Achilles tendinopathy is an injury to the taut band of tissue at the back of the heel which connects the calf muscles to the heel bone.
There are 2 types of achilles tendinopathy;
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- Non-insertional affects the middle section of the tendon,
- Insertional which affects the bottom of the tendon where it attaches to your heel
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Secondary issues such as achilles bursitis (a painful irritation and swelling of the fluid filled sac which lays in between the heel bone and achilles tendon) are also common.
Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response.
How does it occur?
Most often this injury occurs due to overuse of the tendon over time or with a sudden increase in use without adequate recovery. Overuse of the achilles tendon can occur in many ways, such as:
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- Increasing intensity of training (running speed)
- Increasing the overall training volume (total step count)
- Increasing training frequency (number of days running) to starting a new job that requires more walking
Other, less frequent causes of tendinopathy or perceived tendinopathy pain include:
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- Inflammatory/autoimmune disorders
- Chronically reduced ankle mobility
- Joint related injury or nerve related injuries
How long does it take to heal achilles tendinopathy?
Achilles tendon rehab can often take upwards of 12 weeks.
What NOT to do:
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- Do NOT rest completely -resting the tendon and muscles completely only results in loss of strength, therefore reducing your ability to take load.
- Do NOT stretch the tendon -stretching the achilles whilst standing will increase compressive load which can often provoke pain shortly afterwards. Instead loosen off by massaging the calf muscles.
- DO NOT expect an effortless rehab -as stated above, tendon rehab takes time, this is primarily due to their limited blood supply when compared to faster adapting tissues like muscle. Getting correct professional advice and management is the only fast-track to reducing symptoms here.
Treatment for achilles tendinopathy.
Manage the load:
In the initial phase of treatment it is important to modify activity to ensure that the symptoms begin to settle down. This does not always mean avoiding exercise (gym, walking or running) altogether. It is important to identify and reduce the overloading stimulus which is aggravating symptoms at the earliest opportunity.
Strengthen:
Once we have achieved this we can begin to establish the load tolerance of the tendon before loading the tendon at a rate that will stimulate adaptation and subsequent tissue regeneration. By doing so, we are aiming to increase the load capacity of the tendon so that it can withstand more load without pain or prior symptoms.
Hands on treatment:
It is important in this phase that we do not consistently overload the tendon as this will further drive the process of pain and degeneration. There are various techniques that we can employ to adjust the load on the tendon during rehabilitation to align with the tendon’s current load capacity. This is likely to vary between different types/areas of tendon pain and with different people, therefore, it is important to seek individualised professional guidance when it comes to tendon rehabilitation.
Shockwave:
Extracorporeal Shockwave Therapy (Available at all Regen Clinics)Shockwave therapy is a non-surgical treatment that delivers impulses of energy in the form of sound waves into focused areas of damaged tissue. This treatment speeds up the healing process in tendons by up to 40%.
The treatment works by increasing blood flow to injured tissue, stimulating the healing process and cell regeneration, whilst decreasing local factors associated with pain including the size of tendon calcifications (inefficient tissue which can form in the tendon rather like plaque on teeth) far better than exercise alone.It is therefore effectively implemented alongside tendon loading programs to help reduce symptoms of pain during physical activity at any stage of injury acute to chronic (early to late stage).
Other pain relieving modalities such as activity modification, heel lifts, arch supports, stretching exercises and Non-steroidal anti-inflammatories (NSAIDs) are known as standard treatment mostly without proven evidence of success.
Speed up your healing by combining Shockwave therapy with Physiotherapy in Leeds
Pain relief:
NSAIDs such as ibuprofen have been used previously for the pain reduction in tendinopathy, however, current research is mixed on the effectiveness of such medications and their application to tendon injury. Corticosteroid injections have been indicated for use in tendinopathy and have shown to improve short term outcomes, however, have shown worse outcomes than physiotherapy alone in the medium and long term. There is also a risk of further weakening the tendon associated with this treatment.In the treatment of achilles tendinopathy (particularly chronic) shockwave is seen to be the most effective treatment modality.
It is generally advised to avoid steroid injections due to the risk of further weakening the diseased tendon.
Top 5 tips for Achilles tendinitis / Achilles tendinopathy:
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- It is a break down issue, not an injury. You MUST address the cause
- You are asking your body to do more than it can cope with… manage your load
- Become more resilient: you need a loading program to develop a healthier and “stronger” tendon
- Shockwave therapy with a loading program speeds up the healing process by up to 40%
- There are no quick fixes! If it took time to create a problem it will take time to fix.
At Regeneration Physiotherapy we combine hands-on treatment, 1-to1 insite gym rehab and Shockwave therapy to deliver industy leading therapy.
Our apprach produces the fastest recovery from Achilles tendonitis in Leeds and Yorkshire.
Book online at any of our 12 clinics throughout Yorkshire and the North East.
By Jay Milomo, Physiotherapist at Regen Physio.
References:
- Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007 Apr;41(4):211-6. doi: 10.1136/bjsm.2007.035543. Epub 2007 Feb 20. PMID: 17311806; PMCID: PMC2658946
- Cheng Y, Zhang J, Cai Y. Utility of Ultrasonography in Assessing the Effectiveness of Extracorporeal Shock Wave Therapy in Insertional Achilles Tendinopathy. Biomed Res Int. 2016;2016:2580969. doi: 10.1155/2016/2580969. Epub 2016 Nov 28. PMID: 28004000; PMCID: PMC5149604.
- Cook, J.L., Rio, E., Purdam, C.R. and Docking, S.I., 2016. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? British Journal of Sports Medicine[Online], 50(19), pp.1187–1191. Available from: https://doi.org/10.1136/bjsports-2015-095422.
- Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet (London, England), 376(9754), 1751–1767.
- Dedes, V., Stergioulas, A., Kipreos, G., Dede, A. M., Mitseas, A., & Panoutsopoulos, G. I. (2018). Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Materia socio-medica, 30(2), 131–146. https://doi.org/10.5455/msm.2018.
30.141-146 - Gerdesmeyer L, Mittermayr R, Fuerst M, Al Muderis M, Thiele R, Saxena A, Gollwitzer H. Current evidence of extracorporeal shock wave therapy in chronic Achilles tendinopathy. Int J Surg. 2015 Dec;24(Pt B):154-9. doi: 10.1016/j.ijsu.2015.07.718. Epub 2015 Aug 29. PMID: 26327530.
- Hart L. (2011). Corticosteroid and other injections in the management of tendinopathies:a review. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 21(6), 540–541.
