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 on a pretty regularly basis.

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.
  2. 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).
  3. 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 lack of pelvic stability due to 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 with any questions you might have.

Proximal Hamstring Tendinopathy

This injury is a serious pain in the butt. Literally.

I actually suffered with for a few months myself and weirdly I have since seen about half a dozen women with the same issue.

Proximal hamstring tendinopathy (sometimes known as hamstring origin tendinopathy) is a painful condition that presents as pain in the lower buttocks which can refer down into the hamstring. Often it will warm up with activity only to return after exercise. It can linger around for several hours, or in more severe cases several days.

In almost all of my clients the onset of pain correlates with a change in volume or intensity of training combined with compression factors such as long periods of sitting and increased hamstring stretching. It’s not unusual for symptoms to appear quite suddenly, but unfortunately don’t tend to resolve quite so quickly.

The rehabilitative phase can take up to 12 weeks however rest assured our tendons are strong, adaptable and in most cases very responsive to a good strengthening program.

Management of hamstring origin tendinopathy can differ slightly between clients but the general principles of rehab are constant.

There may be an initial period of rest required, not from training altogether. I often encourage pain free cross training. Too much rest will actually be detrimental for the tendon when it comes to coping with load again.

I make a concerted effort to allow my runners to keep running, albeit with a modified load. For example reducing the speed, eliminating hills or a shortened stride length are all ways to facilitate overall load reduction on the tendon without stopping running altogether. In the gym one may reduce the weight of their squats & deadlifts or work through a smaller range. Using pain as a guide is important, a 2-3/10 is acceptable, anything more and you are in the no go zone (we call it the red zone)

Avoiding compression is really important. Sitting on softer surfaces instead of hard chairs and steer clear of stretching your hamstrings. Other gym related sources of compression include lunges and heavy deadlifts.

A strengthening program will often start with isometrics – an isometric is a contraction where there muscle is switched on but not moved through range at all. Such exercises have been shown to assist pain modification as well as preparing the tendon for both concentric and eccentric strengthening. The rehabilitative process can take several months so a little patience and perseverance is important.

There are also some hands on techniques that your physio can use which can be helpful. I use both active release and dry needling to target areas of tension both in the hamstring but also around the glutes and lateral hip.

If conservative management doesn’t seem to be working there may be some more invasive options such as PRP injections that your physio or sports doctor may discuss with you. You will most likely need an MRI scan to confirm the diagnosis as hamstring origin tendinopathy prior to this discussion.

Recovery from hamstring tendinopathy can be a slow process, and one that requires careful consideration of each individual case with regards to load management, training and strengthening. We strongly advise you seek guidance from your physio if you’re dealing with a pain in the butt, it may save you weeks worth of rest or self guided rehab that is targeting the wrong issue.