My Achilles hurts

Achilles tendinopathy occurs when the Achilles tendon becomes aggravated due to repetitive stress and overuse. The Achilles tendon is attached to your calf muscle (gastrocnemius and soleus) and is responsible for helping you walk, run, and jump.  Again, achilles tendinopahty is not related to one specific event, but from repetitive overuse.

Those with the highest risk for developing Achilles tendinopathy are active and athletic individuals, but that does not mean individuals who are not active do not develop this condition. Typically the mean age for those who develop Achilles tendinopathy are between the ages of 30-50 years old and males have a much higher incidence then women. Risk factors for developing Achilles tendinopathy include training errors, such as increasing training mileage or intensity to quickly and returning to exercise after an extended break, and tight calf muscles.

Signs and symptoms

Typically, this condition presents as a gradual onset and worsens with continued use. Common symptoms include:

  • Stiffness along the Achilles tendon in the morning
  • Pain along the tendon that worsens with activity
  • Swelling along the tendon that worsens with activity. It is important to note that swelling may not always be present.
  • Point tenderness over the tendon
  • Pain when pointing your toes

Physical Therapy

The overall prognosis for Achilles tendinopathy is good, but it may take several weeks to months to resolve depending on the level of severity.  Physical therapy is one of the most effective options to address this condition and help you return to the activities you love.  Based on your physical exam, the physical therapist will take an impairment based approach to your treatment.  In physical therapy, we will utilize the following treatment options:

  • Manual Therapy– Many individuals who suffer from Achilles tendinopathy have decreased motion at different joints within their ankle and increased tissue tension in the gastrocnemius and soleus. Your physical therapist will utilize a hands on approach to help restore normal motion at the joint helping you return to your activities pain free. 
  • Stretching– One of the most common causes of Achilles tendinopathy is tight calf muscles. Your physical therapist will show you specific stretches that you can perform throughout the day to help decrease the stiffness of the Achilles tendon as well as improving your flexibility at the ankle.
  • Strengthening exercises– Another common exam finding in those with Achilles tendinopathy, is decreased strength of your calf muscles as well as more proximal muscles in your hip and thigh. Decreased strength in your hip and thigh muscles can cause the muscles in your lower leg to compensate for these weaknesses when walking or running and places increased stress on the Achilles tendon.  Overtime this increased stress can leave you more susceptible to developing Achilles tendinopathy. Your therapist may also choose to incorporate eccentric strengthening exercises for the calf muscles. This specific type of strengthening has been proven to reduce pain and improve function.
  • Activity modification– Activity modification is one of the most important aspects of your treatment plan to help unload the repetitive stress placed on your tendon. Your physical therapist will work with you in establishing alternative exercises to help keep you active and maintain your current fitness level. As your symptoms begin to subside, your therapist will work with you to gradually reintroduce you to activities, like running, that place increased stress on the Achilles tendon. Properly reintroducing these types of activities is key because you do not want overload the tendon to quickly. 
  • OrthoticsOrthotics may be warranted for individuals who over pronate when they walk or run. Over pronation is when the ankle turns in more then it should and results in more stress being placed on the Achilles tendon. Using the proper orthotic can prevent your ankle from over pronating thus preventing increased stress on your Achilles tendon helping decrease the pain as you walk. Your physical therapist can help you pick out the proper orthotic to use. 
  • Taping– Different types of taping techniques may be used in the short term to help alleviate and take stress of the Achilles tendon.

If you are experiencing what you believe to be Achilles tendinopathy, call Total Performance Physical Therapy today to make an appointment with one of our therapist!


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