By Paula Clayton, MSc Physiotherapy, MSc Sports Injury Management, FA. Dip. Mast. STT, MSMA (L5), MCSP, HCPC.
The Achilles is the longest and strongest tendon in the body. And for very good reason; it needs to absorb and amplify huge forces. Did you know that when running, for example, it functions under a force of up to seven times our own bodyweight? With such great demands being placed on this tendon, it is little wonder that it is so susceptible to injury.
You may be reading this as your own Achilles is causing you irritation or pain. You may be a physical therapist who regularly sees it in clinic, or a fitness instructor who would find it helpful to understand more so that you can advise your clients appropriately. You will all be starting with the same question – ‘how do I know it is Achilles tendinopathy, and not something else?’
Who gets it?
Anybody! It is a common misconception that Achilles tendinopathy only affects highly active people. Just because you haven’t been sprinting up hills, doesn’t mean you won’t experience it; a holiday in flip-flops could just as easily be the culprit!
What causes it?
In short, Achilles tendinopathy is an overuse injury. The cause is most likely to be connected to physical exertion: returning to exercise after a break; insufficient recovery time; training at high intensity; a change in terrain, or incorrect technique. It could be connected to tight or weak calf muscles, or instability at the hips or ankle. Being overweight will also increase your likelihood of experiencing problems. However, there are a number of factors outside of our control which are also known to increase the chances of suffering from Achilles tendinopathy, such as degeneration of the tendon, diabetes, rheumatoid arthritis, antibiotics containing fluoroquinolone, and exposure to steroids.
What is it?
When the Achillestendon is damaged, it becomes unable to tolerate the loads placed upon it. At this point pain will typically present in the mid-portion of the tendon, 2 -7cm above the heel – where there is relatively poor blood supply – or where the tendon inserts at the heel. It is important you do not continue to overload the tendon at this point, as you risk causing structural damage.
Is my pain Achilles tendinopathy?
The following algorithm is the most simple way to diagnose if you have Achilles tendinopathy:
Of course, there is more to it than this, but this should be your starting point. From here further investigation will determine which stage your Achilles tendinopathy is at and the treatment approach required to rehab the injured tendon back to full strength.
In her new book, ‘How to Treat your own Achilles Tendon’, Physiotherapist and Sports Injury specialist Paula Clayton brings together the most up-to-date research and treatment recommendations so that you can confidently address Achilles Tendinopathy. It distils everything you need to know; from understanding the mechanism of injury, to testing and diagnosis, treatment options and tailoring a rehabilitation programme for successful recovery from injury.
Paula worked as a senior physical therapist for the English Institute of Sport and British Athletics between 2003 and 2014, and served as part of the medical team at the Olympic Games (Athens, Beijing and London), the Commonwealth Games, and the World and European Championships. She is a member of the Health Care Professions Council (HCPC), Chartered Society of Physiotherapy (CSP), Sports Massage Association (SMA), and the Association of Chartered Physiotherapists in Sports and Exercise Medicine. Her first book, ‘Sacroiliac Joint Dysfunction and Piriformis Syndrome: The Complete Guide for Physical Therapists’, is also available now.