Achilles Tendon Pain - The 3 Key Questions You Need Answered
Here are the most common questions people ask me about Achilles tendon pain. Hope that you find this useful in understanding your own injury and exactly what you need to do in order to help resolve it.
Q. What causes Achilles Pain?
The achilles tendon can become inflamed and pain as a result of excessive amount of force on the tendon. This can happen in two ways and will result in two types of injury. The first is if we apply a huge amount of force extremely quickly. When this happens the achilles tendon can tear. The fibres have been pushed to breaking point. The second is if there is slightly too much force and this error is repeated over and over. Once won’t cause too much of an issue but if the tendon is overloaded multiple times, the tissues can become inflamed and tedinopathy begin.
Everything in the body has a certain amount of force that it can tolerate. This is different for every structure and every person. When a bone is put under too much force, it breaks. When a muscle is put under too much stress it can pull or rupture. The tendon is no different. Even though a tendon is incredibly strong and resilient but like everything it can only sustain so much. If it takes a little too much force then it is tough enough to handle it. But when that happens day after day, it starts to react.
When this happens, the body has a job to do. It has to go into protective mode. We all have an inbuilt system that uses pain as a way of telling us that there is damage or danger and we can therefore protect us. Pain in this case is good. It tells us that something is wrong and we can therefore change our behaviour. If we didn’t have pain then we wouldn’t know that we put the tendon under too much stress. Pain let’s us know there is an issue and something to fix.
Q. What are the key symptoms?
Along with pain, an achilles tendinopathy also presents with a range of other symptoms. They do not all need to be present in order to accurately diagnose an achilles tendinopathy but a combination of them is almost always the case. You could feel:
Swelling and tenderness around the achilles tendon
Pain after keeping the achilles tendon static. E.g. Getting up to walk after sitting for 1 hour being painful
It often feels like it ‘warms up’ once you get it moving. Many people will report that it is painful when the begin walking or running but after 10-15 mins the pain stats to decrease and it feels more normal
Usually feels worse first thing in the morning
Aggravated by being stretched - this would happen when walking downstairs up up a hill for example.
It does not require imaging for an accurate diagnosis, but the presence of an Achilles Tendinopathy can be confirmed using ultrasound. Using a feature called power doppler which will identify something called neovascularization which is the formation of new blood vessels in an area of the body. This indicates that there is a tendinopathy present
Q. What are the most effective treatment options?
So we know what has caused the tendinopathy, we know how to diagnose it accurately. The next most important question is how do we fix it! The good news is that it there is an answer to this question. We are going to discuss the two best ways to treat an achilles tendinopathy, exercises and focused shockwave.
Exercise
Using exercises and in particular strengthening work is the BEST way to manage an achilles pain. When you do an exercise that exposes the tendon to an appropriate amount of force the it releases a number of chemicals in the tendon that begin to repair the tissue.
This is incredibly important because, unlike a bone or a muscle, a tendon does not have a naturally strong blood supply. Therefore, the tendon cannot just heal with rest. We need to stoke the healing process like a fire. This is why we cannot rest a tendon and we have to use exercises. More on this in later posts. There is one huge unspoken to repairing the tendon through strength work - it simultaneously prevents it from happening in the future
Focused Shockwave Therapy
This is a treatment that we swear by in clinic. A study in 2008 by Furia studied 34 patients with mid portion Achilles pain that were treated with a Shock-wave therapy vs a control group of 34 that received a different treatment. The shockwave group’s improvement was significantly higher.
There was another randomised controlled trial of 75 patient split into three different groups. One reveived exercise therapy, another shockwave and the third were the ‘wait and see’ group. Both of the first two groups had improved function and less pain. 60% of the tendon loading and 52% of the shockwave therapy groups reported they were resovled or significantly better. (Rompe et al., 2009).
We believe that the best approach is in a combination of therapy and as shockwave will do little to strengthen the tendon and therefore prevent future issues, we always use this in conjunction with strength testing.
