Achilles Tendinopathy: Causes, Risk Factors, and Physiotherapy Treatment
I use the term “Achilles tendinopathy” to describe overuse changes to the Achilles tendons. It is not surprising that I see the overuse condition in athletes, but I see it in non-athletes, too. Those Achilles tendons that are tight or even inflexible are at risk for developing the condition, irrespective of the activity level.
Understanding Its Mechanism
What is even more fascinating is what is occurring at the tissue level for Achilles tendinopathy. It makes sense why the condition is so persistent. At the earliest stage, Achilles tendinopathy is characterized as reactive tendon formation. In this stage, there is proliferation of the tendon’s cells to the overload of the tendon, especially to the tensile or compressive overload, and it occurs without any inflammatory response.
Things get worse when the overload keeps occurring. Rupturing the tendons when performing physical activities is one of the most common ways it can be triggered. When the tendon gets stressed continuously, tendinopathy begins to develop.
Tendinopathy is exacerbated from a combination of repetitive microtrauma, differing tension of the gastrocnemius and soleus muscles that are continuous to the Achilles tendon. All of this contributes to the friction that the tendon fibers are subjected to, along with a poor tendinopathy response. When the tendon does not get enough time to recover from these stresses, it will become tendinopathic.
In chronic situations, simpler forms of inflammation evolve into a more complex picture involving hypoxic metabolism in the tendon, diminished local airflow, and possibly even malnourishment. Advanced forms of inflammation present a complex problem involving more consistent decreased tendon blood circulation and chronic inflammation.
Who is at Higher Risk?
Increases in the following attributes are known to raise the likelihood of developing Achilles tendinopathy:
- Bodyweight
- Blood Pressure
- Type II diabetes
- Increased corticosteroid usage
- Family history of tendinopathy
- Age
- Poor quality footwear
Rapid increases in the level of activity undertaken during the normal course of the day.
If these factors characterize you to a significant degree, consider being more vigilant in taking steps to maintain good tendon health to avoid the pain of tendinopathy, as the factors involving rapid increases of activity are easily the most preventable.
Tendon Health and the Role of Physiotherapy
The gradual, phased strengthening of an injured tendon is increasingly recognized as one of the most beneficial ways of improving tendon health and forms the basis of most treatment pathways for Achilles tendinopathy. The best way of strengthening tendons of this nature is to load them in a controlled manner.
Most rehabilitation of tendinopathy focuses on the use of eccentric strengthening techniques, where the tendon is both allows to and encouraged to lengthen under tension. A comprehensive treatment plan also includes the stretching of tight calf muscles, improving footwear, addressing any biomechanical issues, and a gradual increase of training load.
Manual therapy can help reduce pain while improving tissue mobility for surrounding tissues, but the most evidenced based approach toward actual tendon healing is the development of a structured, patient-specific loading program, as opposed to symptom management.
Importance of the Early Intervention
Achilles tendinopathy has the potential to become chronic when not treated correctly early on due to the limited blood supply to the tendon which naturally slows healing. Progression of activity with pain often leads to a worsening of the condition. Early intervention of a quality physiotherapy assessment positively impacts the disorder.
Frequently Asked Questions
What are the causes of Achilles tendinopathy?
The causes of Achilles tendinopathy are considered to be mainly overuse and repetitive strain to the Achilles tendon. Considered risk factors can be tight calf muscles, quick increases in activity, and diabetes.
Not exactly, while in some cases they are interchangeable. Tendinitis refers to the inflammation of the tendon, while tendinopathy refers to a degenerated tendon which is beyond the scope of simple inflammation.
Yes, most cases of Achilles tendinopathy are managed through physiotherapy which consists of eccentric strengthening and loading programs without the need for surgery.
Impacts are most likely seen among the overweight and aging population, diabetics, and those with a prolonged history of taking steroids. It is also considered to be of higher risk among the family of those affected and those with a history of poor footwear, along with those increasing their physical activity too rapidly.
Achilles tendinopathy occurs often and is misunderstood as an overuse state of the tendon resulting largely from repetitive stress and an overdeveloped load capacity. The vast majority of patients experience a marked improvement in symptoms and are able to return to their usual activities without the presence of pain after undergoing a physiotherapy assessment and a program that employs a manageable and progressive level of physical load.
About the Author
Dr. Seenath A. has a Master of Physiotherapy degree and additional certifications in dry needling, orthopedic manual therapy, and cupping therapy. He is a physiotherapist who specializes in the treatment of musculoskeletal and cardiorespiratory conditions and practices at the Kottakkal Ayurvedic Treatment Centre.
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