Pain from Achilles tendinopathy comes on slowly over a period of weeks and months. It often begins as a mild discomfort after a run or field training session.
As it worsens, the pain increases in intensity and takes longer to resolve after a training session.
As it becomes more chronic, the symptoms associated with Achilles tendinopathy are more noticeable after prolonged rest and first thing in the morning.
During gentle movement (like walking) or light training, it often feels like it “loosens up” after 5-10min.
However, undertaking more vigorous movements (like jumping or sprinting) without giving it a chance to loosen up, can often lead to worsening symptoms during training.
A commonly reported feature of Achilles Tendon issues is a thickening of the tendon. But this injury doesn’t always present with noticeable thickening so, while thickening can confirm the diagnosis, the absence of thickening didn’t rule it out.
There are some situations when the pain is suddenly noticeable, such as after a vigorous football game, however the condition was likely building up for weeks beforehand.
A rapidly increasing load or sudden bout of jumping or sprinting can cause a mild, asymptomatic tendinopathy to become painful within a few minutes.
TIPS TO AVOID THE COMMON PITFALLS OF REHAB PROGRAMS
Achilles rehab programs are available everywhere on the web. Some have good exercises for Achilles tendinopathies but results from the programs are often poor. Why?
Too often the positive aspects of the program are offset by the negative factors influencing the condition.
- The tendon needs consistent manageable loads to improve, so taking frequent rest days will inhibit recovery
- Doing daily exercise involving Achilles loading, such as running or fast/hilly walking, is vital for recovery
- Running small distances every day is better than running longer distances infrequently
- If pain isn’t responding after 1-2 weeks, continue to slightly reduce the load rather than taking rest days or weeks off
- Avoid calf stretching as it only aggravates the injury
- This includes heel drop exercises over a step
- A sustained heel raise & hold is more effective for symptom relief than classic heel raises, such as the “Alfredson” program
MYTHS, RUMOURS AND OUTRIGHT LIES
Achilles tendon pain is a common issue. So it’s not surprising that there’s an overload of info on the web. And much of it is outdated, incorrectly interpreted or just plain BS. Here are the most popular myths:
- Achilles tendinopathies don’t lead to Achilles rupture!
- Achilles ruptures occur with a sudden overload, requiring a huge amount of force. As a healthy Achilles tendon has a breaking strain of around 3000kg (~6600lbs), even a slight weakening of the tendon isn’t a problem
- In Achilles tendon ruptures, there are no symptoms prior to the rupture in around two third of cases
- Anti inflammatory meds don’t solve the problem as there’s no inflammatory component to this injury
- They may help manage symptoms but this makes it even more difficult to manage. Without symptoms as a guide, you’re flying blind for load management and rehab program
- Daily exercise is ineffective IF the cause of the injury hasn’t been addressed or if the diagnosis isn’t correct
- Note: posterior ankle impingement and retrocalcaneal bursitis both feel like an Achilles tendinopathy but they get worse with heel raises
- Calf strength is not a factor as either a cause or as part of the rehab for this injury
- More common causes include stiff ankles or a sudden increase in Achilles loading (eg. the addition of hill sprints to a program)
WHAT ELSE COULD IT BE?
- Retrocalcaneal bursitis
- Posterior ankle impingement
- Achilles tendon tear – this injury occurs with a sudden forceful stretch
- Severs Disease (growing pains) – typically occurring between 11-14 years of age and on both heels
- Low calf muscle strain
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