Any problem relating to a tendon, either short term or long term, is called a tendinopathy. Achilles tendinopathy is an irritation of the Achilles tendon, a thick band of tissue that connects the calf muscles to the heel. It is one of the most common causes of pain felt behind the heel and up the back of the ankle when running or walking. It is estimated that males experience 89% of all Achilles tendon injuries, and 50% of runners will experience Achilles discomfort at some point in their running careers. Overall, Achilles tendinopathy can result in a limited ability to walk, climb steps, or participate in recreational activities.
HOW IS ACHILLES TENDINOPATHY GRADED?
The Achilles tendon assists with movement of the lower leg and ankle, and helps to balance forces in the leg. Achilles tendinopathy results when demand placed on the Achilles tendon is more than its ability to function. This may happen after 1 episode (an isolated incident), called an acute injury, or after repetitive irritation, called a chronic injury, which can also lead to micro trauma. The severity of acute injuries is graded according to the amount of damage to the tendon as follows:
- Grade I–Mild strain, a few fibers disrupted. Mild to moderate pain, swelling stiffness, tenderness. Expected to heal normally with conservative treatment.
- Grade II–Moderate strain, several fibers disrupted. Moderate pain, swelling, difficulty with normal walking. Expected to heal normally with conservative treatment.
- Grade III–Complete rupture, often characterized by a “pop.” Immediate pain, unable to put any weight on involved leg. Typically requires surgery to repair.
In the majority of cases, Achilles tendon pain is the result of repetitive trauma to the tendon. Over time this leads to breakdown of the tissue, and is most often treated with Physical Therapy.
WHAT ARE SOME CAUSES OF ACHILLES TENDINOPATHY?
Achilles tendinopathy may be the result of a number of variables, including:
- Calf tightness
- Calf weakness
- Ankle stiffness
- Improper footwear
- Abnormal foot mechanic
- Abnormal foot structure
- A change in exercise routine or sport activity
WHAT ARE SOME SYMPTOMS OF ACHILLES TENDINOPATHY?
One may experience:
- Pain in the back of the heel or higher up in the Achilles tendon
- Tightness in the calf
- Tightness in the ankle
- Swelling in the back of the ankle
- Pain and stiffness with walking, especially with taking the first several steps.
HOW IS ACHILLES TENDINOPATHY DIAGNOSED?
Your Physical Therapist should conduct a thorough evaluation of your lower leg and ankle, including medical history. The goals of the initial evaluation are to determine the cause and contributing factors to your injury, as well as to assess the degree of injury. Included in the initial assessment should be questions regarding your daily activities, footwear, and exercise regime to determine other contributing factors. It is critical that this evaluation also includes a movement assessment, which should include looking at the range of motion and strength in your leg, measuring any swelling, watching you walk and squat, go up and down steps, and observing balance on one leg. It is important to note that imaging techniques, such as X-ray and MRI, are often not needed to diagnose Achilles tendinopathy.
HOW CAN PHYSICAL THERAPY HELP?
Your Physical Therapist will work with you to develop a treatment plan to help you achieve your individual goals. Treatment strategies should be utilized to address the following areas:
- Pain–This often includes the use of ice or bracing, and sometimes using ultrasound and/or electrical stimulation (in the very acute stage).
- Mobility/Range of Motion–Increased strain on the Achilles tendon may be a result of improper movement of your foot, ankle, or knee. Stretching exercises for the lower extremity will help to restore and normalize motion in the foot, ankle, and knee, thus reducing strain and tension.
- Strength–Muscle imbalances or weakness can cause excessive strain on the Achilles tendon. Strengthening exercises should be tailored specifically to your condition and desired goals. These exercises would typically start in a gravity minimized position such as sitting and progress to standing for increased weight bearing.
- Manual Therapy–Skilled hands-on treatment by your Physical Therapist is absolutely critical for your rapid recovery. These techniques may include joint mobilization, soft tissue massage, manual stretching, and neuromuscular re-education.
- Functional Training–Your Physical Therapist should work with you to transition you back to your stated goals. This could include return to sports, return to work, or just return to normal activities around the house that you have been unable to perform. You should be instructed in safe, controlled movements to minimize strain on the Achilles tendon, thus minimizing your risk for repeated injury.
- Patient Education–Your Physical Therapist should teach you how to identify and establish plans to address any potential external forces causing discomfort. This most likely will include education on improper footwear and/or inappropriate exercises.
CAN ACHILLES TENDINOPATHY BE PREVENTED?
The best methods for preventing Achilles tendon injuries are maintaining proper lower extremity mobility and muscle strength, and to also pay very close attention to your exercise routine, most notably changes in an exercise surface, wearing appropriate footwear for your exercise regimen or functional activity, and the volume of exercises performed.
Physical Therapy promotes recovery from Achilles tendon injuries by addressing issues such as pain or swelling of the affected area, as well as any lack of flexibility, strength, or body control. Keep in mind that returning to activities too soon after injury often leads to chronic, persistent pain, making the condition much more difficult to resolve. Also, when the condition remains untreated, pain will persist and will often lead to a complete tear of the Achilles tendon. If this occurs, surgery is most likely indicated for full recovery.
If you or someone you know is experiencing symptoms related to Achilles tendinopthy, don’t wait to take action. Call my office at once at (302)691-9055 or visit my website at www.wildermanpt.com to schedule your FREE 30 minute consultation to see how Physical Therapy can help. Don’t delay–schedule now!