Achilles tendinopathy

What is the Achilles tendon?

Your Achilles tendon is an important part of your leg. It is found just behind and above your heel. It joins your heel bone (calcaneum) to your calf muscles. The function of your Achilles tendon is to help in bending your foot downwards at the ankle. (This movement is called plantar flexion by doctors.)

What is Achilles tendinopathy and what causes it?

Achilles tendinopathy is a condition that causes pain, swelling, stiffness and weakness of the Achilles tendon. It is thought to be caused by repeated tiny injuries (known as microtrauma) to the Achilles tendon. After each injury, the tendon does not heal completely, as should normally happen. This means that over time, damage to the Achilles tendon builds up and Achilles tendinopathy can develop.

There are a number of things that may lead to these repeated tiny injuries to the Achilles tendon. 
For example:

• Overuse of the Achilles tendon. This can be a problem for people who run regularly. (Achilles tendinopathy can also be a problem for dancers and for people who play a lot of tennis or other sports that involve jumping.)

• Training or exercising wearing inappropriate footwear.
• Having poor training or exercising techniques - for example, a poor running technique.
• Making a change to your training programme - for example, increasing the intensity of your training and how often you train.
• Training or exercising on hard or sloped surfaces.
• Having a high-arched foot.
• Having poor flexibility - for example, having tight or underdeveloped thigh (hamstring) muscles.

Achilles tendinopathy is also more common in people who have certain types of arthritis, such as ankylosing spondylitis or psoriatic arthritis. It is also thought that your genetic 'makeup' (the material inherited from your parents which controls various aspects of your body) may play a part for some people who develop Achilles tendinopathy.

People who are taking medicines from a group called fluoroquinolones (eg, the antibiotics ciprofloxacin and ofloxacin) for long periods also have an increased risk of developing Achilles tendinopathy.

Achilles tendinopathy used to be known as Achilles tendonitis. In general, 'itis' usually refers to inflammation, so tendonitis would mean inflammation of a tendon. However, Achilles tendinopathy is now thought to be a better term to use because it is thought that there is little or no inflammation that causes the problem.

If the Achilles tendon is torn, this is called an Achilles tendon rupture. There is a separate leaflet called Achilles Tendon Rupture that discusses this in more detail. The rest of this leaflet is just about Achilles tendinopathy.

How common is Achilles tendinopathy? 

About 6 in 100 inactive people develop Achilles tendinopathy at some point in their lifetime. However, the chance of it developing is higher in athletes or those who train regularly or do a lot of exercise. It can be a particular problem for some runners. It is also more common in men than in women and typically tends to affect men between the ages of 30-40.

What are the symptoms of Achilles tendinopathy? The main symptoms include pain and stiffness around the affected Achilles tendon. Pain and stiffness tend to develop gradually and are usually worse when you first wake up in the morning. (Severe pain that comes on suddenly and difficulty walking can be symptoms of Achilles tendon rupture. See a doctor urgently if you develop these symptoms.)
Some people have pain during exercise but, in general, pain is worse after exercise. Runners may notice pain at the beginning of their run, which then tends to ease and become more bearable, followed by an increase in pain when they have stopped running. Pain due to Achilles tendinopathy may actually prevent you from being able to carry out your usual everyday activities such as walking to the shops, etc. You may notice that you have pain when you touch the area around your Achilles tendon. There may also be some swelling around this area.

Diagnose:
usually diagnose Achilles tendinopathy because of your typical symptoms and from examining your Achilles tendon. They may feel for swelling or tenderness of the tendon. They may also ask you to do some exercises to put some stress on your Achilles tendon. 

For example, they may ask you to stand on the affected leg and raise your heel off the ground. For most people with Achilles tendinopathy this movement brings on (reproduces) their pain. 

If this does not reproduce pain, your doctor may ask you to hop on that foot, either on the spot or in a forwards direction. Your doctor may also do some other tests to make sure that there are no signs that you have ruptured your Achilles tendon. For example, squeezing your calf muscles and looking at how your foot moves.

X-rays or other tests are not usually needed to diagnose Achilles tendinopathy. However, an ultrasound scan or an MRI scan may sometimes be suggested by a specialist if the diagnosis is not clear.

What is the initial treatment for Achilles tendinopathy?
There are a number of treatments that may help. The treatments below are usually suggested first. 

They are all considered as conservative treatments. This means treatments that do not involve surgery.

Rest:

Rest and time off from sporting activities are important if you have Achilles tendinopathy. At first, you should stop any high-impact activities or sports (such as running). As pain improves, you can restart exercise as your pain allows. 

It is thought that complete rest, if it is prolonged, can actually be worse for the injury. Talk to your doctor about when you should start exercising again.

Ice packs:
Ice treatment may be useful for pain control and may help to reduce swelling in the early stages of Achilles tendinopathy. An ice pack should be applied for 10-30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. Make an ice pack by wrapping ice cubes in a plastic bag or towel. (Do not put ice directly next to skin, as it may cause ice burn.) A bag of frozen peas is an alternative. 

Gently press the ice pack on to the injured part. The cold from the ice is thought to reduce blood flow to the damaged tendon. This may limit pain and inflammation. Do not leave ice on while asleep.

Achilles tendon exercises

Some special exercises to help to stretch and strengthen your Achilles tendon can be helpful. You should aim to do these every day. Such exercises may help with pain control and stiffness.

A physiotherapist may be able to help you with these exercises as needed. They may also use other treatments such as ultrasound and massage to help relieve symptoms and promote healing of your Achilles tendon.

The following exercises can be used to help treat Achilles tendinopathy:

AVOID 5 exercises...if you suffer from Back Pain & Slipped Discs

60% of Adults experience back pain at some point in their life....and, for the most part they’re totally unaware that they are exacerbating their back pain by making bad exercise choices.

When you’ve got back pain the last thing you should be doing is rounding the spine (and reversing the natural lumbar curve).  The moment we bend forward or hunch the back, whether sitting or standing, the load on the disc space increases dramatically, putting a huge amount of pressure on the lower lumbar vertebra!

It may come as some surprise that some of the more common exercises are actually some of the biggest culprits!

1) Toe-touching; and twisting the spine:

Repetitive toe touching rounds the spine and puts pressure on the lumbar curve, performing this repeatedly places pressure on the intervertebral discs which leads to degeneration.

2) Situps/Crunches:

While sit ups used to be a favourite for working the belly this move only works 20 percent of your abdominal muscles and puts a huge strain on the back.  Pulling on the neck while crunching hurts the upper back and your lower back gets hit when as your hip flexors pull on the spine to raise your upper body off the ground.  So instead of opting for a gruelling sit up routine, consider planking – which works your entire body while really focussing on your core.

3) Double leg raisers:

Another favourite in the gym, but again a common exercise that can stress the lower lumbar and Sacro iliac joints. For most people, it’s nearly impossible to keep the back from arching as both legs raise and lower. When that happens, the back hyper-extends, placing stress on the spine and increasing the risk of injury. 

If you’re set on doing double leg raises, try placing your hands underneath your lower back for added support, moving in a slow, controlled way. If you have any back pain – simply avoid this exercise.

4) Spinning with a rounded back: 

Mountain biking and cycling with an upright posture honours the correct lumbar curve and doesn’t create undue stress on the back, however leaning forward on a spinning bike or doing long distance road cycling may put stress on the lower spine and exacerbate tension in the area.  

Commonly cyclist who complain of numbing fingers and numb toes while riding are actually suffering from the effects of locked up muscles which have tightened in response to the body’s rounded posture.

 5) Running:

Running is a high-impact exercise. The faster you run, the harder your feet hit the ground and this repetitive jarring is very hard on the joints and the spine. 

Studies such as the one published in the September 1986 issue of the “British Journal of Sports Medicine” found that the spine shrank by several millimeters after a 6 km run, and the shrinkage was directly proportionate to running speed. 

Although the relationship of spinal shrinkage to spine pain isn’t fully known, those results show how much stress running can put on the spine. If you experience chronic back pain, running may not be an option.

SUCCESSFULLY MANAGING BACK PAIN
Rule no 1 : you CANNOT build strength or tone into stressed or tight muscles!
When  one is experiencing pain or tension from body stress being present in the body the first approach is to release the tightly locked up muscles to allow the muscle tone to relax back to a more normal tone.  You’ll do by working with your Body Stress Release practitioner.

When the muscles have had an opportunity to release you’ll be able to build up strength through well directed exercise such as:
Swimming ; Walking ; Pilates and Core excercises that your BSR practitioner will give you.Training with an instructor who understands the Biomechanics of the spine 
Manage your limits :  In doing exercise, remember to listen to your body. Pain in the warning signal that you are starting to push yourself beyond your individual limit into “overload”.   When you feel pain, stop or adapt the activity- don’t try ignore the pain or “work through it” or supress it with pain killers.  In the long run a little rest often goes a long way in bouncing back stronger.