Treating the ACHILLES TENDon

Treating the Achilles Tendon

Many of us are probably somewhat familiar with the Achilles Tendon and would have heard the terms “Achilles Tendinopathy”, “Achilles Tendinitis” and maybe even “Achilles Tendinosis” but what do these terms really mean?

To simplify, Achilles Tendinopathy is an umbrella term used for both Achilles Tendinitis and Achilles Tendinosis. The suffix -itis is used when a structure is inflamed whereas -osis is used when a structure is degenerated - an inflamed acute Achilles Tendinitis or a chronic degenerative Achilles Tendinosis respectively (3).

It is important to understand the anatomy of the Achilles to understand why someone would develop an Achilles injury. The Achilles tendon is a confluence of the two calf muscles, gastrocnemius and the soleus which inserts into a bony tuberosity on the calcaneus (heel bone).

The main function of this structure is to transmit force generated by these two muscles acting as a buffer to absorb forces when performing activities (1). The Achilles tendon is mechanically strong, flexible and has good elasticity. A cross sectional area of 1sqcm can support a force between 500-1000kg. When a person runs, the loading on their tendon reaches up 12.5 times their body weight (e.g. 70kg x 12.5 = 875kg). The collagen content and the thickness of the tendon determines the tensile strength however, microscopic ruptures will occur if the stretch of the tendon exceeds 8% (2). When the tendon is overloaded repetitively beyond the threshold, it responds through local inflammation and localised pain, normally experienced over the main body of the tendon which is 2-6cm above the heel bone insertion (2)

Here at Habit Physiotherapy, we often see clients presenting with acute Achilles tendon pain after the long summer break due to overloading the tendon through a sudden increase in activity – for example, increased running load to make the most of those summer days! It is very important in the initial stages of acute Achilles Tendinitis to reduce the level of activity to allow active repair on the tendon. Otherwise, the constant overloading could potentially become chronic leading to a degenerative stage, Achilles Tendinosis.

For those clients visiting the Physio clinic suffering from ongoing chronic pain in the Achilles tendon, a slightly different approach is taken. Your physio may look at the intrinsic and extrinsic factors which are perpetuating this pain. These may include:

• Gastrocnemius-soleus dysfunction
• Gait pattern i.e. excessive movement of the heel when performing heel strike
• Type of footwear/orthotics used for exercise
• Training regime i.e is overtraining a factor?
• Poor motor control or movement patterns

Luckily, evidence shows that physiotherapy can be effective in rehabilitating a grumpy Achilles tendon. At Habit we are able to utilise gait scan and video technology to assess your movement patterns, and provide advice and treatment to get you back into any activity your Achilles is restricting you from. So, whether it is either an acute and chronic injury, we are here to help you get back on your feet.  

1. Maffulli, N., Sharma, P., & Luscombe, K. L. (2004). Achilles tendinopathy: Aetiology and management. Jrsm, 97(10), 472-476. doi:10.1258/jrsm.97.10.472
2. Rompe, J. D., Furia, J., & Maffulli, N. (2009). Eccentric Loading versus Eccentric Loading plus Shock-Wave Treatment for Midportion Achilles Tendinopathy. The American Journal of Sports Medicine, 37(3), 463-470. doi:10.1177/0363546508326983
3. Bass, L. E. (2012). Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice, 5(1). doi:10.3822/ijtmb.v5i1.153

Nikko Kim, Staff Physiotherapist