Achilles Tendinopathy

Tendinopathy has replaced the term tendinitis to reflect the latest research on the source of the tendon pain.

The term tendinitis refers to pain from inflammation.

Current research on tendon health demonstrates that instead of inflammation the tendon has micro tears with evidence of poor tissue healing. A good analogy is that the painful tendon breaks down and is much like the end of a frayed rope. If the tendon continues to be strained the breakdown of tissue and pain continues. Often the tendon becomes thickened around the area of strain as the body creates an increase in the quantity of tendon rather than quality.

Achilles Tendinopathy is common in both elite and recreational athletes.

The most common type of Tendinopathy is a midtendon, i.e. about 1” or so above the attachment to the heel bone. Less common is an insertional Tendinopathy, which is pain at the Achilles attachment into the heel bone. The site of pain can be swollen and thickened or normal in appearance. The pain can be brought on with activity or only become painful after activity.

The goal of manual physical therapy is to decrease the stress on the Achilles while promoting healing.

Reducing stress involves a careful biomechanical assessment of the foot, ankle, knee, hip, pelvis and lumbar spine looking for areas that would increase the stress on the Achilles. The problem areas are addressed by a combination of manipulation, mobilization, stretching, therapeutic exercise, and modalities such as electrical stimulation and taping.

Proper footwear, a heel lift, night splint and possibly orthotics can also be helpful. Often a ‘low dye’ foot (which supports the arch) tape is used to determine if orthotics would be helpful.

A therapeutic exercise program consisting of an eccentric loading program is critical to promote healing.

The eccentric loading program has been well researched and demonstrates good success in both reducing pain and improving function. The key components of the program are heel drops on a stair with the knee bent and knee straight. The program is done in 3 sets of 15 repetitions, twice daily 7 days a week. The program can take up to 3 months. The eccentric loading promotes the tendon to produce better quality tendon cells and promote healing and reducing pain. It is also suggested that some discomfort while doing the exercise program is normal. It is best to check with your physiotherapist about the correct exercise dosage and technique.

A video of correct technique can be seen below: