Physiotherapy and Achilles Tendinopathy (Tendonitis)
The Achilles tendon anchors the soleus and gastrocnemius muscles to the calcaneus at the back of our heel. It is a common source of pain, often due to overuse in running or jumping sports like football and basketball, among many others. Research has deemed the term tendinopathy to be more appropriate in these cases than tendonitis due to the lack if inflammatory cells present, and the more likely presence of microtears within the tendon.
- Pain at the back of the heel (insertional) or a few centimetres above it (mid-portion);
- Tenderness to palpation of the tendon (or insertion) as well as possible heat and swelling;
- Stretching or contracting the calf muscles is often painful;
- Difficulty walking or trying to stand on your toes;
- The patient may report the area feeling “tight” or “weak”.
Severity of the condition
Achilles tendinopathy can be graded 1 to 4 according to Sports Medicine Australia, depending on its severity…
Grade 1 – (mild) – Pain after running only;
Grade 2 – (moderate) – Pain before and after running, pain gradually lessens during the run;
Grade 3 – (severe) – Pain with activity, causing a decrease in the volume of activity;
Grade 4 – (extreme) – Pain worsening or progressing, even with simple everyday activities.
Physiotherapy treatment and Rehabilitation
Following the vital acute management of RICE as for any soft tissue injury, physiotherapy treatment will depend on the grading of the tendinopathy. Patient compliance is crucial in these cases, as management may take quite some time. Treatment methods may include…
- Local ultrasound and electrotherapy in the early stages to reduce swelling and stimulate healing of damaged tissue;
- Hands on therapy such as massage, myofascial release and dry needling of the calf muscles to reduce tightness;
- Strapping of the heel/foot to offload the tendon, or Kinesiotaping of the calf and Achilles itself;
- Stretching and Strengthening of the calf (once pain subsides) as well as the rest of the lower limb to restore full pain free range of motion and strength to prevent re-injury;
- Core stability training and correction of any predisposing biomechanical issues are highly recommended;
- If the client is returning to sport, then a specific speed, agility and power program is implemented to ensure the best possible recovery and successful return to their pre-injury state.
I hope this summary will help you or someone you know. As always, we are here at PhysioWorks WA to help out with any musculoskeletal disorders you may have, tendons or otherwise! Feel free to call us, email, or drop in for a great service.