Achilles Tendinopathy & Physiotherapy

"Achilles tendinopathy can affect anyone, from athletes, recreational exercisers to inactive people. The cause of Achilles tendinopathy is not inflammatory as previously thought. Research has shown, it is a failed healing response of the tendon from being loaded. Overuse of the Achilles is considered to cause the condition, but the cause has not been scientifically clarified. It is seen most commonly in the middle part of the tendon, but also occurs where the tendon inserts into the heel bone (Alfredson et al, 2007)".

Common symptoms:

Tenderness over the Achilles tendon when gently squeezed, you may also feel tender lumps or nodules along the tendon.

Stiffness and tenderness around the tendon in the morning, which may make walking in the morning difficult. This may take a few minutes to settle but this will take longer for others, depending on the severity of the injury.

Pain can vary from person to person – some people can exercise through the pain, this means that the pain settles during exercise but after resting it may then increase. Some people experience severe pain which stops them from doing their sport.

So you might be wondering what's the best treatment method? 

Most of the most recent research suggests an eccentric (lengthening while strengthening) programme is beneficial for mid‐portion Achilles tendinopathy. This model of training emphasises the need for you to complete the exercise protocol despite pain in the tendon. If you experience no tendon pain doing this programme, then the load is increased until the exercises provoke pain. Good short‐term and long‐term clinical results have been reported from the research. The eccentric training programme is usually 12‐weeks in duration and research has shown to be effective and is successful in resolving symptoms in approximately 90% of those with mid‐tendon pain and pathology. Insertional Achilles tendon pain is not as responsive, and good clinical results are achieved in approximately 30% of tendons (Alfredson et al, 2007).

 How can your Physio help?

Your physiotherapist will also look at the surrounding muscle groups to assess any weakness and provide you with a simple home-based exercise program to assist with retraining the surrounding musculature. If your Achilles tendinopathy does not respond to conventional treatment, we can consider referring you to a Sports Physician, who may be able to provide you with extracorporeal shockwave therapy or corticosteroid injections, but these are usually only provided to patients who don't respond to physiotherapy management. 

References:

1) Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. British Journal of Sports Medicine. 2007;41:211–6.