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Achilles Tendonitis or achilles tendinopathy is an overuse injury causing pain, inflammation and potential degeneration of the achilles tendon at the back of the ankle.
If not caught early this can be a difficult injury to cure, but with the correct treatment - with a particular emphasis upon eccentric strengthening exercises - a full recovery can usually be achieved.
Symptoms can be either acute or chronic. Acute tendonitis is usually more painful and of recent onset. Chronic injuries will have come on gradually and over weeks or may follow an acute injury. Chronic injuries do not necessarily prevent, however they can aggravate the sufferer, causing discomfort and affecting performance.
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The achilles tendon is the large tendon at the back of the ankle. Medically known as the calcanea tendon, it is the joint tendon of the calf muscles made up of the gastrocnemius and soleus and inserts into the back of the heel bone or calcaneus. It provides the power in the push off phase of walking and running where huge forces are transmitted through the achilles tendon.
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Achilles tendonitis is usually an overuse injury caused by doing too much strenuous activity. Poor footwear, soft training surfaces, tight muscles and foot biomechanics can all increase the likelyhood of injury. The term achilles tendinopathy is probably a better term to describe the range of conditions that can cause achilles tendon pain. Strictly speaking tendonitis suggests an inflammatory condition of the tendon but in reality few injuries are actually down to pure inflammation. The main causation factor, particularly in older athletes, is usually tissue degeneration. Other very similar conditions may actually be due to inflammation or degeneration of the tendon sheath which surrounds the tendon rather than the achilles tendon itself.
Treatment is initially based around reducing pain and inflammation with ice or cold therapy and electrotherapy such as ultrasound. A Doctor may prescribe anti-inflammatory medication such as ibuprofen which might help with acute achilles inflammation and pain but has not been proven to be beneficial long term and may even inhibit healing. Taping the achilles tendon can provide protection and support while the injury is healing and wearing a heel pad can also reduce the strain on the tendon.
Chronic injuries, however, are likely to respond better to heat. Sports massage can help mobilize the tissues of the tendon and relax the calf muscles. Stretching exercises for the calf muscles and eccentric strengthening exercises should form part of the treatment plan along with a gradual return to activity. A combination of treatment approaches and patience will work best. Occasionally a steroid injection may be given however injecting directly into the tendon is not recommended.
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Eccentric strengthening exercises have been shown to be probably the most effective treatment method for recovering from achilles tendon pain. The Hakan Alfredson's heel drop protocol exercises involve the patient dropping the heel to horizontal in a slow and controlled manner. An eccentric muscle contraction is one where the muscle gets longer as it contracts rather than shortening. Exercises must be done daily for 12 weeks and pain may get worse before it gets better.
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Avoiding overuse and modifying training methods is important to prevent the injury from returning. Make sure you have the right running shoes for your foot type and the sport. If you are a runner that over-pronates then a motion control or support running shoe may be needed. Visit a specialist running shop for advice. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.
Professional Football Physiotherapist Neal Reynolds explains early stage treatment, exercises, prevention and returning to full training as well as hints and tips on how to prevent achilles tendonitis. We also talk to sports massage teacher Susan Findlay on how massage can aid in the treatment of achilles tendon injuries.
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We have a number of resources to help in the recovery of achilles tendonitis including our 12 week exercise check sheet and our downloadable VISA achilles pain questionnaire which is a great way to monitor how bad your injury is.
We recommend number of products which may help. A re-usable hot and cold pack is excellent for keeping in the freezer and applying cold or heating in a microwave or hot water to apply heat. An achilles tendon strap works by applying pressure to the tendon which changes the angle of the forces going through it which in turn relieves pain and stress on the tendon. A heel pad worn in both shoes slightly shortens the tendon, again reducing strain.