Do you know the story of Achilles’ heel? Achilles was an ancient Greek warrior, when he was a child his mother picked him up by his heels and dipped him into a magical river to protect his body. The warrior was unbeaten in many battles until a stray arrow struck his heel – the one place the water didn’t touch. That is why someone’s Achilles heel means two things, the first being your greatest weakness or area of vulnerability and the second being a descriptive anatomical term describing the back of your heel bone where your calf tendon (Achilles) attaches. Ironically, the Achilles tendon is by far the thickest and strongest tendon in the body. During high velocity activities like running, jumping and hopping the tendon needs to withstand up to ten times a person’s body weight! Due to this significant load going through the tendon it is the most frequently injured tendon, yet another reason for it to be the Achilles heel.
What are the main signs and symptoms of Achilles Tendinoipathy?
- Gradual onset of pain over the Achilles tendon
- Stiffness in the Achilles tendon with activity following a period of rest e.g. in the morning after resting during sleep
- Swelling around the Achilles tendon
- Tenderness upon touching the tendon
- Pain and stiffness initially with an activity e.g. Running which can lesson or disappear after a few minutes and then increase later after the activity is completed
What Causes Achilles Tendinopathy?
You can see the Achilles tendon helps the calf muscle attach to the heel bone. The main function of the calf muscle is to point the foot downwards – think of a ballerina standing on their toes – the calf muscle and Achilles tendon is fully activated during this position. This action is also vital in everyday activities such as walking, running, and jumping.
Achilles tendinopathy is primarily an overuse disorder from repetitive overloading or when the load being applied to the tendon puts too much stress on the tendon too quickly for it to withstand leading to microtrauma. A common example we see of this in the clinic is a sudden spike in someone’s Achilles tendon loading. For instance, a client may usually run approximately four km three times a week but then last weekend they have ran the City to Surf (14km) without increasing their training and have pain in their Achilles 1-2 days later. This is an example of too much stress on the tendon too quickly leading to Achilles pain.
There are also some external risk factors that can contribute to the microtrauma going through the tendon
- Overweight – increases the load going through the tendon
- Diabetes – can affect the tendon quality and structure, which can make it breakdown easier
- Previous lower limb tendinopathy
- Over pronation of the midfoot (flat feet/losing your foot arch)
- Increased age
- Reduced ankle range of motion
- Reduced strength in calf muscles
How can Physiotherapy fix Achilles tendinopathy?
Achilles tendinopathy is a multifaceted condition and it can be one of the greatest areas of weakness for many runners. Additionally, only 65% of patients have complete recovery and are symptom free after five years. That is why It’s so important to receive early intervention at Fixio Physio Dee Why; experts with years of experience treating this niggly condition.
The first part is to reduce the stress on the Achilles tendon to a level that the tendon can manage. We do this by monitoring your pain levels any activity that we know spikes your pain we will temporarily reduce. Generally during this stage you want to stop stretching the tendon. Stretching the tendon only results in more compression and irritation of the tendon. During this stage often hands on treatments like soft tissue massage of the calf, intrinsic foot musculature or dry needling (link) can be useful.
The next stage of rehab is to improve the tendon’s ability to tolerate load. This will be done by a very specific exercise program that will progressively load the calf/Achilles muscle tendon unit. This will involve some variety of heel raises but done in a very specific gradual incremental way. During this stage we will also address any biomechanical factors that may be causing more stress through the tendon e.g. strengthening the foot arch to offload the Achilles to ensure long-term recovery.