Achillies Tendinopathy: Causes, Treatment and Recovery
Named after the Greek mythological hero, as it was the only part of his body that was still vulnerable after his mother had dipped him (holding him by the heel) into the River Styx, the Achilles tendon is a thick cord that connects your heel bone to your calf muscle. It is this tendon that forces your heel to follow along with your contracting calf, lifting your foot from the ground during walking, running, climbing and jumping.
It is the strongest tendon in your body with the ability to support up to 4 times your body weight, increasing to 8 times while you are running. Despite its power, the Achilles is also vulnerable to injury due to force it is regularly subjected to.
Achilles tendinopathy is a common soft tissue injury that is usually caused by repetitive stress and overload, which results in changes to the structure of your tendon, sometimes resulting in tiny tears, which make it weaker. As the Achilles has a very low blood supply if it does become damaged, it can take longer to heal than a muscle as it must use the blood supply that exists in the sheath around the tendon in order to repair.
Any sports or activities that put stress on your Achilles tendon can lead to Achilles tendinopathy. This includes running and any activity involving jumping, pivoting, such as dancing, gymnastics, squash and tennis. Suddenly increasing the volume or intensity of activity, training without poor technique, training on hard or uneven surfaces and wearing badly fitting or the wrong type of footwear for an activity, can all increase the changes of damaging your Achilles. Despite being most often connected to sporting activities, Achilles tendinopathy can also affect people who do not practice sports. Interestingly, the condition is more common in people ages 30 or over, and generally affects men more than women.
Achilles Tendinopathy: What are the symptoms?
Achilles tendinopathy can cause several symptoms, including
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pain in your heel – this may be an ache or a sharp pain, which feels worse when you’ve been active or put any pressure on it
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stiffness in your tendon – often worse first thing in the morning or if you’ve been resting for a while. This usually eases after a few minutes of walking but might take longer
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swelling at the back of your ankle.
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tenderness when you touch your tendon
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a grating noise or creaking feeling (crepitus) when you move your ankle.
If you feel sudden pain in your heel or calf, this could mean you’ve torn or ruptured your tendon. You might even hear it snap and have trouble bearing any weight on your leg. If this happens, you must seek medical advice urgently.
Treatment
There are several at-home treatments you can try to support your Achilles tendinopathy self-management.
Firstly:
- No pain no game is not the answer, but similarly, if you don’t challenge a structure at all in recovery, it is unlikely to be as strong and durable moving forward. Complete rest is rarely advised for tendinopathies, even in the short term. It is important to load tendons during their recovery AS SYMPTOMS ALLOW. Of course, if certain actions/movements ramp up your pain you should not rush into them, but you should not be afraid to move a tendinopathy with slight discomfort.
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Get back to normal walking: with most lower limb injuries, the priority is to get back to a regular walking pattern as soon as possible as this aids recovery in many ways. This may require using a walking aid in more severe cases or starting with easier exercises and tendon-loading strategies.
If you have any uncertainties with how to load your Achilles tendinopathy with controlled symptoms, you should consult a physiotherapist.
- Ice – For very angry tendinopathies, cold packs (not directly to the skin, wrap it in a towel first!), can be helpful in easing an inflammatory flare-up. However, inflammation is a natural healing process and therefore it is not encouraged to constantly ice something as you are dulling the healing response. Use ice and other pain management strategies such as paracetamol, ibuprofen/anti-inflammatory gels when the pain is limiting your life significantly such as sleep, walking, and general day-to-day tasks. If you are unsure of medications, ask your Dr/pharmacist.
(studies have shown that it is recommended to limit the use of anti-inflammatory medications (Neurofen/Ibuprofen) as they can impair the natural healing process of the tendon. )
Once the pain starts to ease, you can slowly start to resume your normal activities, taking time to warm up well and doing plenty of calf stretches before you begin.
Tips for when running are to start with no hills and hard unstable surfaces if possible with sensible footwear and to keep the distance/durations short to start with and see how your symptoms feel afterwards. Tendinopathies often play nice when you are active but come on with vengeance afterwards, so be sensible with gradually building up your activities without getting carried away or you could flare it up again!
If however, after a week or of self-management your symptoms do not improve you should see a physio. After undergoing a series of movement tests to diagnose the issue, your physio can create a programme of exercises designed to build up the strength and function of your Achilles. These exercises usually start with some gentle stretches, before moving on to what are termed as ‘eccentric exercises’. These are exercises that are designed specially to load or stretch and lengthen your Achilles tendon over time, gradually increasing the stress going through the tendon in a controlled way. You’ll probably need to perform the exercises twice a day, every day for at least three months to get the best out of them.
Other treatments
If your Achilles tendinopathy doesn’t improve with self-help measures or physiotherapy exercises, there may be other treatments you can try. These include the following.
- Shockwave therapy - this is where a machine passes shockwaves through your skin to the damaged part of your tendon. You can learn more about shockwave therapy here.
- Dry needling or acupuncture - this involves passing a thin needle into your tendon with the aim of triggering the healing process and strengthening your tendon.
- Podiatry – the shape of your foot or your gait – the way you walk or run - could have an impact on the stress and load going through your Achilles. Seeing a podiatrist who can undertake a full biomechanical assessment or create custom orthotics (insoles) for your shoes can make a huge difference for some people.
- Pilates - Pilates strengthens, lengthens and re-balances your muscles by working on your stability and posture. Through Pilates exercises, you can effectively isolate and progressively eccentrically load and strengthen the Achilles. Pilates is not only a suitable treatment programme for rehabilitation, but it is also key to injury prevention.
Recovery
Recovering from Achilles tendinopathy can take weeks or months depending on the severity and the individual patient. For most people, pain and movement will become noticeably better after around 12 weeks of self-help measures and physiotherapy. However, other people may need more specialist treatments to gain improvement. While you undoubtedly need time to recover, if you are struggling with Achilles tendinopathy you can still enjoy activity and movement.
For help with your Achilles tendon pain, please don’t hesitate to contact us on 0131 315 3105 or via email at info@balancededinburgh.co.uk.