Achilles tendinopathy, often termed ‘Achilles tendonitis’ refers to pain and dysfunction relating to the Achilles region. It is typically an overuse injury and is most common in those in running or jumping based sports, due to the repetitive nature of the actions.
The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone) and is the largest tendon in the human body. It allows us to walk, run and jump by pulling on the heel when we flex our calves.
- Overuse in running/jumping sports
- Poor conditioning
A ‘too much too soon’ approach to training or exercise
Calf muscle weakness
- Changes in training surface. E.g. from grass to road, outdoors to treadmill, increase in beach/sand training
Changes in footwear - from shoe with a drop to a flat/’barefoot’ shoe
- Biomechanical problems of the foot, such as overpronated or ‘flat’ feet
- Tight calves and/or hamstrings
Signs and symptoms
- Pain and/or stiffness of the area.
Depending on the stage of your Achilles tendinopathy, you may experience start up pain that eases with exercise. You may also experience pain the next morning after getting up out of bed.
- Tenderness of the area
At the insertion or mid-tendon
- Swelling of the tendon
Your physiotherapist can diagnose an Achilles tendinopathy in the clinic, using your history, symptoms and a range of clinical tests. For differential diagnoses, further examination may require an MRI, however is generally not necessary.
Treatment will vary depending on the severity of each individual injury.
Initially, treatment should include the POLICE principle (protection, optimal loading, ice, compression and elevation), as with any soft tissue injury.
After initial treatment using POLICE, your physiotherapist will recommend tailored exercises to begin reloading the tendon and stimulate load tolerance and resilience. Isometric exercises may be used during this initial acute phase to help settle symptoms. The next step will be to restore strength and load tolerance. Concentric and eccentric strengthening will be included, and your physiotherapist will guide you through tailored exercises to help strengthen the whole kinetic chain/lower limb and pelvis. Building load tolerance will be key to end stage treatment. Elastic loading (eg. plyometrics) will be key to returning to full capacity and with the aim to help prevent recurrences.
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