What Causes Achilles Tendonitis?
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.
Achilles tendonitis especially common for joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.
A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.
Common Causes of Achilles Tendonitis include:
- Over-training or unaccustomed use – “too much too soon”
- Sudden change in training surface – e.g. grass to bitumen
- Flat (over-pronated) feet
- High foot arch with tight Achilles tendon
- Tight hamstring (back of thigh) and calf muscles
- Toe walking (or constantly wearing high heels)
- Poorly supportive footwear
- Hill running.
- Poor eccentric strength
What are the Symptoms of Achilles Tendonitis?
Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise.
- Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area.
- The pain may get worse when you use your Achilles tendon.
- You may have more pain and stiffness during the night or when you get up in the morning.
- The area may be tender, red, warm, or swollen if there is inflammation.
- You may notice a crunchy sound or feeling when you use the tendon.
How is Achilles Tendonitis Diagnosed?
Your physiotherapist or sports doctor can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests. Achilles tendons will often have a painful and prominent lump within the tendon.
How do I fix Achilles Tendonitis?
Well the bad new is it won’t get better with just rest. It will feel a little bit better with rest but once you start doing the aggravating exercise or activity again it will become painful again. Continuing to do aggravating activities may advance the process and may significantly prolong the recovery time. The goals of treatment are to identify any predisposing factors, reduce pain and inflammation and promote healing to restore the muscle and tendon.
Early treatment may include:
- Activity modification, to prevent further irritation.
- A targeted stretching and strengthening program.
- Massage and soft tissue therapy.
- Bracing or taping may be used to unload the muscle and tendon.
- Acupuncture and dry needling.
- Addressing secondary problems, such as ankle stiffness, poor running technique etc.
Other things that may be used if the condition doesn’t settle are:
- Shockwave Therapy
- Corticosteroid injection.
- Nitric Oxide therapy.
- Blood injection.
When can you return to sport or activity?
It is important that you return to sport or aggravating activities slowly. Depending on the severity of the initial condition and the length of rehabilitation, a graduated return may take 3 weeks or 3 months, your physiotherapist will guide you through this.
What is the prognosis?
Achilles tendinopathy, if treated and managed properly will not have any long term effects. If not, it can lead to prolonged pain and dysfunction , a prolonged period away from sport/work/aggravating activities and may cause degeneration of the tendons, causing lingering pain. The rehabilitation can be frustratingly slow but persevere, it will get better.