Overview

Achilles tendinopathy is a condition that can cause pain in the mid-portion of the achilles tendon or near the attachment to heel (insertional tendinopathy). Injury usually occurs as a result of repetitive stress on the tendon causing micro-trauma, combined with a failed healing response results in achilles tendinopathy.

Symptoms

- Pain in the back of the leg above the heel associated with physical activity like running or jumping

- Thickening of the Achilles tendon

- Tenderness on palpation

- Morning stiffness may occur and can ease with gentle movement

Risk Factors

- Tightness or weakness in calf muscle strength

- Activity or sports involving repetitive or high impact loading on the tendon e.g. squash, running, sprinting

- Poor biomechanics causing uneven loading on the tendon

Physiotherapy Treatment

Initial phase of physiotherapy treatment is to control the pain and reduce further damage to the tendon. This can be achieved by activity modification, reduce the load on the achilles tendon and gentle stretching.

Heavy eccentric loading has shown to be effective in treating tendinopathy, particularly mid-portion Achilles tendon injury. The movement of eccentric loading is to apply weight on the tendon when it is lengthening as shown in the Video.

Another treatment modality which has shown to help with Achilles tendinopathy is shockwave therapy

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References:

Sussmilch-Leitch et al. (2012).  Physical therapies for Achilles tendinopathy: systematic review and meta-analysis

Vlist et al. (2018). Clinical risk factors for Achilles tendinopathy: a systematic review