Jane Breen-Turner, with over 18 years as a Physiotherapist, shares her clinical expertise with us on treatment for Achilles Tendonitis…………..
We are often given the diagnosis “Achilles Tendonitis” which suggests the tendon is inflamed. This has never been found to be the case – so what is meant by this term and what effects does this have on treatment & management?
The Achilles is a tough band of fibrous tissue formed by both the deep calf muscle, Soleus, and the more superficial calf muscle, Gastrocnemius. Small sacs of ‘bursa’ cushion it against the heel. It is a contractile tissue that attaches these two muscles to the heel bone, the ‘Calcaneus’. It’s the largest and strongest tendon in the body but seems more vulnerable to injury than expected. Its function is to act as a lever around the ankle joint allowing you to stand up onto your toes while walking, running or jumping. One possible reason for its vulnerability are the high tensions and loading we place through it. Coupled with the fact it doesn’t have as good a blood supply as muscle, therefore can take time to heel. Most important is getting the diagnosis correct so that the most effective treatment and management can follow.
The Achilles is made up of the tendon body itself and the peritendinous sheath surrounding it. Research has proven on numerous occasions from tendon biopsies that never has an inflammatory cell been found within. Inflammation occurs in the surrounding sheath. The tendon body itself, however has shown to be degenerative as a result of the continuous loading we put it through. This is termed as ‘Tendinosis’, where a gradual thickening of the Achilles’ tendon develops due to ageing or overuse. Despite its thickening however, the tendon is weakened as a result and therefore more prone to further injury or even rupture. A tendon can also tear as a result of small micro tears or larger tears either from a sudden movement or gradually loading over time.
Causes of Achilles problems vary. It can be as a result of overuse or a change in running training like suddenly doing hill reps or increasing volume or speed. It can be due to tight calf muscles, inappropriate footwear, altered or poor biomechanics. Biomechanics is how we move including muscle imbalances around the hip & pelvis. Failing to rehabilitate properly from calf or Achilles ‘niggles’ can also aggravate. Correct diagnosis is essential as the treatment and rehabilitation will vary. It is dependent on whether it is inflammatory (Tendinopathy) or degenerative (Tendinosis). It may even be a combination of both.
At 5 Valleys Physio we have the skills to determine which of these is correct. Treatment for Achilles Tendonitis may include any of the following:
- soft tissue massage
- specific soft tissue mobilisations
- biomechanical correction
- myofascial release
- muscle imbalance correction
- lumbar spine mobility check
- advice on training
- rehab exercises
- running clinic
The running clinic assesses & analyses your running technique. It provides a bespoke corrective rehab exercise program to enhance performance.
Call the clinic to book yourself in with Jane Breen-Turner on 01453 755948.