The Achilles tendon is a tough band of fibrous tissue that attaches the calf muscles to the heel bone. When the calf muscles contract, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running or jumping. The Achilles tendon is the largest and strongest tendon in the body, but despite its strength, it is vulnerable to injury. This is due to the high forces placed on it and its limited blood supply.
Achilles tendon pain, often referred to as Achilles tendinopathy, is a troublesome condition, most often seen amongst middle aged to older individuals. This can affect both active and non-active people and is more common in men than women. Although middle age athletes are at a higher risk of developing Achilles tendinopathy, younger athletes can also be affected. Sports and activities that are higher impact and require large forces to be transferred through the Achilles tendon, such as running, jumping, hopping and landing, are more often associated with Achilles tendinopathy.
Achilles tendinopathy is characterised by localised tendon pain particularly when loading the tendon. Injury to the Achilles tendon causes dysfunction and can severely impact recreational and everyday activities.
ACHILLES TENDON PAIN TREATMENT
Many different conservative treatments have been proposed to treat Achilles tendinopathy over the years, including rest, nonsteroidal anti-inflammatory drugs (NSAIDs), ice, massage, electrotherapy and shock-wave therapy. However, research evidence suggests that the best form of conservative management for Achilles tendinopathy is a tailored, patient specific, graded strengthening programme.
Several different strengthening programmes have been studied, each with varying positive effects on Achilles tendinopathy. Some of the strengthening exercises studied include isometric loading (exercise involving a sustained muscle contraction without movement during the contraction), eccentric loading (loading a muscle whilst it is lengthening) and concentric loading (loading a muscle whilst it contracts and shortens).
The type of strengthening exercises prescribed will depend on the presentation of the patient and the physiotherapist’s clinical reasoning. The physiotherapist may focus on one type of muscle contraction or combine several. The exact effect that strengthening exercises have on the Achilles tendon is unclear but it is suggested that they can stimulate remodelling and tissue repair.
Studies have found that an appropriate strengthening programme is not only safe and easy to do, but after just 3 months, many patients return to normal pre-injury levels of running, strength and pain. An appropriate strengthening programme can also help reduce the need for surgery for Achilles pain.
If you are currently struggling with Achilles pain, get in touch with a Physiotherapist here at Ponsonby Physiotherapy. We can advise you on the appropriate strengthening exercises to help resolve your issue.
