Achilles Tendonitis

Achilles Tendinitis, also known by the broader term Achilles Tendinopathy, is a repetitive stress injury that occurs at the Achilles tendon. The Achilles tendon is located at the back of the heel, where the calf muscles are attached to the heel bone. If you have Achilles Tendinopathy, you might have pain and stiffness at this area around the back of the heel and ankle, typically during or after exercise, and sometimes at rest.

Causes of Achilles Tendonitis

Achilles Tendinopathy is caused by an imbalance between the stress, or load, being placed on the tendon, and the tendon’s ability to handle that stress. Typically this involves a sudden increase in activity volume or intensity; for example, starting a walking program, or adding sprinting when you are used to jogging. Sometimes additional factors, such as changes in footwear, changes in gait, or stiffness in the ankle or foot, can also contribute.

Normally, our tendons respond to gradual increases in stress by adapting and getting stronger. However, if the amount of stress is too great or too sudden, the body is not able to recover and strengthen the tendon quickly enough; instead the tendon becomes weaker, and this is typically when an individual begins to experience pain. Many people feel this type of pain and believe they need to rest the area; however, complete avoidance of activities that stress the tendon can actually make the problem worse, because the tendon will continue to get weaker during a prolonged period of rest.

Once the individual returns to activity after prolonged rest, the tendon once again gets over-stressed, and the cycle starts again. For this reason, it is extremely important to address Achilles tendinopathy with a specific, graded exercise program to help the tendon gradually rebuild its strength.

Achilles tendonitis accounts for over 10% of all running injuries and is also common in jumping activities such as basketball. Beginning or increasing an activity or even simple walking can lead to the onset of this condition. It occurs when calf weakness or tightness or poor foot biomechanics make the tendon vulnerable to stress.

Imbalance of Stress or Load on Tendon
Sudden Increase in Volume or Intensity of Strain on Tendon
Changes in Footwear, Gait, or Ankle/Foot Stiffness
Other Medical Risk Factors

Symptoms of Achilles Tendonitis

If you are dealing with Achilles Tendinopathy, you might experience pain and stiffness at the back of your heel and ankle, tightness in your calf muscles, or decreased strength or endurance in your calf muscle. Often, these symptoms are felt during or after exercise; sometimes, pain is felt at the start of exercise, then temporarily improves as the area gets warmed up, but worsens again after exercise is over. Pain and swelling of the Achilles tendon where it attaches to the heel bone and slightly above indicates Achilles tendonitis. Symptoms get worse with weight-bearing activities and may develop suddenly or gradually. The symptoms can come on suddenly, for example, after a hard workout, or gradually. If the problem is very new or acute, you might have swelling or inflammation at the back of your ankle, but if it’s been going on for longer than a week or two, this is typically not a problem of inflammation, but of weakness and dysfunction in the tendon.

Pain or Stiffness at the Back of Heel and Ankle
Tightness in Calf Muscles
Decreased Strength and Endurance in Calf Muscles
Worsening Pain After Exercise
Swelling and Inflammation

Diagnosis of Achilles Tendonitis

Achilles Tendinopathy is typically diagnosed clinically, via a thorough history and hands-on tests that can be performed by your PT. Imaging such as x-rays or MRIs are not typically needed, unless the problem is chronic and not improving. Your physical therapist will also assess the strength and endurance of muscles in your calf and foot, the motion of your foot and ankle joints, muscle tightness, your gait, and other functional movements that could be contributing to your problem.

Treatment of Achilles Tendonitis with Physical Therapy

Hands-on myofascial release of the calf muscle and Achilles tendon help prevent scar formation. "Eccentric" exercises, which develop tension while the muscle is lengthened, help restore pain-free flexibility of the calf. Ultrasound, ice and electrical stimulation relieve soreness while the exercise promotes healing. Taping, orthotics and footwear changes may also be needed.

Your physical therapist will work with you to devise a program of specific exercises to help strengthen the tendon without over-stressing it. They may utilize hands-on, manual therapy strategies to help decrease the pain and reduce irritation of the tendon, including mobilization of the calf muscles and foot/ankle joints, dry needling for the calf muscles, and taping techniques.

Your physical therapist can also help you to address any underlying contributors such as gait or movement patterns that could be putting extra stress on your Achilles tendon. It can take several months of strengthening to regain full strength in the tendon; however, pain relief is typically felt much sooner than that, and it is usually advisable to gradually return to your desired activity as soon as it is tolerable.

Prevention Tips for Achilles Tendonitis

The best way to prevent Achilles tendon problems from recurring is through a regular strengthening program, and by making sure any changes to your exercise routine are gradual. Your Results Physiotherapy physical therapist can help you to make a long-term plan for returning to or increasing the activities that you enjoy.