Let’s Talk About Achilles Tendinitis
Let’s Talk About Achilles Tendinitis
What is a tendon?
The portion of connective tissue that joins a muscle to its bone insertion.
What is tendinopathy?
Tendinopathy is a maladaptive response to loading overtime that causes a gradual change in the structure of a tendon. These structural changes are what are believed to make the tendon become a pain producing structure.
Is it inflammatory?
Whilst this can be a controversial topic, it is still believed that in the early/acute onset of tendon pain there can be an inflammatory component, however the longer somebody has had tendon pain the less likely this is to be the case. If somebody has had tendon pain for a long period of time that has been well managed but then has a rapid flare in symptoms there can then also be a mild inflammatory component in this acute repeat flare up.
What does achilles tendinopathy feel like?
- Pain isolated around the achilles tendon – can be further up the tendon or directly at the heel bone.
- Morning stiffness when taking first step, or after a prolonged period of inactivity (sitting).
- Pain often warms up with activity/moving.
- Increase in pain in the achilles up to 24 hours following activity.
How do we treat achilles tendinopathy?
As strange as it may seem, despite tendinopathy resulting from overload, they do respond best to being loaded in an appropriate way. This is the mainstay treatment.
General progression of loading from a painful achilles tendon through to a nonpainful tendon:
- Calf raise isometric holds/heel raise holds: 2 sets of 5 with 10 second hold morning and night (pain settling approach) > 4 sets of 20-30 second hold with moderate-heavy load (tendon remodeling approach)
- Heavy loaded calf raises/heel raises
- Plyometric activities: jumping/hopping (there are 100’s of different variations and progressions)
How long will my achilles tendon be painful?
Expecting to be pain free quickly is a poor assumption. It is not uncommon for tendon pain to take anywhere between 3-6 months for improvement, however, depending on the demands somebody places on their tendon can sometimes take upwards of 12-24 months.
Whilst our goal is to be pain free often aiming for a stable 2-3/10 pain that does not consistently worsen as we continue to do more is the main goal.
