Achilles tendon pain
The achilles tendon is a band of strong fibres which connects the muscles at the back of the leg, commonly known as the calf, onto the heel bone.
There are a few conditions that can lead to you having pain in your achilles tendon, but the most common is an ‘Achilles tendinopathy’. A tendinopathy is the word used to describe a non-inflammatory condition, where the tendon has become irritated and/or degenerative.
Why do people get pain?
People develop tendinopathy for a number of reasons but there is still a lot to learn about what is actually going on in the tendon to cause the pain. A sudden increase in activity can overload these soft tissues. This could cause a flare up of pain in a sporty individual but also an inactive, deconditioned person. The pain is often aggravated by squashing of these tendons or direct pressure at the point where the muscle attaches into the bone. When the condition persists for a long time, the soft tissue explanation for the pain can sometimes become less relevant as the experience of the pain involves a lot of different factors. It may be worth discussing this with your physiotherapist.
Who does it affect?
Achilles tendon pain can affect anyone at any age. However, it is most commonly seen in middle aged males or individuals who make the same movements over and over in their jobs and daily activities. Therefore, it is most commonly seen amongst hill walkers, runners and sports involving jumping.
If your pain has occurred with no change in activity there are other factors that may be worth considering when it comes to lifestyle. Research evidence stated that the following factors can affect the health of the tendons in our bodies:
- Having a high BMI
- Having high BP
- Having a diet high in fats
- Being type 1 or 2 diabetic
A thorough examination by your GP or physiotherapist is usually sufficient to diagnose an achilles tendinopathy.
The initial focus of physiotherapy is to reduce the pain. You can do this by modifying your day to day activities; this means changing the intensity in which you do activities or how often you do them. This is important to help prevent overload of the tendon and any further degeneration. However this does not involve stopping any activities; so if you are able tolerate some pain whilst remaining active this will help your recovery.
When managing an achilles tendinopathy it is important to know whether the problem is in the mid portion or nearer where it attaches onto the heel bone. This allows us to manage the problem correctly and avoid irritating the tendon further. For example, when the problem is nearer the heel bone, we advise people to avoid lots of stretches as this can irritate the tendon when it compresses against the heel bone during a stretch.
Research evidence shows a strengthening exercise programme should be started to improve your tendons ability to handle load. Most people with this condition have improvements in their pain and function levels with physiotherapy, however it can take 4 to 6 months and will involve some hard work.
You may experience some discomfort whilst performing some of the exercises and this may persist for some time after finishing them. How much and how long the pain lasts for is something you will discuss with your physiotherapist, but usually if the pain and the length of the time the pain lasts for is acceptable to you, then it’s fine. The pain you may experience after the exercises does not mean you are damaging anything.
Early strengthening exercises
Below are some early strengthening exercises you can start as soon you feel able. You may experience some discomfort whilst performing some of the exercises and this may persist for some time after finishing them. How much and how long the pain lasts for is something you will discuss with your physiotherapist, but usually if the pain and the length of the time the pain lasts for is acceptable to you, then it’s fine.
The pain you may experience after the exercises does not mean you are damaging anything. You can progress yourself gradually through the exercises as your pain, technique and swelling allows. This means if you have good technique, and you don’t experience any severe reactions like unacceptable pain and swelling after the exercises then you can progress yourself onto the next video.
Return to impact and running
Below are some exercise videos which will help you to strengthen and increase power in your calf through jumping and hopping drills. This will form part of the later stages of your rehabilitation. These exercises will help you return to sport as it is important to get your calf muscle and tendon used to the individual demands of your chosen activites. If you are unsure if you are ready to start these exercises or return to sport, you can discuss this with your physiotherapist.