The achilles tendon is a fibrous band of connective tissue which connects your calf muscle to your heel bone. The role of the achilles tendon is to act as a spring, which absorbs and releases forces to produce movement at the ankle, essential for functions such as walking, running and jumping. The achilles tendon is primarily made up collagenous fibres which are bunched together.
Achilles tendinopathy is a common overuse injury of the achilles tendon, often the result of increased demand/load placed on the achilles tendon. Changes in running/sporting frequency, training terrain, changes in footwear or biomechanical insufficiencies may all play factors in the development of achilles tendinopathy. This condition is most likely to be found in individuals who participate in running and jumping sports. Achilles tendinopathy is divided into a 3 stage continuum including; reactive tendinopathy, tendon disrepair and degenerative tendinopathy (Li & Hua, 2016). Dependent on the location of symptoms, achilles tendinopathy is divided into ‘insertional’ (at the insertion point of the tendon into the heel bone) and ‘mid-portion’ (2 – 6cm above the insertion point of the achilles) tendinopathy (Li & Hua, 2016).
Symptoms of achilles tendinopathy are typically localized within the achilles tendon. Dependent on the stage of tendinopathy pain may be elicited with placing the tendon under load or stretching the achilles tendon. Morning pain in the achilles is another clinical presentation seen in achilles tendinopathy. In more chronic tendinopathy the tendon may be thickened and have a changed appearance. In the early stages of achilles tendinopathy, the pain felt will often warm up during activity and return when cooling down. Jumping, hopping and running are likely to aggravate the affected tendon.
Management of achilles tendinopathy initially requires the athlete to relatively rest the tendon allowing for a resolution of symptoms. Rest will not fix the condition, it may improve symptoms but without improving the load tolerance of the tendon it is likely pain will return when activity loads exceed the tendons tolerance.
Adjuncts such as massage, foam rolling and ice/heat may also provide some temporary reduction in pain and stiffness during the acute phase of the condition and may be an appropriate method for some individuals to assist their rehabilitation. Stretching of the achilles should be minimized as it has been found that compressive loads to the affected tendon can exacerbate symptoms.
Once acute pain has settled, the following may be used to address the underlying factors contributing to the patient’s tendinopathy (Li & Hua, 2016):
- Heavy strength training of the ankle and foot complex (Performed gradually over an 8-12 week time frame)
- Using heel wedges or altering to a shoe with a greater heel-toe drop ratio.
- Altered running biomechanics
- Gait/biomechanical analysis and running re-education.
Achilles tendinopathy is not a condition that will recover in days. However, with the correct loading and management program, function can be restored, pain can be decreased and individuals can return to their desired level of function.
If you are suffering from achilles tendinopathy or any other musculo-skeletal complaint, then the staff at Northside Sports Physiotherapy can guide you to recovery and get you back on the trails. Call 9476 1666 for an appointment.
Written by Jack Penny – Physiotherapist (B. PHTY)
If you are suffering achilles tendinopathy or any other musculo-skeletal complaint, then the staff at Northside Sports Physiotherapy can guide you to recovery and get you back on the trails.
Call your nearest practice to book in an appointment:
Hornsby – 9476 1666
Wahroonga – 9489 4588
Lindfield – 9489 4588
Li, H., & Hua, Y. (2016). Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Biomed Research International, 2016, 1-9. doi: 10.1155/2016/6492597