Achilles Tendon Clinic

Achilles Tendon Pain

 

At our tendon clinic we see lots of Achilles Tendinopathies and Achilles Heel pain.  We use our expertise in diagnosis using over 20 years of experience and ultrasound scanning to understand your problem and how best to fix it.  Our unique clinic combines all of our knowledge to understand how your pain started and what we can do to stop your pain coming back. 

There are two types of Achilles tendon pain: Mid portion Tendinopathy and Insertional Tendinopathy.

The mid portion one is the most commonly injured part of the tendon.  People often present with pain after they have been running and start to develop pain in the region or they may feel a sudden onset of pain in the tendon.  They typically find the tendon becomes stiff when first walking in the morning and they may have pain when running or after running.  On occasions, there is severe pain and you are not able to run.  Typical patients at Core Body Clinic are runners who have been training very hard or are attempting to compete.  Our desire gets the better and we run through pain.  Tendons become injured when they are overloaded.  We keep running beyond the capacity of the tendon and therefore we get tendon reaction and eventually the signs of degeneration.  Simply, the tendon can no longer cope and starts to thicken up with inflammatory tissue, scar and excess debris.

TENDON OVERLOAD

Tendons are composed of tenocytes and are therefore structurally different from other tissues in the body.  Initially, there is some inflammation but it appears this is not the main driving force behind the condition.  Because of pain, the calf muscle (in the case of the Achilles) is not able to deliver as much force or contraction. The tendon is loaded to a lesser extent and over time becomes ‘deconditioned’.  The tenocyte matrix is less organised and is again less tolerant to loading. There may be the presence of different cells like proteoglycans which are big sponges and can give the tendon its inflamed appearance.  There is also a suggestion of scar tissue build as the tendon tries to heal itself.

"I wasnt even training hard!"

In any case these tendons are not functioning and your capacity to run and eventually walk pain free becomes limited.  You are able to run a little and then not at all.  It gets better for a few days and then it worse again. Very frustrating.  The key to success is in the understanding of how the pathology and biology of your tendon has changed.  Only then will you become aware of the parameters of training to enable you to appropriately rehabilitate the tendon without over loading it. 

Sometimes, you may not even be aware of over loading the tendon.  You may have enjoyed a problem free year without pain, normal training and excellent times.  You may have been running on the sunny promenade on a day like any other, and then develop a sharp pain.  The key here is that your training may have become attritional and plateaued.  Your tendon starts to go backwards and is no longer functionally capable of loading without injury. This is the danger zone and makes you vulnerable to injury. or stiffness in the tendon.

"Im not very fit" or "Im new to running"

If you are severly out of condition, perhaps you have suffered a long illness or you have taken steroids for a long period of time.  Such persons are more susceptible to Achilles Tendon Pain. 

Snapped tendons or ruptured tendons tend to occur without warning.  It is not common to have a history of tendon pain and then rupture your tendon.  

 

Symptoms:

  1. Pain in the middle of the tendon 
  2. Pain on running
  3. Pain may get better or worse with activity
  4. Pain in the morning for the first 5 or 100 steps
  5. Pain on descending the stairs.
  6. Pain on hopping

 

What you will not have:

With Achilles diagnosis you will not experience burning pain and Pins and needles

You also will not suffer pain shooting up the leg and into the back

 

Assessment:

At Core Body Clinic we have a dedicated Tendon clinic for assessing the Achilles tendon.  We use a combination of history (what happened), examination and also Ultrasound Scanning.  The scan helps us to understand to what extent the tendon is damaged and this provides you with a prognosis.  We will use a battery of tests to diagnose your problem with checks of your balance, knee alignment during function, foot posture and strength.  

 

 

Tendon Scanning 

 

 

 

 

We will also check your hamstring strength and length, hip flexor length and also the ranges of movement in your spine.

We will look at calf strength and ankle flexibility and probably give the tendon a poke and prod.  While this helps to show us where the issue is it does not tell us

 

Treatment:

We know that activity is good for tendons. They love it! But in the early stages gentle massage, rest, ultrasound (big placebo but can be therapeutic), taping, R.I.C.E and Anti-inflammatories (NSAIDS) can all help.  But none of these will sort your tendon out.

Once we have confirmed diagnosis we will set about prescribing a bespoke plan of action to get you back to your normal functional level.

Isometric exercises are thought to be helpful by contracting the calf muscle, like a heel raise and holding the position for 30-60 seconds.  

Graduated exercises are the main stay once pain begins to settle. These are carefully constructed and prescribed in consistency with your pain. Over doing the exercises too quickly will land you back to square one. They need to be gradual and increase in load so that getting you back to climbing the stairs or Everest is a smooth pathway of recovery

Massage and Ultrasound can be helpful to manage pain to allow you to exercixse and load the tendon.

For more difficult tendon pains we can use Shockwave therapy and in very small numbers PRP injections are helpful. 

 

We may also use taping if you are struggling with pain and orthotics if we feel your footwear is a factor in your Achilles Tendon pain. 

Return to Running

At Core Body Clinic the focus of our Sports Physiotherapists is to work with you to get you back running.  We will NEVER say don’t run unless we truly belive it will do you harm.  If you are a keen runner then we will aim to get you running again at the earliest possible convenience.

We can manage your pain and symptoms with effective strategies like appropriate footwear, taping, load management (how much running and how much exercise you should do) and direct therapies (Massage, ultrasound).

Graduated running is KEY.  Start small.  Walk for 5 minutes, run for 5 minutes, walk, run, walk, run – get the picture? The tendon essentially stores kinetic energy and if in a state of reaction it will become more tender and painful over the time of the run.  Key is to stop before it becomes too sensitised.

Avoid hills to begin with (Hard to do in Reading and Tilehurst!) and have no expectations.  You may need a week or two off.  Aqua jogging is a great alternative early on and changing activity to cycling can be a great way to keep your cardio fitness up.

 
 
Last modified onTuesday, 09 February 2021 17:55
Adrian Wagstaff

Adrian is the Lead clinican at Core Body Clinic.  He is a well known and experienced physiotherapist who qualified in 2001 from the University of Huddersfield with a BSc (Hons) in Physiotherapy.

Website: www.corebodyclinic.co.uk

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