The Achilles tendon is located on the back of your ankle and connects the gastrocnemius and soleus (the big muscles in your calf) to your heel. It is the strongest tendon in your body which is important because during running and jumping it can be subject to forces 6 to 12 times our body weight. However, it is also a common injury with a lifetime injury incidence rate of 2.35 per 1000 adults.
Signs of Achilles tendinopathy include:
- Pain and stiffness in the back of your ankle or heel
- Pain and stiffness that is worse first thing in the morning and after a high amount of use
- Swelling or a bump on the tendon
- Tendon is tender to touch
- Pain with walking, calf raises, running, and hopping.
Achilles tendinopathy is caused by an overload to the tissues. Think of the tendon as a living rope. It has the ability to get stronger or weaker depending on what we do with it on a daily basis. Factors that influence the capacity or strength/endurance of the tendon include:
- Age
- Physical activity
- General health conditions: obesity, hypertension, hyperlipidemia, diabetes
- Use of fluoroquinolone antibiotics
- Prior Achille tendinopathy
- Genetics, especially genes related to collagen
If our activities overload the capacity of the tendon by too much we develop wear and tear on the tendon and it can become painful. Overload can be either a short duration of a high level of overloading or a longer duration of moderate overloading. Factors that influence the loading on the tendon and can lead of overload include:
- Frequency, intensity, time and type of activity
- Body weight
- Footwear – less shock absorption increases loading
- Flexibility
- Restrictions to ankle and/or heel movement
- Strength of gastrocnemius and soleus
- Strength of other muscles in the leg and hip (especially hip abduction, external rotation, extension)
- Balance (proprioception)
- Running biomechanics
Achilles tendinopathy is divided into two categories depending on where the injury has occurred in the tendon. Insertional tendinopathy occurs where the tendon connects to the heel bone. Mid-portion tendinopathy occurs 2-6cm up from the insertion point, more on the back of the ankle than the heel. This can be an important consideration for rehabilitation and will effect the type of calf raises you should do.
Conservative treatment of Achilles tendinopathy involves adjusting the capacity and overload equation. In the first phase we focus on pain control, bringing loading of the tendon back within its capacity. Common areas for quick adjustments are footwear and activity levels. This is followed by the second phase which is a progressive strengthening program to build the capacity of the tendon and supporting muscles and then a gradual return to activity. Exercise therapy has been consistently supported as a mainstay of treatment in this condition. No other intervention studied in isolation has been as effective as exercise. It is recommended that a conservative program be trialed for 3 months minimum before other interventions be considers AND that recover for Achilles tendinopathy can take over 1 year to recover in some cases.
Please see the Physio Fixes below for a step-by-step program!
DISCLAIMER: This information is not intended as medical advice or a substitute for medical counseling. By choosing to follow the information that follows, you recognize that despite all precautions taken by Physio Fixes Inc. there is a potential risk of injury and you expressly acknowledge such risks and waive, relinquish, and release any claim that you may have against Physio Fixes Inc. You should always get evaluated for exercise by a physician or medical professionals, especially if symptoms occur from a trauma or are worsening. The user agrees by purchasing this program that Physio Fixes will not be held responsible in the event that an injury occurs.
References
Kujala UM, Sarna S, Kaprio J. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005 May;15(3):133-5. doi: 10.1097/01.jsm.0000165347.55638.23. PMID: 15867554.
Martin RL, Chimenti R, Cuddeford T, Houck J, Matheson JW, McDonough CM, Paulseth S, Wukich DK, Carcia CR. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. J Orthop Sports Phys Ther. 2018 May;48(5):A1-A38. doi: 10.2519/jospt.2018.0302. PMID: 29712543.
Silbernagel KG, Crossley KM. A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation. J Orthop Sports Phys Ther. 2015 Nov;45(11):876-86. doi: 10.2519/jospt.2015.5885. Epub 2015 Sep 21. PMID: 26390272.
