Achilles Tendinopathy Types and Treatment

Nina Crowhurst - APA Sports & Exercise Physiotherapist

Achilles Tendinopathy (previously known as Achilles Tendonitis) is a condition commonly treated by Sports Physiotherapists. It frequently affects athletes from running and jumping based sports but may also result from every day life. The main complaint is of pain and/or stiffness localized to the mid-portion of the achilles tendon or at its attachment into the heel bone (calcaneum).

Symptoms are often worse after exercise or activity, particularly the following morning on first getting out of bed. They may also be felt on warming up for exercise, after a period of time exercising or the tendon may stay sore throughout activity and progress to the stage of being unable to exercise. The initial onset of pain can be gradual or may occur suddenly in one or both legs.

MAIN TYPES OF TENDINOPATHIES

1. Reactive Tendinopathy

• Generally younger individuals
• No prior history of issues
• Onset following a sudden increase in tendon load above and beyond what is usual for the individual e.g. a significant increase in running distance, time, elevation or speed work

2. Degenerative (or Reactive on Degenerative) Tendinopathy

• Usually middle age to older adults
• Onset following a small but definite increase in load on the tendon eg – increasing running from 3 days to 4 days per week
• The tendon is dysfunctional prior to the onset of pain (poor strength, biomechanical issues contributing, may have an injury history that contributes)
• May occur in athletes with a long history of high levels of loading e.g. a Lifelong masters runner who has completed multiple marathons

TREATMENT

The basic premise of tendinopathy treatment is to increase the load capacity or strengthen the tendon such that it will handle the activities placed upon it.

The challenges of treatment include:

• Ensuring symptoms settle without deconditioning and losing more capacity and fitness. This may mean decreasing your aggravating activity (running) at times, but it needs to be substituted for another activity, such as cycling and strength training, or it will take longer to return to your previous activities. Total rest is rarely the solution!
• Providing the right strength exercises at the right time. Progressing strength exercises too quickly or starting at the wrong level will aggravate the condition further.
• Tendon response to rehab and loading must be monitored. Whilst exercising with some pain is acceptable, there should be no increase in symptoms the following morning. If there is, you’ve done too much.
• Identifying and addressing all of the contributing factors, including muscle strength deficits throughout the lower limb, range of motion limitations, biomechanics, appropriate training loads and progressions.
• Maintaining appropriate sports load during rehab. Some will be able to maintain their usual sports, others will need to modify in order to progress.
• Patience! Tendons are slow to heal and gain strength, requiring consistent small overloads. The rehab process can take over 12 months for many cases, and initial improvement in symptoms can take time. An ongoing strength maintenance program is required once symptom-free.
• The earlier treatment is always better – the longer the condition has been present, the longer the rehab process. It rarely goes away by itself.

If you are struggling with Achilles Tendinopathy, please speak to your Physiotherapist to devise an individualized rehab program. The sooner you have an action plan in place, the sooner you will be back to 100% and beyond!