Have you been diagnosed with Achilles Tendonitis? Have you been told that the cause of your injury is a tight calf and you should stretch it to get help with the pain? If you answered yes to any of these questions then this blog post is for you.
I wrote this post in order to educate you on the modern approach to treating reactive achilles tendinopathy. We now know that overloading the tendon by doing something too fast, too much or too soon causes a series of reactions to occur at the tissue level. These reactions are not necessarily a product of inflammation and therefore rest, anti-inflammatory medication and applying ice isn't an appropriate treatment. Current research tells us that the most effective way of treating achilles tendinopathy is a good evaluation to determine the stage of tendon injury followed by initiating combined loading program as well as functional/sports-specific training.
What is a Tendon?
A Tendon is a fibro-elastic tissue in between a muscle and a bone. The tendons’ main role is to transmit forces from the muscle to the bone and absorbs external forces to prevent injury to the muscle.
Stages of Tendon Injury (Tendinopathy):
Reactive tendinopathy is a non-inflammatory proliferative response in the tendon cell and matrix which occurs after acute overload from tensile or compressive forces
Tendon Dysrepair is the progression of the reactive tendinopathy and can occur if the tendon is not offloaded and allowed to regress back to the normal state. This is now visible on MRI and ultrasound scans. This phase of tendinopathy can be developed by frequently overloading the tendon in phase 1 of the continuum.
Degenerative Tendon.This is the final stage on the continuum and is suggested that at this stage there is a poor prognosis for the tendon and changes may now be irreversible.
How We Treat Achilles Tendinopathy:
Initially, a thorough evaluation of the injury to determine the stage of tendon injury is imperative. Consideration of other risk factors such as age, co-morbidities (diabetes), and location of injury plays a role in the initial treatment plan.
A loading program can be initiated once the severity of the injury is assessed. Loading type and intensity is tailored specifically for the individual patient. (Pictured right is an example of a treatment program for tendinopathy from Tom Goom PT)
Treating the entire kinetic chain and working on functional/sports specific training is important in order to return to sports or more high level activities.
Some Great References
As Always, if you or someone you know is dealing with pain at their achilles tendon please contact me by phone/text (201)468-0282 or by email YKatsnelson@precisionptnj.com
Eugene Katsnelson PT, DPT