Common in runners and people who participate in sports that require lots of jumping, Achilles Tendinopathy (AT) can cause debilitating pain and result in a significant restriction in daily living.
So what is a tendinopathy? And how does it happen?
A tendinopathy is a pathology related to tendons (of course!), which are the connection between muscle and bone. Tendons are vital in allowing us to move, and they are generally pretty robust structures. The shape and size of a given tendon will vary depending on the role that tendon plays and what movements it helps to produce. For instance, the Achilles tendon (subject of today’s blog) is thick and cord like, which allows it to act like a spring – storing and releasing energy quickly.
The structure of the Achilles tendon can be thought of as like a ‘bungy cord’. It has lots of thin collagen fibres that are densely packed and aligned which results in an extremely strong elastic structure that allows us to skip, jump and run.
Just like muscle tissue, when tendons are asked to do lots of work, they go through a cycle of micro-damage and repair which builds and strengthens the tissue. However, problems can occur when there is too much micro-damage and not enough time to repair the tissue. Unlike muscles which have lots of blood flow and a relatively quick repair time, tendons have minimal blood supply so the repair process takes a little longer (around 24-72hrs) – an important factor in the development of AT.
Due to the slower repair process, repeated bouts of running or jumping activities in a relatively short period of time doesn’t allow the tendon sufficient healing time which can have a detrimental effect on the tendon structure. The result is increased fluid intake, blood vessel and nerve ingrowth and subsequent disorganisation of the thin collagen fibres (see figure 1) – which leads to a reduced capacity of the tendon (i.e. frayed bungy cord).
How do I know if I have an Achilles tendinopathy?
Achilles tendinopathy signs and symptoms include:
- ‘Pinpoint’ pain in the Achilles tendon
- Pain that ‘warms up’ – sufferers will often complain of pain in the Achilles region when starting to move (first thing in a.m.) or after sitting at work, which resolves after a short period
- A thickening or swelling in the tendon
- Feeling of lack of power or spring in the calf
- Pain with hill walking or plyometric activities (i.e. box jumps)
How is it treated?
Once you have your dianosis, a treatment plan will address any range of motion, neuromuscular control or strength deficits found in your assessment that may be a contributing factor to your tendinopathy. This isn’t just focused on the foot and ankle, but the knee, hip and trunk as well – including a gait analysis if appropriate. The focus of a good rehab plan should be to progressively increase the capacity of the tendon, by exposing the tendon to strength and plyometric exercises in a graded manner. Basically, we want to make the ‘bungy cord’ thicker and more robust, and do it in a way that allows the tendon time to adapt!