The Ultimate Achilles Tendinitis Guide- By Alex Nicholson, Sports Physiotherapist
What is Achilles Tendonitis?
The terms tendonitis, tendinosis and tendinopathy can be used interchangeably and are referring to when the tendon is overloaded, most commonly causing pain and reduced function. For the purpose of this blog I will use the banner abbreviation AT.
What are the signs and symptoms?
AT most commonly presents as pain where the Achilles tendon joins to the heel bone (Insertional AT) or 3-5cm above the heel bone (Mid-portion AT). The Achilles tendon is often thickened and tender to the touch in the area that is overloaded and this thickening can be felt on the surface. Pain is commonly experienced when running, walking, going downstairs, or whilst stretching the tendon.
Is it ok to walk with Achilles tendonitis?
Yes, it is ok to walk with AT but you may need to moderate your walking volume for a period of time if it is quite irritated. Walking uphill is also more provocative as it applies more stretch to the tendon, so you may opt to find flat terrain where possible. Early in the condition, most patients find it more comfortable walking in shoes that have a raised heel as it will reduce the amount of pulling on the sore tendon. If all your shoes are very flat, you may find it helpful to put a heel raise into your shoe (always put it in both shoes though so you aren’t lopsided).
Does Achilles Tendonitis ever go away?
Yes, AT does go away. However, it can be a stubborn condition for some. The key to resolving the condition is in getting the balance of activity right and this differs from case to case. If your tendon is weak and not capable of doing the activities that you demand of it during the day, then it tends to remain overloaded. In order to progress your recovery, you need to strength and expose the tendon to progressively tougher exercises and activities. If the tendon flares up the day after a bout of new exercise, then it is telling you that it is not ready for that level of activity and you should reduce the intensity or duration of the aggravating activity so as to avoid chronically aggravating the tendon. If you are doing heavy exercises, you will need 1-2 days rest between repeat exposures to allow the tendon to adapt.
What happens if Achilles tendonitis goes untreated?
If you don’t use your tendon, it won’t be painful, but that isn’t very practical. Furthermore, inactivity causes your tendon (and all your other muscles) to become progressively more deconditioned, which makes your tendon weaker and more easily aggravated. Therefore, it’s worthwhile to see a physio who specialises in tendon rehabilitation who can give you guidance on how to safely progressively rehab your AT.
What aggravates Achilles tendonitis?
An already aggravated or overloaded Achilles tendon is commonly further aggravated by activities such as running, hopping, walking (especially uphill), stairs, calf raises (especially over the edge of a step) and stretching.
Can shoes cause Achilles tendonitis?
If the back of the shoe rubs against your heel and/or Achilles tendon, then this repetitive frictioning can cause AT.
Should I stretch a sore Achilles?
Generally speaking we discourage patients from stretching their Achilles, particularly in the early stages, as it compresses and irritates the tendon that is already overloaded. Many patients find it hard to resist the urge to stretch their tendon as it often feels stiff. However, the length of the tendon returns through specific strengthening exercises and avoiding aggravating it.
How can I treat Achilles tendon pain at home?
Exercise is the key to rehabilitating AT pain. Most exercises can be performed at home, but sometimes additional weight is needed that can be difficult to find at home (e.g. seated calf raises with 30kg added!). This is particularly for cases where patients are wanting to return to running or higher level sports.
How do you treat Achilles Tendonitis?
The TPP Tendon Clinic is a one stop shop for rehabilitating all types of tendon injuries, including the Achilles. The Clinic uses a myriad of the latest scientific research evidence on tendons and then tailors treatment to the individual based on their specific needs, to ensure that you get better faster.
The first stage of rehab for most patients involves off-loading the tendon a little (modifying or removing aggravating exercises and using a heel raise) and some early tendon loading exercises such as isometric heel raises. The next stage involves progressive strengthening and restoration of the length of the tendon through slow, heavy resistance exercises. The later stages involve plyometric exercises and sport specific exercises (where appropriate).
