A problem that affects a great deal of people and limits their ability to exercise is a condition called Achilles tendinopathy. It presents as a discomfort and often a lump in the Achilles tendon just above the heel. The Achilles tendon is the thick band like structure that connects your calf muscle with your heel.
WHAT ARE TENDINOPATHIES
Tendons are made up of thousands of tough, elastic fibres. These fibres are subject to stress or load when our muscle contracts to move our joints and especially when we use our muscles to absorb shock. Stress to the tendon causes multiple micro tears to the small fibres and our body then rebuilds the tissue. This is a state of equilibrium where an almost equal number of fibres breakdown then repair maintaining the status quo. The problem arises when the breakdown outweighs the rebuild and then the tendon structure changes and becomes less efficient at dealing with the stress this is what is termed a ‘tendinopathy’.
Initially you may start to feel Achilles tendon ache after a long walk or run and one of the most common times to feel this is when your first start walking as you get out of bed in the morning. The discomfort usually disperses as the tendon warms up but can return again after long periods of inactivity in the day. When you squeeze the tendon it is common to feel tenderness and often there is a hard nodule.
The nodule is nothing to worry about and is a collection of fluid that seeps into the tendon when increased breakdown in the fibres occur. As your body tries to repair this problem a new blood supply is created around the nodule and with a new blood supply comes a nerve supply which causes an increase in sensitivity and therefore pain. As the condition progresses it takes less and less load to aggravate the tendon and the discomfort felt can become more constant.
MANAGING ACHILLES TENDINOPATHY
Reactive tendon: It is common to feel Achilles discomfort following and increase in activity or training. If this happens you will have just caused a mild increase in micro tears in the tendon due to the overload. Firstly reduce the load on the tendon by avoiding high impact exercise for 7-10 days. You may also want to avoid long walks for a few days. Once you return to exercise or walking it is important that you leave further exercise for 24 hours as tendinopathy discomfort tends to be worse the day after.
Tendon Disrepair: If the problem starts to become more persistent for more than 2 weeks this problem might not settle by just reducing the load. The tendon micro tears will be more extensive and there will probably some swelling or a nodule to the tendon. If this happens you need to make sure the tendon starts to repair in the most efficient way.
The key to the best recovery is strengthening the calf muscles. It is really important to find the optimum level of strengthening to start at and then progressively add more weight and speed to the exercise until you are replicating the activities you would like to get back to. For example to be able to run your tendon needs to be able to tolerate lifting 6X your body weight this equates to your calf muscle being able to lift 2X your body weight.
If you start strengthening work that exceeds your load tolerance level you will cause another reaction in the tendon and if you don't push the tendon enough the will be no change in your load tolerance level.
The pictures here show you some of the exercises we use at The Performance Lab. Don't worry if you are finding it hard to set your exercise level, here at The Performance Lab we are a centre of excellence for Tendinopathy management.