Your Guide to Achilles Tendonitis & Tendinopathy

Introduction

Achilles tendinopathy is a term used for conditions which affect the Achilles tendon (the band of fibres that connect the calf muscle to the heel bone). Problems are usually caused by overuse or repeated movements during sports, work or other activities. Other factors include poor footwear and with changes in training frequency and intensity.

Anatomy

A tendon connects muscle to bone. The Achilles tendon connects 3 muscles – the gastrocnemius, soleus, and plantaris muscles into the heel bone. It is the thickest and strongest tendon in the body. This tendon allows you to rise up on your toes and push off when you walk or run. When the tendon becomes overloaded (e.g. running up a hill) inflammatory changes within the tendon can occur causing thickening of the tendon. Over time, with repeated overload the tendon may not heal adequately and microtears can form in the tissue in and around the tendon.

Symptoms

What does the condition feel like?

Symptoms of Achilles tendinopathy include mild to severe pain at the back of your heel over the tendon. Pain can come on gradually and may only occur as you begin or end a walk or run. There may also be swelling in the tendon or ankle area. Sometimes a rupture (a large tear) of the Achilles tendon can occur. This may cause a sudden, sharp pain. Most people feel or hear a pop at the same time. Swelling and bruising may occur, and you may not be able to point your foot down or stand on your toes.

What happens if I don’t fully fix my Achilles pain?

If an activity is causing repeated stress to the Achilles tendon and causing you pain it is important seek advice early. If left untreated your pain may become constant and will require a longer period of rest from your activity. In more severe cases, normal everyday walking can become difficult and the Achilles tendon will not heal with physiotherapy treatment. The tendon will also become vulnerable to rupturing due to the chronic inflammation. When this happens, surgery may be required to repair the rupture.

How long does it take to get fully better?

This will depend on the severity of your injury. If you seek advice early to control the inflammation, you could make a full recovery in 8-10 weeks. However, the rate of recovery differs from patient to patient, and in come cases can take up to 6 months.

Ticket to freedom ~ your journey to full recovery
Your physio has been extensively trained by Precision Physio to give you a thorough assessment to determine exactly what is happening and prescribe the best management plan for your injured Achilles tendon.
Precision Physio’s unique phase based rehab system makes your rehab easier for you to understand as it gives you a step-by-step program to ensure you achieve your best possible results. The most common phases, or steps, that you will go through during your rehab program are outlined for you below. The order and timing of the phases will be individually tailored for you and so may vary form this list. Please feel free to ask your physio if you have any questions about the phases in your recovery plan.

Phase 1: Clarify Diagnosis

Your physio will ask you a series of questions and perform an assessment to determine whether you have an Achilles tendinopathy.
If you have a serious injury involving your Achilles tendon and a rupture is suspected, your physio will refer you back to your GP for further investigations (e.g. MRI) and to determine subsequent management.

Phase 2: Optimise & Control Inflammation

Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Inflammation makes chemicals which start up the defence and healing teams within our body. The defence teams destroy and remove damaged tissue which would normally slow the repair process. The healing teams then bring more of the healing chemicals which help your recovery.
Depending on the length of time you have had your symptoms, your physio will determine how much inflammation you have and use techniques to manage your inflammation such as R.I.C.E., ultrasound, interferential therapy and specific local massage.

Phase 3: Restore Muscle Length

When your muscles are tight they put stress on tendons (the ends of muscles) at the point where tendons attach to the bones. Tight muscles can make the job of other muscles harder and cause too much load on joints. Tight muscles also change the way you move and can stress other parts of your body. When your muscles are short you will not have your fullest strength which can also cause damage to muscles or the other things that your muscles are there to protect. Therefore it is important to get your full muscle length back to stop all this from happening.
The muscle group affected in Achilles tendinopathy is your gastrocnemius/soleus complex (i.e. calf) therefore your physio will assess whether you have tightness. If so, your physio may use techniques including stretches, muscle and soft-tissue releases and specific exercises to help regain your flexibility.

Phase 4: Improve Muscle Strength

Weak muscles are a major problem when recovering from an injury. Often muscles are weak because they are not being used properly, they have been damaged, or they have been resting after an injury. When strengthening muscles you must strengthen the correct muscle and in the way the muscle would normally be used.
In Achilles tendinopathy, the calf muscles need to be strengthened to minimize the load placed on the Achilles tendon. To improve your muscle strength, your physio may show you exercises using bodyweight, free weights or theraband.

Phase 5: Correct Biomechanics

Biomechanics are how you use your body in different activities, whether it be walking or throwing a ball. Your biomechanics (how you move) play a big role in causing, repairing and preventing injuries – they can also help in improving performance. Poor biomechanics can happen naturally or from an injury where your body moves differently than normal. When you have poor foot biomechanics your body is not working as well as it could and this puts strain on other areas of your body including your knees, hips and even your back. Correcting your biomechanics will ensure your body can work at its best.
Techniques used to correct biomechanics are Gaitscan Custom Orthotics, taping techniques, specific strengthening and examining training techniques.

Phase 6: Sports/Ballistics & Advanced Strengthening

This is the last phase of your journey to full recovery. When you are returning to your activity you must be able to do it at full speed and resistance before being back in the game. You need to be able to apply your speed and force with the correct technique in training first to prevent another injury. In this phase we tailor exercises specifically to your activity with varying speeds, forces and frequencies. This phase is essential both for getting you back to your full level of performance, and also for preventing re-injury due to persisting background weakness or reduced proprioception.

This phase is achieved by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions