Previously known as Achilles Tendonitis, research has shown that there is actually no inflammation of the tendon and so the condition has been more properly labelled tendonopathy. The condition is a breakdown of the tendon and may include partial tears.
What is it
Achilles tendon injuries generally develop over a period of time, although pain may present quite suddenly after a particularly tough training session. Most often, we notice pain and stiffness in the Achilles tendon region when getting out of bed in the morning, which decreases with warming up. Similarly, pain is experienced at the beginning of a training session, lessens with activity and then returns as we cool down…. your classic overuse Achilles Tendonopathy.
Causes of Achilles Tendon Injury
A number of factors have been proposed to contribute to Achilles tendon problems by either increasing the load, or decreasing the ability of the tendon to tolerate it. These may include:
- Excessive or abnormal foot pronation, which causes the Achilles to ‘bow-string’ and increases the load on the tendon when pushing off.
- Poor lower limb biomechanics.
- Poor Footwear.
- Sudden increases in training volume or intensity.
- Toe running, or excessive weight bearing through the front of the foot.
- Genetics – not much we can do about this one – yet!
An analysis of biomechanics and lower limb alignment as well as checking that appropriate footwear is being used is important in identifying the underlying cause of the condition developing. This should be done by a qualified physiotherapist with experience in biomechanical assessment.
The initial phase of treatment is activity modification, ie avoiding activities which overload the Achilles tendon and may cause further breakdown. This usually means stopping running! This can be effectively combined with soft tissue release to break up adhesions within the tendon and tendon sheath which are causing pain as well as taping or providing heel lifts to offload the tendon.
The next phase of management involves commencement of a program of graduated loading exercises to strengthen the tendon and improve its ability to bear load. An eccentric contraction is the slow lengthening of a muscle. Research shows that isolating eccentric load to the tendon gives the fastest and best tendon healing. Your Physiotherapist will set you up with a program of eccentric exercises for the Achilles to strengthen the tendon. During this phase it is also important that exercises are prescribed to correct any underlying biomechanical problems.
The final phase of management of this condition is return to sport and activity. This should be done gradually so as not to overload the tendon and cause another breakdown and should be implemented with the supervision and advice of a qualified Physiotherapist.