Tuesday, 17 January 2017

Achilles Tendinopathy

The Achilles tendon is an extremely strong structure that is put under enormous stress during high impact activities such as running. In many runners, the tendon will withstand this stress and allow the runner to enjoy miles and miles of pain-free running. However, it is common for the Achilles tendon to become injured.

Achilles tendinopathy is often considered an overuse injury, but can also occur in novice runners who are beginning to increase their mileage. Achilles tendinopathy is a degenerative condition in which the tendon is not able to withstand stress placed upon it. Stress or loading as a result of impact results in micro damage to the tendon, which the body is unable to adapt to.

Right it's wrong..left it's normal

Although Achilles tendinopathy is an extremely common injury, the mechanism by which it occurs is still not fully understood. There are various theories presented by scientists, and it is believed that a multitude of factors may contribute to an individual sustaining this injury.

Achilles tendinopathy is also more common in people who have certain types of arthritis, such as ankylosing spondylitis or psoriatic arthritis. It is also thought that your genetic 'makeup' (the material inherited from your parents which controls various aspects of your body) may play a part for some people who develop Achilles tendinopathy. It is also more common in people who have high blood pressure, high cholesterol or diabetes.

The primary symptom of Achilles tendinopathy is pain, which is often accompanied by swelling and tenderness to touch. Pain is normally described in a pattern, whereby it is worse in the morning, and eases with activity throughout the day.

Research suggests that runners with poor calf muscle strength may be more susceptible to injury, as the weakness in the muscle is compensated for by the tendon. This mechanism tends to be prevalent in novice runners who may be running more mileage than their body is prepared for, putting extra strain on the tendon.


Runners who undergo excessive foot motion (known as pronation) may be more susceptible to this injury. Pronation occurs when the bones of the foot move in response to striking the floor, either through walking or running. As muscles are attached to bones (via tendons) the muscles stretch when bones move, which is essential for stimulating them to contract. Over-pronation results in too much movement of the bones around the Achilles, meaning the muscles and tendons have to work in a greater range of motion than is optimal. This additional lengthening means that there is asymmetry within the system, which results in tissue micro trauma and pain for the runner. It is, however, important to note that pronation is a normal movement, and is required to absorb shock during impact.

There are a number of treatments that may help. The treatments below are usually suggested first. They are all considered as conservative treatments. This means treatments that do not involve surgery. 

Principles of conservative treatment:

• Improving the tendons tolerance to load.

• Biomechanical correction 

• Manual therapy 

• Strength training and correcting training errors

Rest and time off from sporting activities are important if you have Achilles tendinopathy. At first, you should stop any high-impact activities or sports (such as running). As pain improves, you can restart exercise as your pain allows. It is thought that complete rest, if it is prolonged, can actually be worse for the injury.

Painkillers such as paracetamol or ibuprofen may help to relieve pain. However, you should not use ibuprofen or other NSAIDs for more than 7-14 days if you have Achilles tendinopathy. This is because they may possibly reduce the ability of the tendon to heal in the long term. They may also cause symptoms of Achilles tendinopathy to be masked, or covered up, which again may delay healing.

Ice packs
Ice treatment may be useful for pain control and may help to reduce swelling in the early stages of Achilles tendinopathy. An ice pack should be applied for 10-30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. 

Achilles tendon exercises

Exercise to strength your achilles

Some special exercises to help to stretch and strengthen your Achilles tendon have been proven to be helpful. You should aim to do these every day. Such exercises may help with pain control and stiffness. A physiotherapist may be able to help you with these exercises as needed. They may also use other treatments such as ultrasound and massage to help relieve symptoms and promote healing of your Achilles tendon.

An orthotics specialist may suggest changing your footwear or putting special inserts in your shoes, such as inserts to lift your heel. This may help to reduce pain and symptoms.

However, if conservative management has failed you then these are the more radical options you could consider:

Injections around, but not within, the tendon may help, but the research is really lacking. The most popular type of injection given at the moment is a high-volume steroid and saline mix. But many are cautious about using steroid near the tendon because of the potential for weakening the surrounding tissue.

There have been quite big advances in surgery and it is possible to have a minimally invasive operation. However, this type of surgery is relatively new and more data is needed to evaluate its effectiveness.

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