The Achilles tendon connects the calf muscle to the calcaneus or heel bone. It’s the largest tendon in the body. And it’s also the tendon that takes the most load through it every day. When we are walking, each time we push off with our foot, our whole body weight is supported by this tendon.
Achilles tendinopathy (or tendonitis) is a common condition, especially in athletic populations. It is also common in people who have recently increased their activity levels.
The main symptoms of Achilles tendinopathy are pain and stiffness around the Achilles tendon. Pain is usually worst early in the mornings. And often, symptoms are worse when getting up after a period of time sitting down, such as sitting at a desk, driving, or watching a movie.
Depending on the stage of the tendinopathy, some people are able to continue to exercise but suffer from increased pain afterwards. If the Achilles tendinopathy is more reactive, symptoms may stop you from performing any exercise altogether.
What causes Achilles tendinopathy
Achilles tendinopathy can be caused by an acute injury, usually involving a large amount of force. Usually, the symptoms present more gradually and are often caused by repetitive loading beyond the capability of the tendon. This can occur with a sudden increase in training or activity volume, a change in the surface trained on, or in footwear used. It can also occur as a result of altered movement patterns when exercising or being active which places unaccustomed load through the Achilles tendon.
Exercise, recovery and rehabilitation
In the early stages of rehabilitation, rest from aggravating activity is usually advised. This often includes sport, but also may involve some strategies around the way you spend time on your feet during the day. Resting is aimed at allowing the pain to start to settle. At this stage of rehabilitation, an orthotic device such as a heel raise can also be useful in taking some extra load off the tendon, which can help it settle.
Specific exercises can be helpful when settling the pain. You should be assessed by your physiotherapist to discuss exercises that are the most appropriate for you depending on your stage of rehabilitation.
As your pain settles, your exercises will need to be progressed with the aim of getting you back into your regular activity and beyond (especially if you were training for something new). A typical exercise program will focus on strengthening the tendon and the calf muscle specifically. It will also usually include flexibility, strength and movement control exercises of the entire kinetic chain, including the leg and trunk. If an altered movement pattern has led to your Achilles problem, this will need to be addressed. It is important that the rehabilitation program is a progressive one and is tailored to the load the tendon can take at each stage of recovery.
A typical rehabilitation timeframe is between 3 and 6 months for an Achilles tendinopathy condition. Your physiotherapist will discuss with you when it is appropriate to return to your usual activities and sports.