Achilles Tendonitis is a term that refers to inflammation of the Achilles tendon or its covering. It’s an injury that commonly occurs to those who jump and jog regularly, or engage in similar activities that require the same repetitive action.
To include both inflammation and micro-tears, most experts now use the term Achilles tendinopathy, though out of habit, some doctors may still use the term tendonitis.
Tendons are the tough fibres that connect muscle to bone, with most injuries occurring near joints, such as the knee, shoulder, ankle and elbow. While a tendon injury may seem to happen suddenly it’s often to result of many tiny tears to the tendon that have occurred over time.
There are many terms to describe a tendon injury, such as:
- Tendonitis (or tendinitis): this means ‘inflammation of the tendon’, however inflammation is not usually the cause of tendon pain.
- Tendinosis: this term refers to tiny tears in the tissue in and around the tendon that is the result of overuse.
Causes of Achilles tendonitis
Achilles tendonitis is an injury caused by overuse that is commonly experienced by those who jump and jog regularly or similar activities that require the same repetitive action.
Tendon injuries are commonly the result of gradual overuse and ageing. Those who make the same repetitive motions on their tendons due to sports, daily activities and jobs are most likely to cause the tendon damage. While a tendon injury can happen both suddenly and gradually, tendon’s that have been weakened over time are most likely to experience an injury.
Common causes of Achilles tendonitis include:
- High foot arch with tight Achilles tendon
- Wearing high heels or walking too much on your toes
- Poor eccentric strength
- Running up hills
- Tight calf muscles and hamstring (back of thigh)
- Unfamiliar use
Symptoms of Achilles tendonitis
Achilles tendonitis usually causes stiffness, loss of strength and pain in the affected area. Signs of an injured tendon could be:
- Burning pain felt at the beginning of an activity, or exercise, which decreases during the activity to then increase when the activity is over
- Tendon feeling stiff at the beginning of exercise or first thing in the morning
- Crunchy sound or feeling when using the tendon
- Tendon area is inflamed and red, warm, tender or swollen
- Painful or prominent lump within the tendon
A qualified physiotherapist, chiropractor or sports doctor can confirm the diagnosis of Achilles tendonitis on consultation. Basis for the diagnosis is on history, clinical tests and symptoms. Further consultation from the specialist may include US scan or MRI, however x-rays are of little use in the diagnosis.
Treatment of Achilles tendonitis
Achilles tendonitis is common and an injury that often recurs if you return to sport too quickly from an injury or do not complete a rehabilitation program.
Calf muscles are a powerful group of muscles that provide force for running, hopping and jumping. Achilles tendons attach your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which has a different level of blood supply and function and alters the rehabilitation from a calf tear.
There are seven stages during rehabilitation to treat injuries and prevent recurrence:
Stage one: Early injury protection – pain reduction and anti-inflammatory phase
RICE (rest, ice, compression and elevation) is the initial treatment for most soft tissue injuries.
Rest: In the initial phase, you will be unable to walk within a limp, so your Achilles tendon requires rest from weight-bearing loads. To relieve pressure on the Achilles tendon, you may need a wedged Achilles walking boot, crutches or heel wedges. Your chiropractor or physiotherapist will advise you on what would be most suited to you.
Ice: During the initial phase of the injury or when you notice that the injury feels warm or hot, apply ice for 20-30 minutes every 2-4 hours. To help reduce pain and swelling, you can take anti-inflammatory medication, however only after the first 48 -72 hours. Taking anti-inflammatory medication before this may result in additional bleeding. As you improve, a kinesio supportive tape (a stretchy tape) will support the injured soft tissue.
Stage two: Regaining full range motion
It will take at least six weeks for scar formation to mature. During this time period, you should be aiming to prevent a poorly formed scar by remoulding your scar tissue so that it doesn’t re-tear again in the future.
Massage, neurodynamic mobilisations, muscles stretches and eccentric exercises are important to lengthen and orientate your healing scar tissue. Signs that your soft tissue is on the mend include performing Achilles tendon stretches and walking without a limp.
Stage three: restoring proprioception
A proprioception program will be developed for you by your chiropractor or physiotherapist to prepare you for light sport-specific training.
Stage four: Restoring isometric and concentric muscle strength
The restoring process of the concentric muscle is a gradual progression from non-weight bear to partial and then eventually full weight bear and resistance-loaded exercises. Your chiropractor or physiotherapist may also advise that you require strengthening for other leg, lower core muscles and gluteal depending on the assessment findings.
Stage five: Restoring eccentric muscle strength
Calf muscles work in two directions by pushing you up (concentric) and control you down (eccentric). Most Achilles injuries occur during the eccentric phase. As and when your injury healing allows, your chiropractor or physiotherapist will guide you on calf strengthening programs.
Stage six: Normalising foot biomechanics
Poor foot biomechanics, sometimes known as flat foot, can result in Achilles tendon injuries. To prevent recurrence your specialist may recommend that you undertake the foot stability program or that your foot requires a foot orthotic (shoe insert).
Stage seven: Restoring high speed, agility and power
Achilles tendon injuries often occur during high-speed activities that place pressure on your body. To prevent a recurrence as you return to sport, your chiropractor or physiotherapist will guide your recovery with exercises of rehabilitation to improve your sporting performance and prevent a recurrence.
Stage eight: Returning to sport
To return to sport safely and injury-free, you will require specific sport related exercises and a customised training regime.
The chiropractor or physiotherapist treating you will discuss timeframes, goals and training schedules with you to support your return to sport with the main objective being a full agility, speed, power and function with increased knowledge on how to prevent any further injuries.
Setting your result expectations
There is no specific timeframe on your progress, with recovery varying depending on the person and the level of injury. Your chiropractor or physiotherapist will determine your rehabilitation status and this will be based on factors associated with your clinical assessment.
To prevent re-injury, it’s important to understand that attempting to progress to the next level too quickly can lead to re-injury.
Ultimately, the length of your rehabilitation will come down to your tendon injury and your compliance with treatment.
Can your Achilles tendon rupture?
A total rupture of your Achilles tendon is the worst-case scenario with treatment requiring surgery, a walking boot or plaster for at least six weeks. This level of this type of injury could take six or more months to successfully rehabilitate.
Sydney Spine & Sports Centre (S3C) is a treatment centre of excellence for all muscles and joints, if you have any questions please call one of our chiropractors or physiotherapists today.