Achilles Tendinopathy

Accurate Diagnosis

Achilles Tendonitis is a term that is very rarely used these days. A more accurate diagnosis would be Achilles Tendinopathy. Although this may just sound like semantics, it is actually very important when it comes to treatment approaches. 

-itis means inflammation. Research has shown that the majority of Achilles Pain doesn't have a classic inflammatory response. It is actually a far more complex process. 

Jill Cook is a key researcher in Tendinopathy. She has identified a tendon can go through 3 different phases. 

reactive phase          into             dysrepair phase        into            degeneration  phase      

An accurate diagnosis will also identify what phase of Tendinopathy you are in, which is crucial when it comes to an appropiate rehabilitation programme. 

Why the different phases matter

Reactive Phase- This is the acute response to tendon overload. Without going too scientific, a reaction to this overloading occurs, and causes a number of chemicals to go the the area.  This is a protective response to help handle the extra load on the tendon. This is a short lived response that has no long term damage. This reaction can also be a painful response.

If this caries on, or is intense enough, then there may be some disorganisation of the collagen in the Achilles. This will affect the ability of the Achilles Tendon to handle load.

This is moving into the Dysrepair Phase. And then when this develops even further, it will move into the Degeneration Phase.

The Reactive Phase however can happen at any stage. So it is possible to have a Reactive Phase ontop of a Degeneration Phase. This is usually seen when an individual has been struggling with Achilles pain for a while, then tries to do to much on it, and experiences a 'flair up' of symptoms.

When should you seek help?

If you are experiencing Achilles Tendon Pain, then you should seek some specialist advice as soon as possible, rather than ignore it for weeks or even months. 

This is because we want to see your Achilles when the least disruption to the tendon has actually occurred. The goal of rehabilitation is to remodel the tendon so it can absorb load again. If the tendon has been ignored for months= more remodelling needed= longer recovery. 

Our team at Resilience will help establish what phase the tendon is in, help settle the reactive response (pain) and then start an appropriate loading programme that will help teach the tendon to absorb load efficiently again. 

Previously failed treatment?

3 sets of 15 heel drops right? This advice came from a study done in 1998! Yes, it can certainly work. However, that completely depends on the phase the Tendinopathy is in, your age and fitness levels and more. 

If you do not match the loading with the appropriate phase, then what may be a perfectly good rehabilitation programme on paper, could actually make the tendon worse.  

We also think it is vital that we identify the causes of the overloaded tendon in the first place. Training load error? Underlying movement imbalances causing too much ankle and Achilles Work? Gait? Strength? Jump-Landing Mechanics? etc.. 

We will assess all of these potential causes in the Initial Consultation and build the corrections needed into your programme. 

Avoidance

There are many areas that need to be addressed when trying to prevent Tendon Injuries. However an easy drill that can be added is skipping ( https://rphysio.com/blog/2018/4/3/running-tip-1-skipping)

Tendons just used to be thought of as connectors of muscles to bone. But they actually have elastic properties in them that help us with force absorption and force transmission. Skipping is a great way of training this mechanism and help keep the Achilles Tendons healthy. 

If you are struggling with Achilles Tendon Pain, or have in the past and would like to discuss how we could help you, feel free to contract us on 07842911104 or email on Clinic@rphysio.com