Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

Health professionals may use different terms to describe a tendon injury. You may hear:

• Tendinitis (or Tendonitis): This actually means "inflammation of the tendon," but inflammation is rarely the cause of tendon pain.
• Tendinosis: This refers to tiny tears in the tissue in and around the tendon caused by overuse.

Most experts now use the term tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendinitis out of habit.

Achilles tendonitis is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise. You will often feel a tender swollen area in the tendon.

The calf muscles of the lower leg become the Achilles tendon. This is the prominent tendon at the back of the heel, which attaches to the heel bone. 

These muscles are responsible for actions such as pointing the toes and standing tiptoe. They are greatly involved in repetitive activities such as walking, jogging, hopping and aerobics.

• Over-training or unaccustomed use – “too much too soon”
• Sudden change in training surface – e.g. grass to bitumen
• Flat (over-pronated) feet
• High foot arch with tight Achilles tendon
• Tight hamstring (back of thigh) and calf muscles
• Toe walking (or constantly wearing high heels)
• Poorly supportive footwear
• Hill running
• Poor eccentric strength

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

• Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
• The pain may get worse when you use the tendon.
• You may have more pain and stiffness during the night or when you get up in the morning.
• The area may be tender, red, warm, or swollen if there is inflammation.
• You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis. 

The worst case scenario is a total rupture of the tendon. 

Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks.
 
Most of these injuries take six months or more to adequately rehabilitate.

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

Achilles tendonitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if a thorough rehabilitation program is not completed.

Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. Your achilles tendon attaches your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which does have a different level of blood supply and function, which does alter the rehabilitation from a calf muscle tear.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are:

As with most soft tissue injuries the initial treatment is RICE - Rest, Ice, Compression and Elevation.

In the early phase you’ll be unable to walk without a limp, so your Achilles tendon needs some active rest from weight-bearing loads. You may need to be non or partial-weight-bearing, utilise crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on the Achilles tendon.

Your physiotherapist will advise you on what they feel is best for you.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. 

Anti-inflammatory medication (if tolerated) or creams, and natural substances eg arnica may help reduce your pain and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

As you improve a compressive bandage or supportive taping will help to both support the injured soft tissue and keep excessive swelling from pooling. Keep your foot elevated above your heart (where possible) to allow for gravity to help drain your swelling.

If you protect your injured Achilles tendon appropriately the torn tendon fibres will successfully reattach. Mature scar formation takes at least six weeks.

During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future.

It is important to lengthen and orientate your healing scar tissue via massage, muscle stretches, neurodynamic mobilisations and eccentric exercises. 

Signs that your have full soft tissue extensibility includes being able to walk without a limp and able to perform Achilles tendon stretches with a similar end of range stretch feeling.

Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for other leg, gluteal and lower core muscles depending on your assessment findings. 

Your physiotherapist will guide you.

Achilles tendon injuries can occur from poor foot biomechanics eg flat foot.

In order to prevent a recurrence, your foot will be assessed. In some instances you may require a foot orthotic (shoe insert) or you may be a candidate for theActive Foot Posture Stabilisation Program. 

Your physiotherapist will happily discuss the pros and cons of both options to you.

Most Achilles tendon injuries occur during high speed activities, which place enormous forces on your body (contractile and non-contractile). 

In order to prevent a recurrence as you return to sport, your physiotherapist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepares you for light sport-specific training.

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your PhysioWorks physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation program has minimised your chance of future injury.

There is no specific time frame for when to progress from each stage to the next. Your injury rehabilitation status will be determined by many factors during your physiotherapist’s clinical assessment.

You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.

For more specific advice about your Achilles tendon injury, please contact your PhysioWorks physiotherapist.