Ah the achilles tendon. That big rope-like structure connected to your calf muscle and heel. So useful when things are going well… and oh so crippling when you did just that little bit too much hill running or those 1000 box jumps you did last week. If you have ever felt this pain before and it stopped you from your usual exercise – chances are you had some form of Achilles Tendinopathy.
Achilles Tendinopathy is a common overuse injury of the Achilles tendon and a condition we treat A LOT in the clinic.
What is Tendinopathy?
The widely accepted Cook and Purdum model explains Tendinopathy in 3 stages:
1. Reactive tendinopathy: When compressive or tensile overloading takes place, the tendon thickens and stiffens in attempt to reduce the stress on the tendon.
2. Tendon disrepair: If the tendon is not offloaded and allowed to repair back to stage 1, the tendon cell matrix will start to separate and breakdown physiologically.
3. Degenerative tendinopathy: If the tendon is further overloaded, permanent damage of the cellular makeup will occur.
Tendon change occurs along this continuum and may go back and forth between these 3 stages.
How does overloading occur?
Overloading commonly occurs in the form of:
· Excessive loading through high impact activity such as running or jumping. The Achilles tendon may take loads of up to 2x your body weight when running.
· An increase in training load of high-impact activity or resistance training.
· A return to training after weight gain.
How can improve you improve your Achilles pain?
The key to moving back through the stages of tendon damage needs to follow 2 simple yet crucial steps.
1. UNLOAD – Give the tendon the rest it requires to move back down the stages of damage. This may not be complete rest, but instead a “relative” reduction in your activity e.g. reduce kilometres running by 20%
2. LOAD the tendon to prevent further disrepair. This step requires a careful gradual and progressive loading program which is tailored to the individual’s needs. Rehabilitation with a safe loading can begin straight away and reduces recovery time versus complete rest.