Achilles Tendinitis: Causes, Symptoms, Treatments, 2015, Paddock, M.
Firstly, what is tendinopathy? Well, it’s an umbrella term used to describe a problem or injury with a tendon. It’s a very common problem and something that is often seen in an Osteopath clinic.
For a long time, tendon injuries were thought to be inflammatory by nature and had been commonly referred to as tendinitis. It is now shown to be more of a degenerative process. This has been supported by research showing findings of affected tendons having a disorganised collagen structure, abnormal tenocytes and an increase in ground substance. As a result, our management of the injury has changed.
Exercise wears our body out which triggers chemical reactions which allow for adaptation making us stronger. These adaptations occur when we rest and sleep. We know the balance between wear and repair is critical otherwise problems like tendinopathy can occur.
A tendon injury will largely occur due to the types of forces that are exerted on it. Forces like compression, friction and traction can all contribute to a tendinopathy.
A continuum is used to determine the stage at which the person is at with their tendinopathy. There are three stages; reactive tendinopathy, tendon disrepair and a degenerative tendon.
Reactive tendinopathy refers to an acute overload of the tendon and can cause thickening and pain. This is often caused by changes in loading such as an increase in training.
Tendon disrepair is where there is more of a breakdown of the tendon on a cellular level. Symptoms wise, this is likely to have been going on for a longer time that a reactive tendon.
In a degenerative tendon, symptoms have been present for a longer period of time and is more common in the older population.
What can lead to Achilles Tendinopathy?
There are two types of risk factors, intrinsic and extrinsic.
Intrinsic risk factors are things like having a previous injury, age, gender, muscle strength and reduced range of movement in certain joints like the ankle.
Extrinsic risk factors are things like a change in loading or technique, training error, activity levels.
A key point to make is ensuring an accurate diagnosis as certain exercises/treatments could aggravate the problem depending on the location of the tendon. Similar common problems such as bursitis, impingement and tendinopathy of the tibialis posterior are all injuries worth considering.
An osteopath will most often be able to feel the tendon for any swelling, thickening as well as any sensitive areas around the tendon. Your osteopath will also look for any factors that may contribute to the injury such as loss of movement in the ankle or foot biomechanics.
Treatment from an osteopathic perspective covers two main ways of strengthening. These are eccentric and isometric strengthening.
Isometric exercise is often used early on with research showing that it can be effective in managing the initial pain from the injury.
Eccentric training has been shown to be very effective in treating tendinopathies. The patient must consider though that the exercises can be painful, they require high volume every day, somewhere in the region of 90-180 repetitions, and that they must be patient and persevere for a number of months.
How can you manage the pain?
Osteopathy can be used with soft tissue techniques around the area to promote blood flow which contributes to healing. Additional joint mobilisations can be used to improve the range of movement at a joint to help take the load of the tendon. Your osteopath will also be able to advice on lifestyle modifications that you can implement which again, can help with the recovery process.
There are a few strategies that can be implemented. The is some evidence to suggest that taping can be used to help modulate the pain, however this method won’t actually change whats going on at the site of injury.
As always, if you’re suffering with any sort of injury then you’re always welcome to come seek my advice and I will do my best to ensure you’re on the right track!