Achilles tendinopathy is a common condition, particularly in individuals who participate in running and jumping activities. The incidence is higher in individuals between 30-55 years of age.
In the last decade our understanding of tendinopathy has continued to involve. Tendinopathy is often classified as reactive or degenerative. Reactive tendinopathy sees a non inflammatory increase in cell activity, which leads to a resultant increase in water in the tendon. Typically patients will present with an acute exacerbation of symptoms that cn be related to an increase or change in activity. Other causes could include a change in footwear, sporting equipment, or work duties.
Degenerative Tendinopathy sees areas of collagen breakdown, reduced tenocytes (cells), and vascular and nerve ingrowth. Degenerative tendinopathy is more likely to be present in people who have had repeated episodes of symptoms over time. Whilst degenerative areas have little capacity to change, strengthening the surrounding tendon leads to improvements. Symptoms may take a few weeks to settle, and rehabilitation can take a minimum of 3-6 months.
Diagnosis
Usually there will be a change in load (Volume, Speed, Intensity or Frequency). Aggravating activities will involve compression of the tendon by another structure, or from higher loads through the tendon (e.g. running, jumping). Tendon pain will usually “warm up with activity”. There may be morning stiffness, and symptoms can be worse for hours/days after activity.
Pathology does not = Pain
Studies have shown patients can have symptoms of pain but no pathology on imaging. Conversely degeneration can be present in the absence of pain. Rehabilitation therefore focusses on treating symptoms and functional deficits, rather than being based on the ultrasound or MRI report.
Associated Structures
Other structures that could be a source of symptoms include the Plantaris tendon, fat pad, paratendon, an accessory soleus, the flexor retinaculum, and retrocalcneal bursa.
Initial Management
- The key to settling symptoms quickly is tailoring the initial management to your activity and lifestyle. Generally we need to unload the tendon with relative rest – but this does not mean stopping all activity as complete rest can also be detrimental to your recovery.
- In cases of insertional Achilles tendinopathy, it is crucial to Avoid compression< of the tendon when the ankle is dorsiflexed. Stretching is not beneficial, and we can place heel wedges in your shoes to unload the tendon.
- Manual therapy can be used to assist in pain relief and regain range of motion. In non irritable cases, isometric exercises have been shown to have good effect on pain relief on lower limb tendinopathies.
Rehabilitation
Crucial to any successful tendinopathy rehabilitation is a graduated Concentric/Eccentric strengthening program. Slow, heavy resistance exercises are used to improve the muscle and tendons capacity to handle load. This is where Zone 34’s gym space is so valuable. Using weights and equipment, we can safely provide patients of all ages and athletic abilities with an individualized program that can be progressed over time. An ideal way to progress your rehabilitation is in our Strong Bodies rehabilitation classes
- In our tendinopathy rehabilitation classes you will:
- be provided with exercises to improve lower limb strength and control
- gradually introduce plyometric exercises (e.g. jumping, skipping, hopping, running)
- receive information on how to structure your load across a week and during a training program
- begin Zone 34’s Return to Running Program
