The Bespoken Word

Rx: Achilles Pain

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[Background]

Achilles tendonitis, or more broadly, tendinopathy is quite common and one of the most frustrating issues to deal with because of the time required to heal. In most cases, this takes around 12 weeks.

 

Generally, tendinitis is inflammation due to small tissue tears that occur due to load applied to a tendon that exceeds its capacity. When this process happens for weeks or months, the inflammation is often no longer present and what remains is a tendon with poor integrity and load capacity. This is called tendinopathy and results in pain, weakness and movement dysfunction.

 

In the ankle, Achilles tendinopathy is often caused by increasing activity too quickly, especially running. There are two types: insertional, and non-insertional, which describe being located where the tendon attaches to your heel bone and about 1.5 inches up from that point.

 

The two types respond differently to exercise, but fundamentally the best way to rid yourself of a tendinopathy is to improve its loading capacity.

 

In some cases, biomechanical abnormalities also impact the Achilles tendon. A lack of hip extension is correlated with increased Achilles tendon loading and can result is damage over time.

 

The bread and butter of any rehabilitation program should include ample eccentric heel raises, which is a slow lowering and lengthening of the tendon, as research shows this is the best way to heal the tendon and improve its integrity. Likewise, you’ll want to stimulate the hip as well to insure enough extension and control are present.

 

[Mechanism of Injury + Affected Tissues]

 

Achilles tendinopathy is the result of repetitive stress and overload of the tendons capacity. While extremely strong, with 1 square cm able to withstand 500-1000 kg of load, repetitive strain through activities such as running can gradually exceed this strength. As you move, then tendon will typically stretch 2% in length. When activities such as a long run that lead to prolonged periods of muscle fatigue, stretch to the tendon can exceed 4% which leads to microscopic ruptures to the tendon, resulting in inflammation and pain.

 

[Treatment]

 

Conservative treatment for Achilles tendinopathy includes stretching, mobility and eccentric strengthening of the gastrocnemius and soleus muscles, both of which connect to the Achilles tendon. Additionally, a physical therapy program should incorporate strength and mobility work to the hip and spine on the affected side as altered gait and movement mechanics can affect the loading and health of these tissues.

 

Additionally, physical therapy should address:

Modulating the pain

Normalizing ankle range of motion

Mobilizing the soft tissue surrounding the joint (ankle)

Making the proper exercise and ADL modifications to promote pain free activities & movements – shoe inserts such as a temporary heel lift may be indicated to offload the tendon.

IASTM may have an impact on physiological changes by providing an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, & an improvement of flexibility of underlying tissue

Kinesiology tape may be used to promote positive blood flow to the area and aid in the removal of wastes and byproducts created by inflammation, assisting in the healing rate of the injury.

 

[Healing Timeline]

 

Research shows that people who seek treatment for Achilles tendonitis have better outcomes than those who prolong seeking care. The average recovery time was about 12 weeks with conservative management.

 

[Stats]

24% of people experience some level of Achilles tendinopathy during their lifetime, with 18% being sustained by athletes younger than 45.

According to a recent study, conservative management (PT) of Achilles tendinopathy is successful 55-76% of the time, requiring no further treatment.

Please refer to our instagram post Rx: Achilles Pain for more information

*This does not constitute medical advice. If you have pain or injury please consult a medical profession in person.