Argh! Where in the HEEL is my pain from?!

1st Feb, 2021

Is your Achilles tendon your Achilles’ heel (no pun intended)?😏

The Achilles tendon (AT) is the thickest and strongest tendon in the human body, and it is exposed to high forces during daily activities and in sports. Its origin lies close to the middle of the calf, and fuses with the gastrocnemius (i.e. calf) muscle proximally.

💡 Did you know…that the AT may be subjected to loads of up to 12.5 times your body weight during running??

The high magnitude of loads and stresses placed on the AT during loading activities thus makes it one of the most common tendons to sustain overuse injuries, or even rupture!

An AT injury is seen frequently in both active athletes and inactive individuals. In athletes, this may be caused by a high external load; whereas in inactive individuals, a low baseline capacity might cause relative overload.

Achilles tendinopathy can result in a reduced quality of life and is notorious for its long-lasting symptoms.

What the HEEL is wrong with me?🤷

Typically, people with Achilles tendinopathy suffer from pain or stiffness in the achilles 2-7cm above the heel. It is commonly experienced in the morning or after prolonged sitting, and is worse with or after activities, although it may persist during rest. Less commonly, some may describe similar symptoms with point tenderness over the insertion of the Achilles on the calcaneus (i.e. heel).

Oh wait, I can experience pain in different areas of my Achilles tendon?? How am I supposed to differentiate them?!

Yes, Achilles Tendinopathy (previously known as Achilles tendinitis) is seen most commonly in the mid‐portion of the tendon, but also occurs at the bone-tendon junction.

Diagnostic criterias for Achilles tendinopathy

Note: This should only be used as a guide and we strongly urge that you seek proper assessment and advice from a trained Physiotherapist if possible.

🦵 Mid-portion tendinopathy:
Symptoms are localised to 2–7 cm above the AT insertion on the heel.
Pain at the midportion of the AT on loading (i.e. during sports).
Local thickening of the midportion of the AT (may be absent in cases where symptoms are short-lived).
Pain at the midportion of the AT on touch.

🦵 Insertional tendinopathy (i.e. at the bone–tendon junction):
Symptoms are localised (within 2 cm) to the region where the AT inserts onto the heel (i.e. insertional region).
Pain at the insertional region of the AT on loading (i.e. during sports).
Local thickening of the AT insertion (may be absent in cases where symptoms are short-lived).
Pain at the insertional region of the AT on touch.

Hmm…will I need a scan to double/ triple confirm?

No additional imaging studies are needed if the presenting case fits all four diagnostic criteria listed above. Achilles tendinopathy can typically be diagnosed based on a clinical criteria.

🔍Additional imaging studies may be needed if:
Your symptoms do not fit with all four of the above diagnostic criterias.
There is an unexpected course or change in symptoms during follow-up.
You are considering surgery.

Should I cease all activities and wait? 🤭

I know what you are thinking…but the short answer is NO🙅🏻‍♀️

It was found that no or limited improvements are expected in the short term as a result of a wait-and-see approach for those with long-standing Achilles tendinopathy.

How can Physiotherapy help with my Achilles pain?

According to a recent consensus statement, conservative treatment is usually the first choice for AT and active treatment is highly recommended! Hence, it is paramount for you to be assessed and treated by a trained Physiotherapist.

Inevitably, injured tendons lose their capacity to withstand forces. With the help of Physiotherapists at PhysioX, we are able to assess, differentiate and diagnose your Achilles pain. We will then be able to devise a treatment plan for the rehabilitation of your tendon so it can withstand high repetitive loads again!

Your Physiotherapist will also help to explain your condition and give you advice on lifestyle load management, especially for pain provoking activities. You will also receive a customized rehabilitation program that is tailored for your individual needs.

Will I ever recover?? How long will it take? 😞

Truth be told, although the majority of patients recover, there is a chance that your symptoms may persist (up to 10 years) in the long term despite treatment. Till date, there is insufficient knowledge about the exact prognosis.

👍🏻As a rule of thumb, a return to full symptom-free loading (during sports) is only possible after a few months (minimum) of active treatment.

Once your symptoms and condition improves, it is important to prevent recurrence. Notably, there is strong evidence that a history of tendinopathy in your lower limb is a risk factor for developing Achilles tendinopathy, with the likelihood of recurrent symptoms.

☝🏻Take note! For those who are becoming more active or looking to increase their training load, a gradual training program is important. This incremental loading process includes the type, frequency, size and intensity of training.

Continual exercise therapy for the calf muscles should be considered after symptomatic recovery from Achilles tendinopathy. For insertional Achilles tendinopathy, consider performing exercises on a flat surface initially.

The following is a flow chart depicting the proposed recommendations for a 12-week progressive calf muscle strengthening and explosive-type (i.e. plyometric) exercise program:

☝🏻You should only consider surgery if you do not recover after at least six months of active treatment.

Now that you know about your Achilles Heel (sorry I meant Achilles tendon pain), here are some exercises you can do for your rehab!

Heel raises with big toe over towel

Heel raise & progression

Single leg hurdle hops

Book now or give us a call to schedule an appointment to see our Physiotherapist who will be able to partner you to recovery as we address your achilles tendon pain!

DISCLAIMER: These advice and exercises should not replace the need for a consultation with a Physiotherapist especially if your condition doesn’t improve. Therapeutic exercise should be carefully selected to suit your condition.

Ref:

Bjsm, B. J. of S. M. (2020, August 10). Which treatment is most effective for Achilles tendinopathy? A new way of finding out! BJSM blog – social media’s leading SEM voice. https://blogs.bmj.com/bjsm/2020/08/10/which-treatment-is-most-effective-for-achilles-tendinopathy-a-new-way-of-finding-out/.
Asplund, C. A., & Best, T. M. (2013). Achilles tendon disorders. Bmj, 346.

de Vos, R. J., van der Vlist, A. C., Zwerver, J., Meuffels, D. E., Smithuis, F., van Ingen, R., … & Weir, A. (2021). Dutch multidisciplinary guideline on Achilles tendinopathy. British journal of sports medicine.

Malliaras, P., Palomino, J. R., & Barton, C. J. (2018). Infographic. Achilles and patellar tendinopathy rehabilitation: strive to implement loading principles not recipes. British journal of sports medicine, 52(19), 1232-1233.

Van Der Vlist, A. C., Winters, M., Weir, A., Ardern, C. L., Welton, N. J., Caldwell, D. M., … & De Vos, R. J. (2021). Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. British journal of sports medicine, 55(5), 249-256.

Filed under: Ankle

Share Post:

Categories

[blog_categories]

Latest Posts

Cross Bracing Protocol

Cross Bracing Protocol

Key Points Novel bracing protocol shows promise in ACL healing: The Cross Bracing Protocol (CBP) resulted in ACL healing in 90% of participants within three months. Patient-reported outcomes improve with more ACL healing: Better knee function, quality of life, and...

Physiotherapy after breast cancer

Physiotherapy after breast cancer

Key Points Current medical management: Breast cancer treatment often involves surgery, radiation therapy, chemotherapy, endocrine therapy, and targeted therapy. Common side effects: Treatments can lead to pain, upper limb dysfunction, and cancer-related fatigue (CRF)....

Prevent running injuries

Prevent running injuries

Key Points Previous Injuries: The most significant risk factor for running injuries is having a previous injury in the past 12 months. Training Errors: High weekly mileage and running frequency increase the likelihood of running related injuries. Biomechanical...

MRI scan for low back pain?

MRI scan for low back pain?

Key Message: Mindful imaging for low back pain: unnecessary medical imaging for low back pain can escalate healthcare costs and radiation exposure. Adhering to clinical guidelines ensures that imaging is employed purposefully. Guidelines as compass: clinical...

Improving outcomes for chronic low back pain

Improving outcomes for chronic low back pain

Key Points: The understanding of chronic low back pain (CLBP) is rapidly evolving thanks to advances in research and technology. Despite the progress, long-term self-management programs for CLBP have not shown consistent effectiveness. A patient-centred, long-term...

Low back pain

Low back pain

Key Messages: Low back pain is a widespread issue, affecting people of all ages and socioeconomic backgrounds. In most cases, it is challenging to identify a specific cause for low back pain, leading to the term "non-specific low back pain." Disabling low back pain is...

Healing of ACL with Cross Bracing Protocol on MRI

Healing of ACL with Cross Bracing Protocol on MRI

Key Points Effective Healing: The Cross Bracing Protocol (CBP) demonstrated a high success rate in ACL healing as visualised on MRI. Improved Outcomes: Patients managed with CBP reported better knee function, quality of life, and higher return-to-sport rates compared...

Exercise for osteoporosis

Exercise for osteoporosis

Key Points Understanding Osteoporosis: Osteoporosis is a condition that weakens bones, making them fragile and more likely to break. Effective Exercise: Regular resistance and impact exercises can help improve bone strength and reduce the risk of falls. Individualised...

Is running safe for my knees?

Is running safe for my knees?

Key Points Health Benefits of Running: Running improves cardiovascular health, strengthens muscles, and enhances mental well-being. Impact on Knees: Moderate running does not increase knee damage and may improve some knee conditions. Clinical Implications: Running,...

Surgery for degenerative meniscus injuries?

Surgery for degenerative meniscus injuries?

Understanding the meniscus and managing degenerative tears Key Points Meniscus Function: The meniscus acts as a shock absorber and stabiliser in the knee. Treatment Options: Exercise therapy is often recommended over surgery for degenerative meniscus tears. Clinical...

Verified by MonsterInsights