Common Achilles tendon injuries and their treatment
The Achilles tendon is the longest tendon in the body, connecting the heel bone to the calf muscles.
Characterised by pain and inflammation of the Achilles tendon or its covering, Achilles Tendinopathy is an overuse injury that is most common in joggers, jumpers and other activities that require repetitive actions. This pain and stiffness is sometimes worse in the morning and at the start of exercise, and may disappear as you warm up. You may also notice the area is swollen and tender to touch.
The suffix ‘itis’ implies inflammation. Previously called ‘tendinitis’ or ‘tendinosis’, physios have moved on from these terms as modern science has proven that inflammation is not the driving force in tendon overuse injuries. So taking anti-inflammatories for your tendinopathy may not have great long term relief.
A more appropriate term is tendinopathy which means dysfunctional tendon health.
Common causes of Achilles tendinopathy include:
- Tight hamstrings and calf muscles
- Walking on your toes (or excessive high heel wearing)
- Overtraining and failing to warm up or down
- Poorly supportive footwear
Achilles tendon rupture
The dreaded ‘snapped’ Achilles tendon. The mere thought of it brings a tear to the eye.
68% of all acute Achilles tendon ruptures occur during some form of athletic activity. Eccentric movements put an enormous amount of stress on the tendon and stop-and-go sports like volleyball, basketball, soccer and squash are commonly involved.
If you have ruptured your Achilles tendon you will probably experience:
- A loud crack or popping sound at the moment of injury
- A sharp pain at the moment of rupture
- An inability to raise or flex your heel
- The back of your heel may swell
How can a physio help?
Achilles injuries do not usually get better on their own. They may feel a little bit better with rest, but once you start doing an aggravating activity again it will become painful. Continuing to do aggravating activities despite pain or dysfunction is a great way to prolong your recovery time.
The goals of physiotherapy are to treat any acute issues associated with your Achilles injury:
- Rest from aggravating activities
- Ice or heat (as directed)
- A targeted stretching and strengthening program
- Dry needling
They will also look to identify predisposing factors, reduce pain and inflammation, and promote healing to restore the muscle and tendon.
Your physio will look to address the factors that caused the injury in the first place, to help reduce the risk of re-injury, commonly including:
- Abnormal lower limb mechanics (foot, knee and hip)
- Calf weakness
- Poor muscle flexibility
- Stiff ankle joints
- Training: inappropriate training load and recovery time between training sessions
- Poor footwear, footwear wearing out
Fixio will also provide you with a targeted tendon rehabilitation program to make your Achilles stronger and more flexible. Finally, we will provide you with advice regarding when and how you can return to sport and/or activity. It is important to follow this advice to prevent recurrence, or worsening, of the tendon injury. Rehabilitation can be frustratingly slow but with perseverance it will get better!
 Raikin SM, Garras DN, Krapchev PV. Achilles tendon injuries in a United States Population. Foot Ankle Int. 2013;34:475–480.