There are two types of Achilles Tendinopathy to be aware of!
I know! There are still people I work alongside who still refer to these as Achillies Tendonitis. I have blogged about this previously, you can follow the link below:
Mid Tendon Achilles Tendinopathy. Insertional Achilles Tendinopathy.
People with mid point Achilles Tendinopathy have palpable pain at the local site. What's becoming more apparent is that people have similar problems where the Achilles inserts onto the Calcaneus (Heel bone). it's unsurprising really. Tennis Elbow is another form of Tendinopathy: Lateral Epicondilopathy. This is another insertional tendinopathy where the forearm muscles adjoin onto the outside of your elbow. There's two type of Achilles Tendinopathy, does it make any difference to me? The fact I am writing the blog gives away the answer. Of course it does! A recent case study Jayaseelan et al. (2017) followed one such gentleman who had Insertional Achilles Tendinopathy. The researchers identified that the gentleman in the case study, for ease, we will call John had joint stiffness following his Insertional Achilles Tendinopathy. John struggles with dorsiflexion (where you lift your ankle upwards) and hip movement in general. Movement restrictions have already proven to contract (shorten) muscle length and when we try to suddenly eccentrically (work under increased length) work the associated muscles, we get pain and tendinopathy. The researchers hypothesised that calf strengthening alone and specific soft tissue mobilisations (SSTM) to the tendon were not effective in the long term. The researchers suggested that joint mobilisations would address the problem in the long term.
By drawing the ankle forwards repeatedly, this increases dorsiflexion. I have used this technique numerous times to great effect on my private clients, achieving near normal dorsiflexion. By achieving full dorsiflexion, the calf muscles can adjust to the new range and strengthen accordingly. John was given 4 sessions by the researchers over a period of 2 months. He was given joint mobilisations and calf strengthening exercises, those similar* to mid tendon Achilles Tendinopathy. * It is noteworthy here, that full range eccentric calf loading exercises are proving less efficable in Insertional Achilles Tendinopathy than Mind Tendon Achilles Tendinopathy. Additionally, it is also worth noting that hip movement and therefore gluteal strength are paramount in Achilles Tendinopathy management. John was back to his baseline for running ability with regards to distance and pain symptoms. Of course, this is a case study and therefore may not be generalisable to the masses. However anecdotally I am found this beneficial for my clients too and will continue to use this when the needs arise. Now there are two types of Achilles Tendinopathy to be aware of. Make sure your local, friendly physiotherapist is aware of both and treats you correctly and accordingly.
