However, most runners and athletes who need to run or jump will know that Achilles heel is better known as Achilles Tendinitis and it is both painful and effects your sporting performance.
Achilles Tendinitis is a term that commonly refers to an inflammation of the Achilles tendon. It is an overuse injury that is common in sports that require running or jumping. Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendonitis, tendinitis or tendinosis out of habit.
Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.
Your physiotherapist can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests.
Achilles tendons will often have a painful and prominent lump within the tendon.
Further investigations include US scan or MRI. X-rays are of no use in the diagnosis.
What are the Aims of Achilles Tendonitis Treatment?
Achilles tendonitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if your rehabilitation program is not completed.
Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. Your achilles tendon attaches your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which does have a different level of blood supply and function, which does alter the rehabilitation from a calf tear.
Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.
Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase
As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.
In the early phase you may be unable to walk without a limp, so your Achilles tendon needs some active rest from weight-bearing loads. You may need to be partial-weight-bearing, and use crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on the Achilles tendon. Your physiotherapist will advise you on what they feel is best for you.
Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Anti-inflammatory medication (if tolerated) may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.
As you improve a kinesio (stetchy) style supportive taping will help to support the injured soft tissue.
Phase 2: Regain Full Range of Motion
If you protect your injured Achilles tendon appropriately the torn tendon fibre will successfully reattach. Mature scar formation takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future.
It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and eccentric exercises. Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform Achilles tendon stretches with a similar end of range stretch feeling.
Phase 3: Restore Eccentric Muscle Strength
Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most Achilles injuries occur during the controlled lengthening (eccentric) phase. Your physiotherapist will guide you on an eccentric calf strengthening program when your injury healing allows.
Phase 4: Restore Concentric Muscle Strength
Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings. Your physiotherapist will guide you.
Phase 5: Normalise Foot Biomechanics
Achilles tendon injuries can occur from poor foot biomechanics eg flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert) Your physiotherapist will happily discuss the pros and cons with you.
Phase 6: Restore High Speed, Power, Proprioception & Agility
Most Achilles tendon injuries occur during high speed activities, which place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.
Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.
Phase 7: Return to Sport
Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.
Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.
What Results Should You Expect?
There is no specific time frame for when to progress from each stage to the next. Your Achilles tendonitis rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.
You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.
It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.
The severity of your tendon injury, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.
Can Your Achilles Tendon Rupture?
The worst case scenario is a total rupture of your Achilles tendon. Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate.
The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.
Contact our clinic directly