What is the Achilles tendon?
The Achilles tendon is a fibrous connective tissue on the posterior aspect of the lower leg. This is the thickest, strongest tendon in the body and its function is to connect the gastrocnemius and soleus (calf muscle) to the heel of the foot. Contraction of the calf muscle pulls the tendon and allows to the foot to push downwards (plantarflexion). This allows functional movements such as standing on toes, walking, running and jumping.
What is a tendinopathy?
Tendinopathies can occur in other areas of the body, such as the patella tendon and proximal hamstring tendon to name just a few. The tendon is in a constant state of building new tissue (synthesis), but also breaking tissue down. Tendinopathies occur when this process becomes unbalanced, when we frequently put too much load on the tendon causing tissue breakdown to exceed tissue synthesis. This changes the structure of the tendon and leads to a tendinopathy.
Tendinopathies often occur in stages. Initially, a rapid increase in load leads to a reactive tendon which will cause visible swelling and pain. Over a longer period of time (chronic cases) the tendon will become degenerate where the tendon becomes thickened and develop nodules. If this condition remains untreated it will fail to deal with the increased load and may lead to a partial or complete rupture of the tendon. However, if the problem is identified and treated early it often fully resolves.
Management & Treatment
If the tendon is in a reactive stage the initial aim of treatment is too settle the irritation and calm it down. We can reduce the stress on the tendon through ‘load management’ allowing the tendon to recover. Load management doesn’t always mean complete rest from sport, and in mild cases you still may be able to participate as long as this is pain free! In more severe cases where exercise cannot be undertaken pain free, complete rest is advised initially. Anti- inflammatory medication such as ibuprofen has been recommended for a reactive tendinopathy, however you must consult with your GP or pharmacist before taking any medication. Other treatments that we can offer at Holcombe Health:
- Ice application- this will help to reduce pain and irritation. Apply for 15 minutes at a time.
- Offload the tendon- if you are able to still exercise during a tendinopathy a heel raise in your shoe to take the tendon off stretch, however this may only be a temporary fix. Kinesio taping can also be an effective way to decrease the load on the tendon during exercise.
- Soft tissue massage- Massage to the calf muscle can reduce tightness. Muscular tightness and reduced ankle range of motion may have been an initial cause, so addressing these issues is very important. Foam rolling can be used for self-massage while away from the physio as an alternative.
- Ultrasound & acupuncture- medical research is varied when it comes to these two modalities, however can often be very beneficial for patients. If you have responded well from these treatments in the past they could work for you. With ultrasound therapy, regular treatments are advised for it to be most beneficial.
- Exercise rehabilitation- isometric calf exercises have been shown in medical research to help reduce pain, and also strengthen the tendon without causing pain. Isometric exercises mean contracting the muscle in a static state. Push up onto your toes and hold this position for 5-10 seconds.
In summary Achilles tendinopathy are very common in sport, especially in running. If this condition remains untreated it can lead other serious injury and significant time away from exercise. However if this condition is diagnosed and treated early it been easily resolved, getting patients back to full function. This injury will often not heal on its own so if you think you may be suffering from Achilles tendinopathy, book an appointment with one of our therapists for advice and treatment!