How to Identify and Treat Achilles Pain
Are you feeling pain, swelling and stiffness in your Achilles region, just below your calf and above your heel? If so, check out our article on Achilles Tendonitis, more accurately known as Achilles Tendinopathy, which is the most common cause of Achilles pain!
What is Achilles tendinopathy?
This is an overuse condition, whereby the Achilles tendon has had repetitive microtrauma to it, resulting in degeneration of the tissue as it fails to recover. During this process the tendon can become weakened, painful, and result in higher change of rupture.
This condition begins with a mismatch between load capacity (tensile strength of the tendon) and load placed on the tendon (how much stress it is being exposed to). There is usually patient history of a spike in activity.
Signs & Symptoms - Mild pain, swelling and loss of function - Pain and stiffness is often experienced in the mornings or delayed after activities
- Weakness in the affected leg
- Pain when bending the ankle
Types of Achilles tendinopathy
Achilles tendinopathy can be broken into two types: Non-insertional and Insertional.
- Non-Insertional/Mid-Portion occurs 2-7cm above the heel bone - Insertional occurs where the tendon attaches to the heel bone
It is important to differentiate between the two types, particularly at the start of rehab, as certain positions can flare up one tendinopathy type but not the other. As a result, exercise loading must be specific in order to promote effective healing of the tendon.
4 Stages for Achilles Tendinopathy Treatment
The ultimate goal is that the athlete regains elastic capacity of the tendon and full optimal function of the leg, pain-free and without any biomechanical changes due to injury.
Rehabilitation should progress through stages of
1. Off-loading: Rest or decrease from activity, begin an effective and pain-modulated isometric loading program.
2. Pain reduction and healing: With decreased load on the tendon from a reduction in activities, eccentric-based exercises can be introduced into a program. Once again, pain should be your guide.
3. Gradual strengthening: Continual build of isometric, eccentric, and the introduction of moderate-heavy load concentric-based exercises should then build into the rehabilitation program. The is to further build tendon tensile capacity, as well as improve supporting strength of the muscles in and around the area.
4. Plyometric loading: Re-establishing elasticity to the tendon, in order for it to better cope with the demands of running, particularly shock absorption and propulsion (absorbing ground contact forces, as well as aiding in the body in pushing off).
If not done right, this type of injury is likely to flare up again and prolong the already long rehabilitation journey.
Check out the button below to see a glimpse into some Achilles Tendinopathy rehab!
Who to see for this condition?
If you've just recently been feeling pain in your Achilles and need an accurate diagnose of your injury, the best person to see is a Sports Physiotherapist. They will be able to kick-start your healing process through manual therapy, and ensure your exercise rehabilitation is appropriate to your injury. Click below to read more!
If however, you have been suffering repeated Achilles injuries, with unsuccessful return to sport, the best health professional to see is an Exercise Physiologist, who specialises at exercise rehab and mid-end stage return to sport treatment. Click below to clean more!
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