Achilles tendinopathy – causes and management
The Achilles tendon is the connection between the calf muscles (gastrocnemius and soleus) and the heel bone (calcaneus). It is the thickest and strongest tendon in the body and can receive a load stress of up to 4 times body weight when walking, and over 7 time body weight when running! Achilles tenindopathy describes dysfunction of this structure which can normally be divided into one of two sub-categories: Achilles Tendinitis (inflammation of the Achilles tendon) or Achilles Tendinosis (degeneration of the Achilles tendon).
Contrary to popular belief, the Achilles is not usually inflamed. This is why the conventional treatment of rest and anti-inflammatory medication results in poor outcomes. The latest research suggests that Achilles tendon problems are normally degenerative, and this degeneration is driven by chemical, neurological, and structural factors. While this may sound scary, it is a rectifiable issue – but what exactly is going on? And how to I go about fixing it?
Most cases of Achilles tendinopathy are a result of overuse. Put simply, when you train the body is being strained/degenerated, and when you rest the body is repairing. If you do too much of the former without enough balance from the latter, the rate of degeneration becomes much faster than the rate of repair which leads to problems!
Other factors that can lead to Achilles teninopathy are sudden changes to your training, for example a new pair of trainers (especially if not suitable for YOU and YOUR running style), sudden increase in mileage, suddenly adding very hilly routes to your training plan etc. All of these issues can add extra stresses to the Achilles tendon without giving it enough time to adapt to them gradually first, which can then lead to problems.
Sudden changes in your training, or other factors such as old injuries, scars etc can also affect the way your brain organizes movement and lead to problems in the Achilles tendon. For example, the calf muscles can be overworking for inhibited gluteal muscles which can lead to extra stresses being placed on the Achilles tendon. Alternatively, especially if the issue is on both sides, something more central such as the core may not be doing its job efficiently and the calf muscles may be overworking to compensate so that the body gets that stability from somewhere. This can again lead to extra stresses on the structure.
In reality (because nothing is ever simple!) most cases of Achilles tendinopathy will be as a result of a combination of all of the above!
To resolve an Achilles tendon issue, you must first find out the true cause and remove any excessive stresses that are being placed on the structure. At ProSport Physiotherapy this is what we would do in the very first initial assessment and treatment session and will lead to a significant improvement in symptoms straight away. To truly resolve the issue PERMANENTLY, you must then gradually increase the load on the structure and start a graded return to your normal activity levels.
While rest and NSAIDs are commonly recommended to treat the condition this can actually lead to an exacerbation of symptoms once you start to return to running. By resting the calf completely without restoring balance to the body first, the calf muscle can become atrophied and weak from UNDER-use. When you then return running you have a weaker calf muscle than when you first started having problems, so even more stress is being placed on the degenerative tendon which can lead to even worse symptoms than before!
In some cases specific strengthening exercises may be needed to both increase the strength in the calf muscles so that the tendon is better supported, and to allow the tendon to adapt to higher loads before going back to normal training. Finally, all of the changes need to be drilled into your subconscious brain so that the problem NEVER returns!
We are all aware that the human body is complex and each one of us is unique. Therefore, every case of Achilles pain is different and there is no ‘one-size fits all’ approach that is 100% effective. At ProSport Physiotherapy we design the treatment around YOU so that you get 100% and permanent results! If you are suffering from Achilles pain, send us your details and help us help you!