Achilles tendinopathy or generally known as achilles tendinitis is a common condition characterised by localised pain and swelling at the achilles tendon. The achilles is a large tendon connecting the major calf muscles, the gastrocnemius and the soleus, to the heel bone. During a calf contraction tension is put through the achilles tendon and if this tension is excessive due to too much repetition or high force, damage to the tendon occurs, leading to subsequent degeneration and inflammation.
Signs & Symptoms of Achilles Tendinitis
Pain at the achilles tendon is most commonly felt either at the mid-point of the tendon or at the portion where it joins with the heel bone. The pain can either be sharp or a dull ache. There may also be limited ankle flexibility, redness or heat over the painful area, a nodule (a lumpy buildup of scar tissue) that can be felt on the tendon, or a cracking sound (scar tissue rubbing against the tendon) when the ankle moves.
Causes of Achilles Tendinitis
Achilles tendinitis commonly occurs in both recreational and professional sports athletes, usually involving running and jumping type activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. It can also be caused by adverse lower limb biomechanics, tight or fatigued calf muscles, previous calf strain/ tear and ankle sprain, weak muscles, overtraining, increasing training load too quickly, excessive hill running or speed work, overpronation and inappropriate footwear.
Treatment, Management & Prevention of Achilles Tendinitis
If you start experiencing achilles pain, then stop doing the activity that started the pain and rest. Ice the area for 10-15 minutes multiple times a day, until the swelling subsides. Take some anti-inflammatory medication is the pain persists for more than 2 days.
Manual therapy such as osteopathy can help with the pain, muscle tightness, joint mobility, body alignment, inflammation and swelling. This may include techniques and modalities such as soft tissue massage, manipulation, dry needling, electrotherapy and taping.
Shock wave therapy has also shown to be effective, especially more for insertional achilles tendinopathies.
A strengthening program should be implemented once the swelling has gone down. This exercise program should consist of eccentric exercises, but also exercises such as concentric strengthening and other exercise to address possible functional deficits (ie. weak gluteals). One of the most useful strengthening technique for the achilles is the heel drop. This is where you lower yourself from being up on your toes and allow your heel to slowly drop down and off the level of a step. This exercise should be done slowly and it can be normal it feel some pain, but as long as it doesn’t stick around longer than the exercise (irritable). From this exercise once it becomes easier and less painful, load can be added (ie. a backpack), increased repetitions, increase in range, and increase in speed (much later). Although this is one exercise it is best if you consult your osteopath or physiotherapist to rehab your achilles tendon correctly.
If you are a runner, you can start running once there is no pain on calf raises, heel drops or hopping. Make sure that there is no speed or hill work in these run sessions and there is at least one rest day between each run. Once there is no pain during or between runs you can gradually increase your volume.