Achilles Tendinopathy

Should I run with a sore Achilles?

We know that pain due to tendinopathy does not often respond well to complete cessation of activity. Tendon tissues require the maintenance of some training load to stimulate tissue healing (collagen synthesis). In many instances, symptoms do not improve or worsen with rest. Furthermore, athletes often re-aggravate their tendon or sustain a secondary injury due to deconditioning. It’s usually appropriate to maintain some running load, however it may need to be reduced to a manageable level.

Does it matter what footwear I wear if I have a sore Achilles?

There is no clear evidence regarding the use of footwear in treatment of achilles tendinopathy. However, shoes with a higher drop and a stiff forefoot rocker sole biomechanically reduces load through the achilles tendon. Therefore if individuals need to reduce load through the tendon, these footwear characteristics may assist in rehabilitation. 

If I have an Achilles tendon injury does this mean it will rupture?

No! Achilles tendinopathy does not result in rupturing of the achilles tendon. It is safe and beneficial to continue loading achilles with tendinopathy. 

What is the difference between achilles tendinopathy, tendinosis and tendonitis?

• Tendinopathy – refers to a pathological or painful tendon. A broad term that encompasses a variety of states in which a tendon may present with.
• Tendinosis – refers to failed healing and degenerative changes within a tendon’s collagen matrix. This is a relatively common finding in painful tendons.
• Tendinitis – historically used to describe a symptomatic tendon, with ‘-itis’ referring to inflammation. As most tendon pain does not appear to be inflammatory in nature, this terminology is no longer widely used.

Can I get shockwave therapy for achilles tendinopathy? Does it help?

Shockwave therapy is effective in the management of achilles tendinopathy, showing benefits for pain at a 3 month follow up post treatment. HOWEVER, should only be used in chronic cases that do not respond to other conservative management strategies. 

What tests are used to diagnose achilles tendinopathy? 

Firstly a detailed history should be conducted, demonstrating pain at the achilles mid portion or insertion. There is often a warm-up effect which initially eases symptoms, followed by worsening symptoms with prolonged activity through the mid portion or insertion of the achilles. Plyometric movements such as calf ‘pulses’, double leg jumps or single leg jumps are usually the most provocative tests indicative of achilles tendinopathy. Calf raises may or may not be painful.

Won’t I hurt it more by doing heavy strength training? Would light be safer?

We know that heavy resistance training is effective in the management of achilles tendinopathy. The application of heavy resistance training stimulates collagen production and reverses tendon dysrepair. Furthermore, heavy resistance training is effective in producing significant long term improvements in pain and function. We also know that it is safe and effective to have moderate levels of pain whilst completing heavy strengthening exercises. So it may hurt whilst completing the heavy exercises, however it is better in the long run! (always check with your physio first!).