Achilles tendinopathy is a frustrating condition that presents to our clinic on a weekly basis, typically the patient complains of pain localised in the tendon that hasn’t improved at all with months of rest. Many have sought previous treatment which has been prescribed as rest, however it is very important to note that TENDINOPATHY DOESN’T IMPROVE WITH REST! In order to become pain free and return to activity you must undergo a personalised exercise rehab plan.
What is Achilles Tendinopathy & why do we develop it?
Achilles tendinopathy is a non-inflammatory, degenerative disease of the main body of the Achilles tendon that is characterised by localised pain and swelling and accompanying functional decline. It commonly affects the active people, but also affects the sedentary population, with males aged 35-45 being most commonly affected. The exact pathology of Achilles tendinopathy remains unclear; however tendon changes relating to increased nerve growth, degeneration, poor tissue healing and neural inflammation are evident on examination. Possible Intrinsic factors including biomechanics and genetics have been hypothesised to be associated, as well as extrinsic factors such as poor equipment and overloading training regimes. Recent research has also shown that physical activity may serve as a provoking mechanism rather than a causative factor, as irregular tendon findings have been noted in non-active and pain free individual’s tendons.
So what treatment options are there?
Conservative non-invasive management has included the use of activity modification, night splinting, ankle-foot orthoses, physical therapy, shockwave therapy and eccentric loading exercise and has resulted in mixed outcomes. In particular, eccentric muscle loading has been used commonly and there is a growing body of research that has shown positive outcomes and that the physiological response of eccentric tendon loading promotes normality of tendon structures with a decrease in tendon thickness, reduced neovascularisation, increased tensile strength and symptom reduction. What is eccentric muscle loading you may be thinking? Well it’s quite simple and basically means that you lengthen the muscle under load, using what is called the Alfredson Protocol.
Despite this body of evidence showing the effectiveness of eccentric loading on tendon healing, there are still other popular invasive treatments such as blood injection therapy being utilised by patients; however this is not currently backed by research and you would be much better off following an eccentric rehab protocol designed by your physiotherapist until they have perfected and proven these invasive techniques to be more effective.
At Physio Fit Adelaide all of our physiotherapists are up to date with the latest in tendon research and management, so if being pain free, fit and active is important to you then contact us today to get started on the proven track to rehabilitation!