Achilles Tendonitis/Tendinopathy

The Achilles is the largest and most robust tendon in the body. Despite this, it has become the bane of existence for many a runner and hiker. The key to treating an achilles injury is a rehabilitative approach with graded loading over time.

Locations of Achilles Tendon Pathology

 

Mid Substance

Mid substance achilles tendonopathy is when the middle of the tendon is affected. This can lead to a painful enlargement at the middle of the tendon. Some joint crepitus (sounds) may accompany these changes

Insertional

Insertional tendinopathy occurs where the tendon attaches to the heel. This has to be managed differently from mid portion presentation because the heel can create a compressive force on the tendon; leading to further pain.

Muscle-tendon junction.

Where the muscle meets the tendon is especially prone to injury because this is where we have a shift from tendon to muscle tissue. This junction between contractile tissue and connective tissue places it at risk for pathology.

 
Tendon Treatment

Treatments to avoid with tendon injury.

When it comes to tendon injury, there is a right way and a wrong way to get back to your full activities and function. Click below to see some of the treatments to avoid when you are experiencing tendon pain.

The Stages of Tendon Pathology

There are a few different kinds of achilles tendinopathic presentations based on their location. But most of them still follow these stages of pathology. This staged model from Cook et al (2009) explains how tendon pathology and changes occur. However, it is important to note that once tendon changes occur, they are typically set after we reach skeletal maturity. But we can still return to full function and performance without changing tendon structure.

 

Reactive Stage

In this stage of tendon pathology we have overloaded the tendon and it is now swollen and somewhat inflamed. This stage can last a few days and it is important to modify or decrease loads placed on the tendon.

Disrepair stage

The disrepair stage of tendon pathology is characterized by the body sending in cells to try and heal damaged tissue. These cells can come through in a bit of a disorganized manner, leading to changes in the tendon structure.


Degenerative stage

When excessive loads are chronically applied to a tendon, it can begin to degenerate. This leads to disorganization of the connective tissues, and decreases in the robust capacity of the tendon.

Optimal treatments for Achilles Tendinopathy

Tendons can take a significant amount of time to heal, especially when non-evidence based approaches are used. Consistency with a guided rehabilitation program is the best way to get back to full activity as soon as possible.