Achilles tendonitis/ tendinopathy is an inflammatory tendon problem. Yet, the right evaluation and treatment provides a plan for reducing the pain and restoring the strength for the area to perform well. Conservative tendonitis rehabilitation focuses on strengthening the underlying problem, not simply reducing the pain temporarily.
Your Achilles tendon is the strong fibrous band of tissue that connects your calf muscles to your heel. The tendon is named after “Achilles” who was a powerful, yet vulnerable warrior in Greek mythology. Likewise, our Achilles tendon, being the largest and strongest tendon in the body, is vulnerable to injury from the high demands life places on it. In fact, running generates over 12 times your body weight on the Achilles tendon. (source)
Like tendonitis at other body parts, Achilles tendonitis results from movement problems.
The tendon may strain or even rupture from excessive stretch or forceful contraction of the calf muscles. More commonly, the tendon suffers repeated overloaded and resulting “micro tears.” Damage usually occurs either directly at the heel, or near the weakest area of the tendon- one to two inches above the heel.
Achilles tendonitis/ Achilles tendinopathy affects between 250,000 and 1 million people per year. Most are middle-aged males, between the age of 30 and 50. Interestingly, Achilles tendon injuries occur more frequently on the left side. Also, if you have suffered a prior Achilles tendon injury, you are at greater risk of injuring the opposite side. Two-thirds of all Achilles tendon injuries involve athletes. And runners are 10 times more likely to suffer Achilles tendon problems. Altered foot, ankle, and calf mechanisms increase your risk for tendon pains.
Symptoms may begin abruptly following a strain but, more commonly, develop slowly from repeated irritation. Pain and stiffness when you first get out of bed are very common. Your Achilles tendonitis symptoms often worsen with activity, especially walking or running. You may notice pain when you rise up on your toes. Walking down stairs stretches the tendon and usually increases symptoms. Some patients notice that the irritated area becomes firmly swollen. Ongoing irritation to the spot on your heel where the tendon inserts can cause a painfully elevated bump.
Treatment for Achilles tendonitis
Research has shown that conservative care, like the type provided in this office, can produce “excellent results” in over 85% of Achilles tendonitis patients (source). Initially, you may need to limit or change activities that cause pain. Runners may need to switch to swimming or cycling for a short period of time. Sudden increases in exercise load is a major injury risk. As such, be sure to introduce new activities slowly and avoid increasing your activity by more than 10% per week.
Runners should begin on a smooth, shock-absorbent surface and start at a low intensity – first increasing distance, then pace. Avoid training on hard or unlevel surfaces like hills. Running uphill or pushing a sled causes significant compression on the tendon. A good warm-up and professional exercise programing are keys to success. Avoid wearing compression socks, high heels, or shoes with an excessively rigid heel counter. One of the most important and effective treatments for Achilles tendinopathy is progressive loading to strengthen the area.