The Achilles tendon is the longest tendon in the body, connecting the heel bone to the calf muscles.
Its role is to absorb and transfer high energy loads in a stretch shortening cycle from the ankle into the calf. Think of the Achilles like a spring, storing energy and then releasing it whilst we walk and run!
Pain in the Achilles is a very common condition physiotherapists see every day.
Two sub groups commonly present with Achilles pain: 1. Athletic populations, 2. Middle to older aged people. Tendons do not like change, and a spike in loads often causes pain into the tendon.
Younger athletic populations are susceptible to injury as they often do not perform adequate strength work and increase their training or games too quickly in a short span of time.
Middle to older aged people may have had periods of inactivity then try to become fitter by increasing their walking.
Walking still loads the Achilles in a stretch shortening cycle. This increase in walking intensity or duration is enough to cause Achilles pain if a person does not have the tendon capacity to absorb the new loads.
Previously Achilles pain was called 'tendinitis' or 'tendinosis'. Physiotherapists are reluctant to use these terms for tendons, as modern science has proven that inflammation is not the driving force in overuse tendon pathology hence the reluctance to use the suffix 'itis' which implies inflammation (so if you're taking anti-inflammatories for your tendon it may not have great long term relief).
Tendinosis implies there is degenerative microtears and cellular death. Once again research has shown that cellular changes occur to tendons, but microtears and cellular death do not occur. A more appropriate term is tendinopathy which means dysfunctional tendon health.
Achilles tendinopathy generally have the following traits:
1. Focal pain - you can generally point to the stiff/sore region with 1 finger over a 1-2cm region
2. A 'stiffness' sensation - this is often worst first thing in the morning, or after periods of inactivity (i.e after sitting down watching TV for 2 hours then getting up). After exercising the the Achilles tendon 'warms up' and the pain decreases. However the pain comes back with a vengeance during or after physical activity.
3. Tendon thickening - the sore Achilles region is thickened and looks swollen
4. Pain and stiffness does not go away with rest - resting the tendon may help in the short term, but when you recommence activity the pain still comes back despite all the offloading! It is not uncommon to see patients who have had ongoing Achilles pain for years.
Jill Cook, a leading tendon specialist, posted a great post on '10 things not to do if you have tendon pain' (see link HERE).
Some of the most useful advice from her post was to stop stretching the tendon, to stop massaging the tendon, to stop resting completely and to not take short cuts with your rehab.
Unfortunately tendons can takes weeks or months to fully settle. Remember tendons do not like change, so it takes time to build them up to tolerate high physical activity levels! However, long term prognosis is often good if a strong and detailed exercise rehab program is prescribed. That means you can fix your problem with the right help!
At Melbourne Sports Physiotherapy our physiotherapists can help identify which activities have caused your Achilles tendon pain, and devise a treatment program to decrease pain and return you back to the activities you enjoy pain free.
If you suspect you have an Achilles tendinopathy or have been told you have an Achilles tendinitis/tendinosis, make the smart decision and book in for an assessment to delve into your symptoms, and get a solution to your Achilles problems.