Do I really have Achilles tendinopathy?
Pain in the back of the heel can be caused by multiple structures and an accurate diagnosis is imperative in successful treatment.
Patients tend to report:
- Localised pain
- Pain or stiffness in the morning
- Swelling or a lump in the tendon
- Pain with tendon loading activities (e.g. running, hopping)
- It warms up with activity and may be worse the next day after a bout of activity
Insertional Achilles tendinopathy benefit from a modified treatment method compared to mid-portion for optimal management.
1. Should I be resting?
‘I thought if I had a couple of weeks off footy I’d be cherry ripe to get back into it’.
On the surface it seems like it would make sense.
Unfortunately, with Achilles tendinopathy, if you do not expose it to Achilles tendon loading activities (e.g. running, jumping, hopping) then you won’t get symptoms but it does not mean you prepare it to be able to tolerate load.
2. What is the best thing to do?
Exercise based rehabilitation is the main evidence based treatment to build the capacity in the tendon to tolerate the activities that you want to do.
3. Modifying load and education
As mentioned in point 2 – complete rest doesn’t help the tendon capacity.
However, modification of aggravating load and gaining a clear understanding of what you can and can’t tolerate can keep you doing your activity at a lower intensity and frequency without the same symptoms which allows you to build back into what you want to do.
4. Exercise needs to be individualised
We are not reinventing the wheel with our rehabilitation program.
Every person will have a different start point for rehabilitation. It’s not a recipe
5. Timeframes – be patient
Transitioning between building strength (3 months +) to energy storage and release is a process.
Be patient and trust the process (with an accurate diagnosis).
6. Treatment adjuncts
Such as stretching, massage, injectables into the tendon all aim to change pain, it will have no effect on the ability of your tendon to tolerate load.
Your clever tendon will not respond to the ‘quick fix’.
7. Imaging pathology does not correlate to symptoms
Partial, large, significant tear of the Achilles tendon.
All these adjectives you can put in front of tear have no direct correlation to symptoms.
Furthermore, Karin Silbernagel (Associate Professor – University of Delaware) has some great work showing that Achilles tendinopathy does not lead to Achilles rupture.
Overall, Achilles tendinopathy is a very debilitating condition that can change your quality of life.
Rehabilitation is not a recipe and needs to be individualised.
You will succeed with an accurate diagnosis, a clear understanding of what you can tolerate and a management plan for your specific goals.