What you might be feeling
Patients typically report a gradual onset of pain and stiffness localised to the back of the heel where the calf muscles attach to the bone. This pain and stiffness is worse in the morning and at the start of exercise, and may disappear as you warm up. Patients may also notice the area is swollen and tender to touch. The pain ranges from a minor inconvenience, to very severe pain, even with walking.
What’s really going on inside
Achilles tendinopathy describes an overuse condition in the Achilles region. In the early stages, minor cell changes occur including increased cell number and size. The later stages are characterised by cell disruption and disorganisation, and increased blood vessels and nerves in the tendon. The changes that are present in early stages are reversible, however once the injury progresses permanent changes may be present.
Acute management advice:
- Rest from aggravating activities
- Ice or heat (as directed by your physiotherapist)
- Physiotherapy electrotherapy modalities to manage pain and swelling
- A targeted stretching and strengthening program
- Acupuncture and dry needling
- Bracing or taping to unload the muscle and tendon
Other things that may be used if the condition does not settle are:
- Corticosteroid injection
- Nitric oxide therapy
- Blood injection
How a physio can help?
Achilles tendinopathy generally does not get better on its own. It will feel a little bit better with rest, but once you start doing the aggravating exercise or activity again it will become painful. Continuing to do aggravating activities may advance the process and prolong recovery time.
The goals of physiotherapy treatment are to address any predisposing factors, reduce pain and inflammation, and promote healing to restore the muscle and tendon.
Your physiotherapist will provide you with a targeted tendon strengthening program to make it stronger and more accustomed to load. This starts with gentle sustained contractions, and progresses to heavy fast contractions.
Furthermore, your physiotherapist will address the factors that caused this injury in the first place, to help reduce the risk of the injury returning in the future. Some things your physiotherapist might address include:
- Abnormal lower limb mechanics (foot, knee and hip)
- Calf weakness
- Poor muscle flexibility
- Stiff ankle joints
- Training errors, including inappropriate training load and inadequate recovery time between training sessions
- Poor footwear, footwear wearing out
Finally, they 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. The rehabilitation can be frustratingly slow but persevere, it will get better!