Kinoveo Physiotherapy Clinic

Achilles tendon injuries are a concern for many, especially for those who engage in activities involving repetitive load on the lower body. While Achilles tendinopathy isn’t the most severe form of Achilles tendon injury, it is relatively common and can significantly impact daily activities. In this article, we’ll dive into Achilles tendinopathy, the signs and symptoms to watch for, the diagnosis process, and effective treatment options like physiotherapy.

What is Tendinopathy?

A tendinopathy refers to any issue or dysfunction of a tendon, often caused by overuse or repetitive strain. In the case of Achilles tendinopathy, the tendon becomes irritated and painful due to overloading. This can lead to changes in the tendon’s structure, decreasing its ability to handle stress and impact, which in turn affects function and performance.

Anatomy of the Achilles Tendon

The Achilles tendon is the thickest and strongest tendon in the human body, connecting the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone). It plays a vital role in absorbing the body’s weight during weight-bearing activities, such as walking, running, and jumping.

Types of Tendinopathy

Tendinopathy can be classified in various ways, but it’s generally categorized into two main types:

• Mid-portion Achilles tendinopathy: Occurs in the middle of the tendon.
• Insertional Achilles tendinopathy: Affects the tendon where it attaches to the heel bone.
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Risk Factors for Achilles Tendinopathy

Certain factors may increase the risk of developing Achilles tendinopathy. Some are modifiable, while others are not. These include:

• Age: Individuals between 40-49 are more prone to tendon injuries.
• Decreased ankle mobility due to previous injuries or stiffness.
• Weakened ankle strength.
• Increased foot pronation, or excessive rolling inward of the foot.
• Obesity.
• Hypertension and diabetes.
• Genetics: A predisposition to tendon injuries may run in families.
• Overtraining and excessive physical activity without proper rest.
• Abnormal body mechanics during physical activity.

Signs and Symptoms

If you\'re dealing with Achilles tendinopathy, you may experience the following:

• Gradual onset of pain near the Achilles tendon, often worsened by activity.
• Pain with tendon palpation: Tenderness when pressing on the tendon.
• Pain during walking or running, especially in the morning or after a period of rest.
• Stiffness and swelling around the Achilles tendon.
• Pain with activity that gradually improves with a warm-up but returns after prolonged or intense activity.

Diagnosis

A thorough assessment by a physiotherapist or healthcare professional will involve asking about your symptoms, previous injuries, and activity levels. The practitioner will likely test your lower body mobility, strength, and look for any mechanical imbalances that could be contributing to the problem.

Some common diagnostic indicators for Achilles tendinopathy include:

• Gradual onset of pain, typically 2 to 6 cm above the Achilles’ insertion or at the insertion itself.
• Tenderness when palpating the tendon.
• Positive clinical tests, such as the arc sign or Royal London Hospital test.

Ultrasound or MRI imaging may also be used to help confirm the diagnosis.

Treatment for Achilles Tendinopathy

1. Protect the Tendon

While complete rest is not always necessary, it\'s important to modify activities to reduce strain on the Achilles tendon. Your physiotherapist will guide you on proper loading techniques to avoid further damage and promote healing. Adjustments to training intensity and volume might be necessary.

2. Mobility and Manual Therapy

Addressing mobility restrictions in the ankle and lower body is crucial for recovery. Stiffness in the ankle joint, limited big toe mobility, or decreased hip extension can contribute to Achilles tendinopathy. Physiotherapists may use manual therapy techniques to improve joint mobility and prescribe targeted exercises.

3. Strengthening

Strengthening the muscles that attach to the Achilles tendon (primarily the gastrocnemius and soleus) is essential for rehabilitation. Eccentric strengthening exercises—where the muscle lengthens while under tension—are highly effective in treating tendinopathy. High-load strengthening has also been found beneficial. Dry needling could also help wake up muscles.

Some common exercises to strengthen the calf muscles include:

• Heel raises: Slowly raise your heels while standing, then lower them back down with control.
• Eccentric heel drops: Stand on the edge of a step, raise your heels, then slowly lower them below the level of the step.

4. Proprioception and Balance Training

Proprioception refers to the body’s ability to sense its position in space. This is important for restoring full function and preventing re-injury. Balance exercises, such as standing on one leg or using balance boards, can improve proprioception and help with tendon recovery.

5. Return to Activity

Once mobility, strength, and proprioception have been restored, it’s time to gradually return to physical activity. You’ll work on more complex exercises that simulate your specific sport or activity. This ensures the tendon can handle the stress of your particular movements.

Additional Treatment Options

In some cases, additional therapies such as corticosteroid injections, shockwave therapy, or dry needling may be used in conjunction with physiotherapy to manage pain and accelerate healing. However, less evidence supports treatments like ultrasound, night splints, or orthotics.

Prognosis

The good news is that the prognosis for Achilles tendinopathy is generally positive. Most individuals recover fully with appropriate treatment, though the timeline can vary from a few weeks to several months. It’s important to note that recurrence is common, with studies showing around 27% of people experience a return of symptoms. Nevertheless, with proper rehabilitation, most individuals can return to their activities with reduced risk of further injury.

What to do next:

If you suspect you have an Achilles injury, the next step is to seek help from a physiotherapist. A trained professional can assess your condition, identify underlying causes, and create a personalized treatment plan to help you recover. Physiotherapy is key to managing pain, restoring function, and preventing future injuries. If you\'re in luck and live in Kanata, Ontario, you can visit us at Kinoveo Physiotherapy Clinic, where our experienced team is ready to help you get back to your activities pain-free.

Conclusion

Achilles tendinopathy can be a challenging condition, but with early diagnosis and a tailored rehabilitation plan, you can recover and return to your usual activities. If you’re experiencing symptoms or have concerns about your Achilles tendon, consider reaching out to a physiotherapist to discuss a treatment plan that works for you.