What Is Achilles Tendinopathy



The Achilles tendon is a band of tissue that connects the heel bone to the calf muscle of the leg. This band of tissue/tendon can have changes in it, which is more described now as degenerative in cause rather than inflammatory and cause pain. Since tendons have least blood supply, recovery in tendon problems can take longer than other soft tissues. Tendon injury/tendinopathy is an over-use injury and occurs in loaded tendons of both upper and lower limbs. Characteristic changes occur in the tendons structure, resulting in a tendon that is less capable of sustaining repeated tensile load. Load is found to be the major cause for tendon changes; it is also reported that intrinsic factors such as genes, age, circulating and local cytokine production, gender, biomechanics and body composition also play a role.


How common is Achilles Tendinopathy?
About 6 in 100 active people develop Achilles tendinitis at some point in their lifetime. It is also more common in men than in women and typically tends to affect men between the ages of 30-40.


Few Causes of Achilles Tendinopathy
Achilles Tendinopathy can be caused by:

· Overuse of the Achilles tendon
· Tight calf muscles.
· Tight Achilles tendons.
· Lots of uphill running.
· Increasing the amount or intensity of sports training.
· Over-pronation, a problem where your feet roll inward and flatten out
more than normal when you walk or run.
· Wearing high heels at work and then switching to lower-heeled shoes
for exercise


What are the symptoms?
Achilles Tendinopathy causes pain and may cause swelling over the Achilles tendon. The tendon is tender and may be swollen. You will have pain when you rise up on your toes and pain when you stretch the tendon. The range of motion of your ankle may be limited. There is a risk of rupturing your Achilles tendon if you have Achilles tendinopathy. This is because the tendon is damaged and weaker than usual. However, this risk is usually quite low. Severe pain around the Achilles tendon that develops suddenly may be a sign of tendon rupture. See a doctor urgently if you think that you may have ruptured your Achilles tendon.


Treatment of Achilles Tendinopathy
Physiotherapists at The Sherwood Clinic specialize in sports injuries. They would plan your physiotherapy treatment so that you get effective pain relief. You will be given an individualized treatment and rehabilitation plan essential for total recovery.

Following are the guidelines for management of Achilles Tendinopathy:

Rest
Raise your lower leg on a pillow when you are lying down. While you are recovering from your injury, change your sport or activity to one that does not make your condition worse. For example, you may need to swim instead of run. As pain improves, you can recommence exercise as your pain allows. Even after the symptoms have subsided it is very important to monitor your training loads. It is important to gradually increase the amount of load(volume, intensity, frequency) to allow the tendon to acclimatize.


Ice packs
Put ice packs on the Achilles tendon for 10 minutes every 3 to 4 hours for the first 2 or 3 days or until the pain goes away. These may be useful for pain control and may help to reduce swelling in the early stages of Achilles tendinopathy. Make an ice pack by wrapping ice cubes in a plastic bag or towel or using a bag of frozen peas. (Do not put ice directly next to skin as it may cause cold burn.)


Painkillers
Painkillers such as paracetamol or ibuprofen may help to relieve pain. Check with your doctor or pharmacist before taking painkillers to make sure they are suitable for you.


Orthotics
A heel lift insert for your shoe or specialist orthotics can be worn at least until your tendon heals and possibly longer. The lift prevents extra stretching of your Achilles tendon. You can buy a good quality orthotics from your physiotherapist who may order the appropriate orthotics for your need they can be custom-made too.

Exercises
    1. Achilles Heel drop protocol
Achilles heel drop protocol was developed by Alfredson and colleagues and this is found to be most effective rehab protocol for Achilles tendinopathy. It is important to remember that you drop the heel just on the painful side and come up back on the non-affected side. In case both Achilles tendons are affected, use your arms to rise.

The sports physiotherapists at The Sherwood clinic will be able to plan a precise exercise rehabilitation plan for you.

    2. Gastrocnemius stretch
Stand in a walking position with the leg to be stretched straight behind you and the other leg bent in front of you. Lean your body forwards and down until you feel the stretch in the calf of the straight leg. Hold for _20_ seconds x 3 times each side.

    3. Soleus stretch
Stand in a walking position with the leg to be stretched behind you and the feet parallel. Hold on to a support. Push your heel down while bending the knee to stretch the back of your calf. Hold for _20_ seconds x 3 times each side.


The above exercise plan is a general guide only. For professional and individualized advice do contact The Sherwood Clinic on 0208 869 0000 to book your appointment.