yourself on the road to recovery today!