Achilles Tendinopathy

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8 Dec

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Your physiotherapist has diagnosed you with an Achilles Tendinopathy. Sometimes you may hear this condition called Achilles Tendinosis or Tendinitis, however people use these terms to mean the same thing. This information page is designed to help you have a better understanding of your condition, in addition to the advice given by your physiotherapist. By following these exercises, we will guide you through each step on your return to normal activities or the sporting goals you have.

What is the Achilles Tendon?

The Achilles Tendon is the biggest and strongest in the body. It is located at the back of your lower leg, just above the heel. It attaches your calf muscles (Gastronemius and Soleus) to the heel bone (Calcaneus) and helps you push up onto your tip toes. It is a very important tendon, which helps with walking, running and sporting activities.

What is Achilles Tendinopathy

Although the cause of Achilles tendinopathy is not fully understood. We do know that tendinopathy usually occurs when a tendon is overloaded and unable to adapt to the strain placed upon it. This can lead to repeated small (micro) amounts of damage to the tendon fibres and the tendon then tries to heal itself causing inflammation and pain.

What Causes Achilles Tendinopathy?

There are many factors which can increase the risk of developing Achilles tendinopathy. It is not just exercising too much which affects the load being placed through the tendon. General Risk factors include:

Age: The risk of Achilles Tendinopathy is most common over the age of 30, especially in men.
Weight: Those overweight are more at risk of developing an Achilles tendinopathy.
Diabetes: If you have Diabetes you are more at risk of developing an Achilles tendinopathy.
Stiff ankle joints.
Tight and/or weak calf muscles.
Sudden increases in normal activity: Walking, running and sports.
Training errors: Lack of variation, increases in running distances too soon, increased hill running.

Reduced core stability and hip/knee strength and control.

What are the Symptoms of Achilles Tendinopathy.

Pain just above your heel: Most people find that their pain is on the Achilles tendon, which can be tender to touch or if gently squeezed. Occasionally there is a visible lump or swelling in the painful region.

Pain after activity: most people will notice that their pain increases after a long walk/run or at the end of the day, particularly when they ‘relax.’ Some people can exercise through the pain but notice as time goes on the pain increases during activity and can prevent them from doing their normal exercise or sport.

Morning stiffness: Frequently people complain of stiffness around the Achilles in the morning, which usually eases after a few minutes of walking, but can take longer.

What Treatments Can Help?

Pain Management

Medication: paracetamol or other simple pain medication can help reduce pain. It is best to consult a pharmacist or your clinician for advice on whether these are suitable for you.

POLICE

Previously we used RICE (Rest, ICE, Compression, Elevation) for injury management. However, rest can be harmful and inhibits recovery. Recent research has now advised we use the acronym POLICE

Protection
Optimal-Load
Ice
Compression
Elevation

The key term is Optimal-load, this replaces Rest.

Modifying your normal activities, by reducing prolonged activities on your feet is a form of optimal loading.

You can maintain your fitness using other forms of exercise that will not aggravate your Achilles tendon, such as swimming, cycling or aqua jogging. You may need to speak to your physiotherapist to discuss what your optimal load might be as it is specific to you but will help speed up your recovery process.

Flare ups

An increase in pain or ‘flare up’ is common with Achilles tendinopathy. The key is to manage this effectively and efficiently. By using POLICE this can help reduce the initial pain. During a flare up managing your optimal load is important. You may need to reduce the stresses at the Achilles tendon, reduce the amount of exercises and daily activities that you do. Over time gradually increase your activity back to previous levels. You can discuss optimal load with your physiotherapist.

How long will it take to get better?

Unfortunately, there is not definite answer to this question. There are no quick fixes and it requires active participation from the patient throughout the process. Due to the biology of tendons they tend to take longer to improve. Conservative management has been proven to be the most effective treatment. If your symptoms don’t improve within 6 – 9 months, other treatment options can be discussed with your physiotherapist.

The Exercises

Participating in an exercise program carries a certain element of risk for some people. You should consult with your physiotherapist before initiating this program to ensure your safety.

If you have any issues please do not hesitate to contact the physiotherapy department. If you feel light headed, dizzy or have issues with your breathing please contact your general practitioner (GP) immediately.

Initial Phase: 2 – 4 weeks

Seated Heel raises + 10kg weight

In a seated position push up onto your tip toesRepeat 20 -25 time, completing 3 setshttps://www.youtube.com/watch?v=XpreTJcWa3k

Isometric Plantar flexion with band:

In sitting or lying, put a strong band (Blue/black) around the ball of your foot. Push your toes away from you.

Hold for 30 – 45 seconds, repeat 3 – 5 timeshttps://www.youtube.com/watch?v=ec1xPGm3k00

Isometric holds over step:

Stand on a step with your heels just over the edge and slight tension on the calf muscles. Repeat with your leg straight and knee slightly bent.

Hold for 30 – 45 seconds, repeat 3 – 5 timeshttps://www.youtube.com/watch?v=fginETfSE-w

Isometric heel raises:

Push up onto your tip toes and hold this position.Hold for 30 – 45 seconds, repeat 3 – 5 timeshttps://www.youtube.com/watch?v=58CNilZ9Ufs

Eccentric Exercise Program.

Eccentric exercises have been shown to provide excellent pain relief and improved function in those with Achilles tendinopathy. An eccentric exercise program is designed to gradually increase the load going through your tendon which will gradually reduce your pain and any swelling. These exercises can take between 6 – 9 months to significantly improve symptoms, however it can improve more quickly.

It is very important to note that you may experience an increase in pain as you begin this program, however this is normal. The pain will gradually reduce as you continue your rehabilitation plan.

Repetitions	15 – 25
Number of Sets	3
Rest period between sets	30 – 60 seconds

Double Leg heel drops: to neutral and progress to full. Repeat with straight leg and slightly bent knee.

In standing, with your heels over the edge of a step, drop your heels down, hold for 3 seconds and return to neutral (starting position).

Once this is comfortable. Repeat the exercise dropping your heels down then pushing up onto your tip toes

https://www.youtube.com/watch?v=Hf9XzIkoXzM

Double leg concentric/Single Leg Heel Drops. Repeat with straight leg and slightly bent knee.

In standing with your heels over the edge of a step, push up onto your tip toes with both legs. Removed the unaffected leg and slowly control your descent with the affected leg.

https://www.youtube.com/watch?v=mPa5ovZOaeQ

Single Leg Heel Drops. Repeat with straight leg and slightly bent knee.

Standing on your affected leg with the heel over the edge of a step, drop your heel down and push up onto your tip toes.https://www.youtube.com/watch?v=i2-fpQEeNUU