15 Things to know about Achilles tendinopathy
You may have heard of the terms tendinosis or tendonitis to refer to an Achilles problem but we use the term tendinopathy as it reflects that cellular changes occur as inflammation is not always present when it comes to Achilles pain
Achilles tendinopathy can be triggered by sudden increases in physical activity that your tendon isn't prepared for. Like starting pre-season after taking a break over the off-season or even suddenly having to take the stairs every day when the lift is broken at work
There are two primary types of Achilles tendinopathy: insertional, which affects the bottom of the tendon where it attaches to the bone
The other is non-insertional which is where changes have occured in the mid-portion or musculotendinous junction
Para-tendonitis is where the tendon sheath becomes inflamed and can exist without tendinopathy
Morning stiffness is a classic characteristic of Achilles tendinopathy. So if your first few steps out of bed are sore around your Achilles and stiffness that eases up once you’ve warmed up, this is an indication you may have Achilles tendinopathy
If you’re experiencing new Achilles pain that is only hours or a couple days old, then resting it for a few days is often the best initial approach
For more chronic Achilles pain, rest alone is not the answer. Chronic tendinopathies respond better to gradual, incremental load with a controlled amount of pain permitted
Get in and see your physio as they will help you to gradually build your Achilles load tolerance. This will involve getting a good understanding of the Achilles current load tolerance, including how intensely the Achilles is loaded, how long for and the frequency or ability to recover
Depending on where your Achilles is at, exercise can involve as little as static hold exercises to help with pain or more strength based ones like calf raises, building up to jumping and running. Exercises need to be planned at progressively greater amounts
The biggest risk to Achilles tendinopathy is a rapid change in load which is also the most important part to get right during rehab
Other risk factors include obesity, high blood pressure, type diabetes, prolonged steroid use and family history of tendinopathy
Other factors your physio may focus on is predisposing biomechanical factors like foot posture, foot strength, entire lower limb control, footwear and ergonomics
Your physio may advise you to wear shoes with a heel or heel insert rather than flat shoes or thongs while your Achilles is irritable
Stretching exercises are not necessarily good for your Achilles tendinopathy and can potentially aggravate it, especially insertional tendinopathy.
The treatment and management of Achilles tendinopathy is very specific to the person and their requirements and is not necessarily intuitive so it is important to see a physio to provide guidance.
Contact us if you would like help with any Achilles problems or issues.
