If you experience pain or discomfort in the back of your heel while running or jumping, it might be Achilles tendinopathy.

The Achilles tendon connects the muscles of your calf to your heel bone, allowing you to move easily. However, when this tendon is overloaded, it can lead to pain and dysfunction, which can impact your daily activities.

So, what causes Achilles tendinopathy?

Well, it’s usually from excessive loading, which means you may have pushed yourself too hard during exercise or physical activity. If you want to prevent further damage, it’s essential to recognise the symptoms and address them early on – before it becomes unbearable.

Remember, the Achilles tendon is a vital part of our body that helps us stay active and bounce around. By actively taking care of it and seeking proper treatment when needed, you can ensure continued mobility and overall wellbeing.

Tell me more about it

When you have Achilles tendinopathy, the increased number of cells in the tendon due to excessive load can cause pain when loaded (but not at rest) in the early stages. In chronic cases, this reaction can lead to structural disorganization of fibers in a small part of the tendon. Although commonly thought to be inflammation, research evidence does not support this as a cause of tendinopathy.

This condition can occur either at the insertion point or the mid-portion of the tendon, and it's essential to distinguish between the two as they require different treatment methods.

How do I know if I have Achilles tendinopathy?

When you have Achilles tendinopathy, you might experience localized pain where the Achilles attaches to the heel or between the heel bone and muscle. This pain is specific and does not cover a large area. If your pain covers an area larger than a coin or is vague, you should consider other diagnoses.

Achilles tendinopathy usually causes pain with loading activities like running, jumping, or sports. It's common in distance runners and is characterized by stiffness and pain first thing in the morning. You may not experience pain at rest, but walking after sitting for a while may be sore. The tendon may appear thicker, but this is a sign of your body trying to adapt and create more tendon tissue to overcome the problem.

If you think you have Achilles tendinopathy, your physiotherapist can diagnose it by carefully asking about your history and changes to your activity and loading. They will perform tests to assess your tendon's response to load and look at the strength of your leg. It's essential to differentiate this condition from other conditions that cause pain in a similar area.

Scans are not necessary for this condition, and there is a poor link between findings on ultrasound imaging and pain. Scans should only be considered when considering alternate diagnoses.

How can physiotherapy help?

Your physiotherapist will create a personalized treatment plan based on your individual findings for Achilles tendinopathy. Initially, treatment will aim to reduce your pain, and it will be essential to modify and temporarily reduce high load activities like running or jumping. It's best to avoid positions where the tendon is compressed, such as stretching, and instead focus on isometric exercises to reduce pain.

Once your pain is under control, your physiotherapist will focus on heavy and slow strengthening of your entire leg, depending on identified deficits. Gym equipment or weights may be required, and exercises should be challenging. As you get stronger and your pain remains settled, higher load activities will be gradually introduced. Eventually, you'll be eased back into the sport or activity you were performing, provided your physiotherapist is satisfied with your tendon capacity.

It's important to note that exercise loading should be the basis for all treatment of Achilles tendinopathy, as complete rest may only make things worse. Massage of the calf, ice, and other treatments are adjunct treatments and alone may not be effective. It's essential to be aware that there are no quick-fixes for Achilles tendinopathy, and the following treatments are not supported: injections (no evidence exists for cortisone, platelet-rich plasma (PRP), blood injections, or stem cells), ultrasound, laser, or electrotherapy, and stretching (as these put the tendon into compressive positions).

How effective is physiotherapy for Achilles Tendinopathy?

To effectively treat Achilles tendinopathy, exercise is key. Published research recommends exercise as the primary treatment option. In the past, it was believed that eccentric exercises (muscle contractions while lengthening) were superior, but recent studies have shown that both eccentric and concentric exercises (muscle contractions while shortening) can be effective, if they are sufficiently challenging. Some people may find that doing only eccentric exercises is painful. Isometric exercises (holding exercises) have also been shown to reduce pain and improve muscle control affected by pain.

Is there anything I can do at home?

Exercise loading is the foundation of Achilles tendinopathy rehabilitation. Your physiotherapist will recommend specific exercises for you to do at home and in the gym, tailored to your individual condition. Monitor your progress by assessing your symptoms each morning; if they are the same or better than the previous day, your exercises were appropriate, but if they worsen, you may have overloaded the tendon.

How long does it take to get better?

To recover from Achilles tendinopathy, a lengthy rehabilitation process is necessary and the duration depends on the level of pain, dysfunction, and the desired activity level. Heavy and challenging exercise loading must be done for an extended period to ensure you’re building the right support structures in your body to stop the pain, and prevent it from happening again. Minor cases can be resolved within 1-2 months, but usually it can take up to 3-6 months or longer in more complex cases to get to 100% capacity.

Dedicated to your wellbeing

Ankle