Achilles Tendinopathy – What it is and common causes
Achilles Tendinopathy is a common lower body injury affecting the tendon that attaches your calf muscles (gastrocs and soleus) to your heel. Consequently, it happens most frequently in people who do a lot of running and jumping activity, but can also occur outside of these populations.
Tendons are the tissues that attach our muscles to the bones. They are elastic in nature and help to absorb force as well as store energy. A tendinopathy develops when the tendon is under more stress than it can tolerate and begins to cause symptoms of pain. Usually, stress involves a high load that is too much or a repetitive load that is beyond the endurance capacity of the tendon.
There are two areas that Achilles tendinopathy will give symptoms:
Midportion Achilles pain – approx. 2-6 cm from the heel bone
Insertional Achilles pain – less than 2cm from the heel bone
Early on, your pain could be considered reactive tendinopathy. This is where an external load has recently started to cause symptoms. Although, if left for too long, it could progress to a degenerative tendinopathy, which requires a much longer period of treatment and time to heal.
So, what should you do first?
STOP any high load activities like running and jumping.
Ice the affected area and consider trying an anti-inflammatory, such as Nurofen or Ibuprofen, after checking with your doctor.
See your physio!
Management of the different types of Achilles tendon injury usually requires different treatment approaches and progression through 3 phases.
- Symptom Reduction – reduce pain and inflammation
- Strengthening and Repair – creating strength and encourage healing
- Elastic Energy Storage and Release – increase tolerance to high intensity activities
Achilles tendinopathies will require multiple exercises and techniques to get back to pain free function and prevent future flare ups. The end goal will be to enable your Achilles to do its natural function of absorbing impact from landings and rebounding that energy as you push off. It will also need the capacity to do this hundreds of times in a short period if you plan to do any running or jumping activity.
Below are two exercises to get you started initially.
1. ISOMETRIC HOLDS:
On a step, float heels off the edge of step in a neutral position (heels inline with the top of the step) without moving. If no step, just lift heels 2cm off the ground. Aim for 45 seconds x 5 sets. You can hold onto something lightly for balance.
Pain should be tolerable and stay under 5/10
**TRY SINGLE LEG IF PAIN IS MINIMAL WITH BOTH LEGS**
If morning pain has reduced and walking is generally pain free, progress to the below exercise.
2. SINGLE LEG SLOW HEEL RAISES:
3 sets x 8-10 Reps
With a single leg at a time, on the ground or on a step, rise up onto the ball of the foot and lower down. The whole movement should be done slowly and take about 5 seconds to complete. It may help if you hold something for balance but don’t lift with your arms. Weight can be added if pain is below 5/10 in the form of a backpack or holding a dumbbell. Increase by 2.5kg every week. This is also a good exercise for injury prevention in running and jumping sports. It is recommend to increase the load of this exercise until carrying up to 50% body weight is pain free, using appropriate equipment at the gym.