WHAT IS IT? Achilles Tendinopathy is usually divided into 2 stages: reactive and degenerative. The reactive stage is usually a response to an increase in loading (such as a sudden increase in training); the tendon will become painful and may swell. The degenerative stage is seen in the more chronic cases; here the tendon’s structure is changed and may have developed nodules or have become thickened. This is a gradual, painful process, however it can sometimes occur without pain with the first sign of a tendon problem being a sudden unexpected rupture.
WHAT ARE THE SYMPTOMS? Symptoms will generally be of gradual onset and the patient will complain of pain in the Achilles tendon, especially between 2 and 6cm above the heel bone (mid-portion); there may also be swelling and thickening of the tendon. Gradually the pain may develop to become a problem on a daily basis. Patients will often complain of pain and stiffness in the Achilles first thing in the morning. Other causes of pain in this region are Insertional Achilles tendinopathy and retrocalcaneal bursitis, which are managed differently from mid-portion Achilles tendinopathy- for this post I will be focussing solely on mid-portion Achilles tendinopathy.
WHAT CAUSES IT? Tendons (like muscle, bone and ligaments) are constantly building new tissue (synthesis) and breaking down tissue. How much load (stress) we put on the tendon will determine how much breakdown and synthesis occurs. If there is too much load on a tendon, the rate of breakdown will exceed the rate of synthesis and the structure of the tendon will begin to suffer. Training errors are a common cause: increasing your training intensity or volume too quickly, increasing the amount of hill work, changing to a forefoot foot strike pattern/wearing minimalist shoes without (sufficient transition). Other common causes are tight calf muscles, poor biomechanics and poor muscle strength/endurance.
WHAT TO DO AT HOME: In the reactive stage treatments should be focused around settling the symptoms: rest, anti-inflammatory medication (consult your GP or pharmacist), ice, gently foam roll the calf muscles, use a small gel heel raise. If the problem is more chronic and there is thickening/nodules, it is important to manage the load in the tendon by not overtraining. However it is also important to increase the capacity of the tendon to cope with load via eccentric strengthening exercises.
WHEN TO SEEK HELP: As there are many conditions that can cause similar symptoms, it is important to seek professional advice before undertaking any treatment plan.
HOW IS IT TREATED: Understanding the reason why your tendon is being overloaded is imperative to a successful treatment plan; a detailed history taking, assessment and gait analysis are all important tools in achieving this. Gait retraining, the correct exercise program, foot orthoses and the correct footwear can all be helpful.