June 2022
By Lindon Beh, Physiotherapist
Can physio help with YOUR ACHILLES TENDON PAIN ? IT SURE CAN!
If you're suffering from Achilles Tendon pain, don't worry, we can help you!
We're so confident we can help you, that we're offering $20 Off your Initial Consultation!
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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!
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.
Pain in the Achilles is a very common condition physiotherapists see every day.
Two subgroups 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. This can result in an overuse injury where the tendon does not have enough time to repair itself from the continuous stress.
Recreational athletes – especially weekend warriors (middle to older aged people engaging in intense sporting activity) may have had periods of inactivity then try to become fitter by increasing their load. This increase in activity intensity or duration is enough to cause Achilles pain if a person does not have the tendon capacity to absorb the new loads.
Occasionally, we can put so much force through a weakened Achilles, that they rupture.
Risk factors for Achilles tendinopathy
· Age: >30 years
· Gender: Men > Women
· Obesity
· High blood pressure
· Rapid change in load
· Type II diabetes
· Prolonged steroid use
· Family history of tendinopathy
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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.
How do sports physiotherapists treat tendon complaints?
Relative Rest
Initially, resting, using ice pack and pain relief will reduce pain, swelling and stiffness of the Achilles tendon.
Resting your Achilles will often have short term relief of pain, however as soon as you return to running or sport, the pain often returns. The Achilles tendon does not have the capacity to take on the extra load and so becomes painful again. Complete rest can often make the problem worse.
Exercise
Your Achilles physio will identify which phase of injury you are in and recommend appropriate exercises to rehabilitate. It is important to feel a heavy load within the tendon when performing exercises and allow adequate time between sessions to recover.
Managing you load
When managing you load, you should be guided by how your tendon responds immediately and 24 hours after exercise. Achilles tendons can have a latent response to load, meaning they can take a while to respond to exercise you did yesterday.
Using the traffic light system to determine how much training is too much is a perfect tool for athletes. Red indicates you must reduce your training load. Amber suggests the current exercise level. Green indicates that it is safe to increase your load.
Extracorporeal shock wave therapy for tendon pain
There is some evidence for shock wave therapy when tendon pain is chronic, especially if other treatments have failed.
Speak to one of the Achilles physio at Melbourne Sports Physiotherapy to see if shock wave therapy is right for you.
Jill Cook, a leading tendon specialist, posted a great post on '10 things not to do if you have tendon pain'.
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.
You can make an appointment by calling or booking online.
BOOK ONLINE NOW TO SAVE $20 & FIX YOUR PAIN NOW