December 19, 2018
Achilles tendinopathy (or tendinitis or tendinosis) is a common overuse injury seen typically in people who enjoy running, or who participant in explosive or jumping sports like football, basketball, soccer or netball. If you have Achilles tendinopathy, you will likely feel pain through the Achilles tendon at the back of the heel. There is often pain or discomfort first thing in the morning, or at the beginning of a run which tends to subside as you get warmed up.
The Achilles connects your heel bone to your calf muscles – the gastrocnemius and the soleus muscles. It assists in the push off phase of walking or running or jumping as it stretches then quickly recoils. Tendinopathy occurs when there is a change in the cellular organisation of the tendon and partial breakdown of parts of the tendon and in some cases micro tears. There are three different phases of tendinopathy:
- Reactive tendinopathy
- Tendon disrepair
- Degenerative tendinopathy
Achilles tendinopathy is most often easily diagnosed through thorough history taking from your physiotherapist and a clinical examination. In extreme cases or if looking for specific impairments, your physiotherapist may order an MRI scan to identify the phase of tendinopathy.
There can be many contributing factors contributing to achilles tendinopathy including:
- a sudden increase in training load (either more sessions or longer sessions)
- lack of adequate recovery time between sessions
- inappropriate footwear or a change in footwear
- a change in training surface (ie going from running on grass to the road)
- reduction in the range of movement at the ankle
- poor calf strength
Immediate management of Achilles pain is relative reduction from the aggravating activity and the use of ice to help reduce pain. Achilles tendinopathy can take up to 3-6 months, depending on the severity, therefore seeking advice from your physiotherapist as soon as possible can help in identifying the contributing factors and begin the rehabilitation period. Complete rest is not beneficial, nor advised, in Achilles tendinopathy. The tendon will respond better to a supervised, guided, loading program. Therefore, starting on a rehabilitation program that strengthens the appropriate muscles and reduces pain for the long term, is crucial. And doing it sooner rather than later will always be the best course of action!
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