Achilles Tendinopathy – What is it?

Tendinopathy is a common condition that can affect any tendon in the body. The most common which you are likely to have heard of are Achilles, Gluteal (check out our blog on this) and Biceps tendinopathy.

We see Achilles tendinopathy regularly in our physio practice.

What is Achilles Tendinopathy? What are the symptoms? How did you get it? How can you get it better?

What is Achilles Tendinopathy

The Achilles tendon is the thickest in the body – formed by a blend of the gastrocnemius and soleus tendons as they unite to attach into the back of the heel.

Tendinopathy itself occurs when the cell matrix (which is what makes up the tendon) undergoes certain changes. This can result in disruption of the cells organisation & number with associated increases in blood vessels and nerves in the tendon. There are three stages of tendinopathy:

  1. Reactive Tendinopathy: Some small cell changes where the tendon has the capacity to return to normal tendon makeup & structure.
  2. Tendon Dysrepair: Larger cell changes and disorganisation where the tendon won’t fully return to normal however shouldn’t result in any activity limitations.
  3. Degenerative Tendinopathy: Cell death, trauma and disorganisation throughout the tendon. The tendon will be constantly thickened, often painful and usually results in ongoing activity limitations.

What are the symptoms?

Often pain will develop in the lower third of your calf down into the Achilles tendon.  Traditionally pain will be worse in the morning – those first few steps upon waking can be the most painful! Pain often improves over the course of the day or during an activity (such as running) but then be worse the following day or after periods of prolonged rest.

Depending on the phase of tendinopathy that you are in simple tasks such as walking up and down stairs can be painful. There may be obvious thickening of the tendon and it can be tender to the touch in some cases.

How do you get it?

Tendinopathy normally occurs with an acute overload of the tendon that comes with changes or sudden increases in intensity, frequency, quantity or type of training. The classic case we see so often is someone who signs up for a running event and rather than slowly building up their running distance they get a little over excited and do too much too soon.

There are several other factors that can predispose people to Achilles related problems including biomechanics, age, gender, tightness of the calf, strength of the calf, footwear and running style.

How can you get it better?

  1. Loading – Complete rest is NOT the way to go! Gradual strengthening and loading is needed, in fact the tendon will respond well to load, but not overload. A strengthening program should be part of your recovery but the key is finding a balance. Your physio will often play a crucial role in guiding you with this.
  1. Relative Rest – Again complete rest is not the way to go about it. You should however avoid activity that makes the tendon feel worse at the time or worse the next day (sometimes it takes a day for the pain to develop).
  1. Improve mechanics – Figuring out what’s tight or weak is important to the longer term management of Achilles tendinopathy. Maybe you need to work on big toe flexibility (yes that’s a thing!), calf strength or endurance, your foot arch or even weakness of your glutes! There are many biomechanical issues that might be contributing to this injury and we would recommend visiting your physio to make sure you address the underlying causes.

Do you think you may be suffering from Achilles tendinopathy? Feel free to send us a email/call/text with any questions you might have.