“Ouch! There is a pain at the back of my heel”. The Achilles tendon is known to be the strongest and thickest tendon in the body. The Achilles tendon can handle heavy forces going through it as we go about our daily activities. When this tendon is overloaded, it can result in a condition known as Achilles Tendinopathy.

Evidence shows that a sudden increase in load to the tendon causes micro-injury to the tendon itself, as the tendon tries to adapt to the increased demand placed on it. If this overload remains,  the recurrent micro-injury leads to delayed healing.  This is called reactive tendinopathy. Here are some interesting facts about Achilles Tendinopathy.

Who is likely to struggle with Achilles Tendinopathy?

  • Middle-aged people who are overweight
  • Athletes participating in:
    • racquet sports
    • track and field events
    • Volleyball
    • Soccer

What are some of the most common causes?

As we now know, repetitive overuse may cause Achilles tendinopathy.

Wearing inappropriate footwear (e.g., worn-out shoes or tight shoes) for sporting activities may cause imbalances in the ankle and cause irritation to the Achilles. In most instances Achilles tendinopathy can because of poor training techniques or a sudden increase in the intensity and frequency of training.

What do we expect to find with an assessment?

  • People will generally complain of experiencing pain in the tendon first thing in the morning
  • Pain in the tendon that worsens with activity
  • Swelling
  • Increased temperature in the area
  • Difficulty with heel raises
  • Thickening of the tendon over time
  • On X-ray: bone spur formation

How can physiotherapy help?

  • Advice on activity modifications
  • Advice on modifiable risk factors like shoe wear and body mass index
  • Manual therapy
  • Electrotherapy
  • Shockwave therapy
  • Dry needling
  • Taping
  • Graded rehabilitation program to load the tendon

What role does Biokinetics play?

Tendons do not heal by rest alone. For tendons to heal they need to be actively loaded.

Eccentric load has been proven to be the best form of exercise for tendon healing as well as decreasing pain. Eccentric contraction is when the muscle length increases.These exercises promote collagen fiber cross-link formation within the tendon, facilitating tendon remodeling.

  • Stretches – Increasing the length of muscles and tendons in their resting state so that there is less strain on the tendon
  • Load – Progressively increasing the exercise load to prevent further injury and overtraining
  • Improving the entire kinetic chain strength and stability
  • Correcting Gait/ posture/ Biomechanics that may cause strain on the tendon
  • Improving strength and stability
  • Balance improvement
  • Working on proprioception
  • Prevent injury
  • Personalized exercise prescription

Keep your Achilles strong and contact a Physio or Bio near you to help you with any pain you may have.