Achilles Tendinopathy

Achilles tendon injuries are one of the most common running and jumping injuries that we see. The tendon in rare cases can actually completely rupture however commonly it is because of an overuse to the tendon. This overuse was previously known as Achilles tendonitis however the recent literature has concluded the name should be Achilles tendinopathy.

In order to fully understand what Achilles Tendinopathy is, we must first understand the role of the tendon. Tendons are located all around the body and their job is to attach the muscle belly to a bony structure. Therefore, when a muscle contracts it causes the tendon to pull on the bone and therefore create movement. The other main role of the tendon is to store and release energy to create powerful movements of the lower limb.

There are two main types of Achilles Tendinopathy, reactive and degenerative tendinopathy. Reactive tendinopathies are more common in the younger population and generally occur with an increase in training load. In this phase, the tendon is overloaded and it adapts by thickening to spread out the load on the tendon. If the load is then reduced and the tendon has an increased time of recovery, then it can return to its normal structure. In the more chronic Achilles injuries or the degenerative tendinopathies, the tendon fibres have become worn out and disorganised and therefore unable to deal with load as well as a “healthy” tendon.

The management of Achilles tendon injuries differs for just about everyone. Initially, it is important to improve the length of the muscles that attach to the Achilles tendon. The “calf” or Gastrocnemius and Soleus muscles attach to the heel via the Achilles tendon therefore it is those muscles that need to be loosened up. The calf responds really well to massage and Dry Needling, both these techniques improve blood flow and relax the muscle. With most overuse injuries, there is also a period of rest required, this enables the connective tissue inside the tendon to recover and remodel. Icing is also very effective in reducing the inflammation inside and around the tendon.

With regards to exercising the tendon, the evidence surrounding the best practice of this is constantly updating. The common theme amongst all studies is that Achilles Tendons do not improve unless you load them. Over the years it was initially thought to be best to isometrically load a tendon. Isometric contractions are when the joint angle and muscle length do not change when under contraction. At other times, best practice has been considered to be concentric or eccentric muscle contractions (contraction while the muscle is shortening or lengthening). At present, it is more important that we load the tendon. The load on the tendon should be related to the individual tendon and how well it copes with loading.

If you have Achilles pain why not come and see one of our experienced Physiotherapists today! You can book online at the link above or phone 6244 0345. We look forward to helping you on the journey to you achieving your goals.