Achilles Tendinopathy

Tendon problems are common in runners and can become a persistent issue if not properly treated. If you have achilles pain it is important you see a physiotherapist to get a proper and correct diagnosis as these injuries have different stages, different treatments and long term consequences if you take the wrong route. As with most injuries, as earlier diagnosis and treatment often means a speedier recovery. 

Tendinopathy is the term we now use to describe that there is a condition or disease that is affecting the structure and function of the tendon. 

There are 3 stages of Achilles Tendinopathy and an early diagnosis forms the pathway for the treatment and management of the injury:

Reactive tendinopathy typically involves the tendon responding to a rapid increase in loading (sometimes termed “tendinitis”). For runners this often means a large increase in mileage, a reduction of rest days or a change in training type (e.g. Introducing hill or speed work). It can also be from direct trauma to a tendon. A key feature of a reactive tendon is that structurally it remains intact and there is minimal change in collagen integrity. This means this is usually a reversible process. “A short term adaptation to overload that thickens the tendon, reduces stress and increases stiffness” Cook and Purdam (2009)

 

Tendon dysrepair is usually the stage that would follow reactive tendinopathy if the tendon continues to be excessively loaded. It is similar to the reactive stage but the tendon structure begins to change.

Degenerative tendinopathy is more common as we get older. It represents a response of the tendon to chronic overloading. There are multiple tendon structure changes making it less efficient at dealing with load. 

Some factors that can lead to the development of Achilles tendinopathy include:  

• Tight or weak calf muscles
• Rapidly increasing the amount or intensity of exercise
• Hill climbing or stair climbing exercises
• Changes in footwear - particularly changing from wearing high-heeled shoes to wearing flat shoes
• Wearing inadequate or inappropriate shoes for the sporting activity being undertaken
• Not adequately warming up and stretching prior to exercise
• A sudden sharp movement that causes the calf muscles to contract and the stress on the Achilles tendon to be increased. This can cause the tendon fibres to tear.

From a physiotherapy point of view exercise-based rehabilitation is the best treatment for tendon pain. A Physiotherapist will assess for contributing factors, loading issues and will give the right loads on the tendon and the best long term results. Make sure you see a qualified Physiotherapist with expertise in this area to guide your rehabilitation.