Achilles Tendinopathy – Diagnosis and treatment

By Ella Guest – Sports Injury Specialist

A tendon is a fibrous connective tissue that attaches muscle to bone. Its main role is to transmit forces from the muscle to the bone and absorb external forces to prevent injury to the muscle. Achilles tendinopathy is an injury to the band of tissue (tendon) that connects the muscles in your lower leg to your heel bone.

Despite being the largest tendon in the body, the Achilles tendon is one of the most commonly injured tendons, especially in athletes who are involved in running and jumping sports/activities. Achilles tendinopathy is a painful overuse injury that affects an athlete’s ability to be physically active. It is characterized by a combination of pain, swelling and impaired performance. During the early stages of the injury, the patient might be able to continue with regular activities and sports, but as the injury progresses the patient’s ability to be physically active is progressively impaired. Repetitive overloading of the Achilles tendon and training errors, such as rapidly increasing training intensity or duration, are reported to be contributing factors in 60% to 80% of those who develop Achilles tendinopathy.

The pain associated with achilles tendinopathy typically begins as a mild ache in the back of the leg or above the heel after running or other sporting activity. Episodes of more severe pain may occur after prolonged running, stair climbing, jumping or sprinting.

Some other common symptoms include:

Pain in your heel – may be an ache or a sharp pain, which feels worse when you put pressure on it or when you have been active
Tendon stiffness- often this is worse first thing in the morning or if you’ve been resting for a while
Swelling at the back of your ankle
Tenderness when you touch your tendon
A grating noise or creaking feeling (crepitus) when you move your ankle

A number of factors may increase your risk of achilles tendinopathy, including:

Your gender- achilles tendinopathy occurs most commonly in men
Your age- the structure of the achilles tendon weakens with age
Physical factors- a naturally flat arch in your foot can put more strain on the achilles tendon, as well as increased BMI and tight calf muscles
Training choices- running in worn out trainers or incorrect footwear, running on hilly or uneven terrain, or running in cold weather

The control of inflammation is recommended in the early phase of Achilles tendon injury. This is achieved initially by using ice packs and decreasing the intensity, frequency, and duration of the activity that caused the injury. During an initial consultation at the clinic patients will be asked to perform a combination of exercises to provoke tendon pain during tendon loading activity, such as a single leg hop for example. Your practitioner will also look at any training errors, decreases in flexibility, and any muscle weakness in order to formulate a treatment plan for you. Eccentric loading and stretching exercises will normally be given to you by your practitioner in order to increase the tensile strength of the tendon and therefore reduce pain and regain function.

If you are suffering with Achilles pain and would like any help or advice from our physiotherapists or sports injury therapists, why not book online at our Thornbury, Thornbury Active or Yate clinics.