Achilles Tendinopathy

By Jennifer Steele

The Achilles tendon attaches the calf muscles to the heel bone and is responsible for raising the heel off the floor, or calf raising. The tendon is used both in our everyday lives when walking, running, or climbing stairs, as well as during most of sports and exercise activities.

We have all heard of people’s weaknesses or vulnerabilities being deemed their ‘Achilles heel’. This reference was brought about because in so many athletes and individuals it is their Achilles that is their weak link. When this tendon is overused and inflamed it can cause such severe pain and disability that it can bring even the strongest people to a standstill.  

When the tendon is over worked and intense repetitive loads are placed on it, it can become damaged which leads to the pain associated with Achilles Tendinopathy. After each loading or training session, the tendon suffers from tiny microtrauma injuries. In a normal tendon, these microtraumas will heal and the next time it is exposed to loading it will be stronger and able to withstand greater loads. However, in the case of Achilles Tendinopathy the tendon does not heal completely between sessions and so over time the damage builds up and this leads to a degenerative tendon and tendinopathy.

Individuals that are at a higher risk of developing Achilles Tendinopathy are:

• exercising without warming up
• suddenly increase their physical activity intensity without proper progression
• taking part in sporting activities that require rapid changes in direction
• wearing old or ill-fitting shoes
• older individuals individuals with bony heel spurs.

Incorrect running or jumping technique can also predisposed athletes to the condition, as can certain chronic diseases such as hypertension and diabetes. There have also been reports of certain antibiotics leading to tendon inflammation and predisposing individuals to tendon ruptures, therefore it is best to check the side effects of all medications before exercising while taking them.

The main symptom of Achilles Tendinopathy is pain at the back of the heel area during walking, running or other physical loading of the tendon. The area may become swollen, red and warm to the tough. The pain is often worse first thing in the morning with the tendon feeling stiff and tight, it is also always worse during activity, exercise or sports that place increased loads on the tendon.

The immediate treatment for Achilles Tendinopathy is treatment of the symptoms using rest and ice. Non-steroidal anti-inflammatory drugs can also be taken to help relieve the pain. Most importantly the individual will need to modify their physical activity and the exercise routine in order to give the tendon sufficient rest, as well as include specific rehabilitation exercises for the tendon.

Before beginning rehabilitation exercises a health care professional such as a Biokineticist or Physiotherapist should be consulted. Generally, the program they will prescribe should include light stretching of the muscles of the lower limb as well as eccentric heel drops that will strengthen and improve the tendons ability to absorb loads placed on it.

Achilles Tendinopathy is not the same as an Achilles Tendon rupture. A rupture is rather an actual tear of the tendon and can be a far more severe injury depending on the severity of the tear. A rupture can either be complete or incomplete and often require surgery as treatment. Achilles Tendinopathy does not necessarily predispose an individual to an Achilles Tendon rupture. However, it can increase the chances of a rupture occurring. It is therefore necessary to follow the correct treatment and rehabilitation protocols to minimize risks of further injury and re occurrence.