Last night I played Futsal (form of indoor soccer) and this morning my achilles hurts. The first few steps to the kitchen feel like I’m walking in bricks. I know it will settle because this has happened before, and I know a trick or two!
Achilles tendons are the largest tendon in the body so that makes them solid things, and often pain like this doesn’t mean I am any more likely to tear my tendon like many people seem to fear. Oddly enough, that single sentence is the one I repeat the most. People are more scared of the “gunshot” achilles rupture than of any tendinopathy.
We’re not exactly sure what causes them, but we do know a few risk factors (58% are male; have reduced ankle motion, power or strength). More commonly, increasing load too quickly including returning from injury, training errors and footwear are common extrinsic factors. Achilles tendinopathy can be acute or chronic. They are most often seen in 15-25 year-olds (young athletes), and 45+ year-olds (desk workers) with limited activity.
Basic stats of achilles tendon pain sufferers: 58% male, risk factor = reduced ankle dorsiflexion (which can occur from previous ankle sprain)
The journey can be tough because there is frustration with the management. The rupture fear factor in achilles patients can actually determine their recovery time, so you can imagine the importance of an accurate understanding and communication with your health care provider. McAuliffe et al (2017) demonstrated the psychosocial components where activities of daily life (up and down stairs, walking, etc) caused fear of further tendon damage and therefore significantly reduced all activities. There can be a great deal of frustration with the management of achilles tendon for both clinicians and patients as it is slow to settle and quick to aggravate.
Silbernagel et al (2010) found only 65% of people with progressive strength programs were symptom-free at 5 years. 15% had new symptoms, 20% had ongoing issues.
What to do?
- Understand your pain, the cause and what exercises are best for your stage of recovery
- Manage fear/stress and assess other health issues including diet and sleep
- Learn what isometric (pain relief) and eccentric (for strength) exercises are!
- Reduce pain, build load tolerance and get you back to what you love!
Ongoing management relies on consistent self-management by the patient, which is both exercise and education based. Patients should find balance with training (avoid morning training, hills, back to back running). This requires an adequate understanding of what to do when certain pain or training changes happen.
Thanks to Clinical Edge, McAuliffe et al (2017), Silbernagel et al (2010), and tendon gurus – Tom Goom and Peter Malliaris