Achilles Tendinopathy: What is this?

As a physiotherapy student, I was advised that this was one of the top 10 pathologies (conditions) that I may encounter in my working career. Yet, despite it's regularity, it is still widely misunderstood and by older clinicians, mis-diagnosed! Before we had the knowledge we have now, we believed this was an achilles tendinitis. Itis means swelling. Numerous studies and imagery have shown that there is no inflammation present, therefore this is an incorrect diagnosis.

What is it then?

Achilles tendinopathy is ultimately a thickening and degeneration of a tendon which is suddenly asked to do more than it is used to. Therefore the tendon loses it's elasticity and ability to take the strain and stresses you are putting through it. Typically, when a runner drastically increases their running distance, or intensity or terrain. It's not just limited to runners, it can affect anyone, depending on their age, gender and weight and change in activity levels. Some scientists are now hypothesising that over pronation (foot falling inwards) is a causal link for achilles tendinopathy. I personally, haven't seen the evidence to support this and knowing how we treat such a pathology, I doubt the accuracy in this. Now here's the science part! Collagen fibres make up your muscles and tendons. A degenerative tendon has an increase in echocoic lesions and neoplastic vessels, which ultimately disrupts the fibres and alters the collagen type to a weaker, more scar tissue like tendon

What are the symptoms?

PAIN! Specifically in the morning and when commencing a run! People report that the pain eases as the day progresses and as a run progresses. If left untreated the pain can increase and affect daily activities for example; getting out of bed in the morning, ascending and descending stairs.

Can it heal? If so, how does it heel?

Yes! Albeit very slowly but it does heel. A lot of people tend to bury their head in the sand with this kind of problem because the pain eases as the day progresses and with running distance, however this is not a cure. The tendon is ultimately going to thicken and degenerate further. The answer? You guessed it: EXERCISE! What else, I am a physiotherapist after all.

People used to try rest, ice and pain relief, but this did not correct the problem. To increase the tendon's ability to manage stress and load, it needs to be strengthened under load! This was discovered by accident by a Swedish Orthopeadic surgeon, named Alfredson, in the mid 1900's who had bad achilles pain and asked one of his colleagues to surgically intervene. His colleague said no. So Alfredson thought he would snap his achilles tendon and his colleague would have to repair it. Alfredson began to stretch this tendon whilst carrying excess weight thinking this would do the trick. Except it didn't. What Alfredson found was his pain got better! We as physiotherapists now use the "Alfredson eccentric calf raises" to rehabilitate this condition. So it worked for him, so it'll work for me, right?

Not necessarily! let's not forget, we are all unique. Unique in appearance, shape, size, technique and ability. All too often, for whatever pathology, lay people suddenly become internet clinicians and diagnose and treat based on their experiences and what someone told them once. it is always advisable to seek a full, accurate assessment from a trained clinician and treated as an individual accordingly.