Physiotherapy for Achilles tendinopathy

Tendinopathy is a broad term used to cover several different types of tendon pathologies that used to be known by names such as tendonitis, tendinitis and tendinosis. Achilles tendinopathy is one of the most common sites for a tendinopathy to occur, especially in sports such as running, basketball, netball and hockey. It usually occurs in middle-aged patients but it can occur at any age, especially in distance runners and people who do play sports that involve a lot of running.

The most common cause of Achilles tendinopathy is a large increase in training volume over a short amount of time, eg suddenly increasing the amount of running training or jumping that you do during the week. Adding hill running can contribute, and being middle-aged and overweight also increases your risk. Other factors such as foot position (flat feet), running shoes and running surface may also andbe important in some cases.

At Central Performance our physiotherapy team are very experienced in treating Achilles tendinopathy, especially because we see a very high number of runners from recreational to elite level due to the Central Performance Running Centre We use the latest hands-on techniques plus progressive exercise to relieve your pain, restore your strength and increase the resilience of your Achilles tendon to reduce your risk of future injury. This is very important, especially in reducing the risk of rupturing the Achilles tendon. Completing an exercise physiology program to really increase the strength of your leg muscles can also be very effective in preventing future problems.

Steps to Physiotherapy Management of Achilles tendinopathy

Your Initial Assessment And Diagnosis                     

Your physiotherapy program starts with an in-depth initial assessment to examine the cause of your Achilles tendinopathy. This includes taking a full history, identifying aggravating movements and performing a thorough physical examination. Your pain may be due to restricted range of motion (tightness), a lack of strength, a big spike in activity and exercise, and/or other reasons for excessive loading of the Achilles tendon. Your physiotherapist will thoroughly explore all the relevant factors to ensure we make an accurate diagnosis and get to the underlying cause of the problem, not just treat your symptoms.

During your first session your physio will take time to clearly explain your diagnosis to you. They will highlight relevant anatomy and factors that have caused your pain, plus guide you through your treatment plan and steps to recovery. Your individual goals are very important when planning your treatment, so your physio will discuss your goals with you and clarify how your treatment plan will help you achieve them.

Your Physiotherapy Treatment Program 

Your treatment plan is tailored specifically for your personal goals, injury history, lifestyle factors and level of sport and exercise. The four main stages that you will progress through during your treatment are;

1. Relieve your pain and modify your exercise to achieve the right level of loading of your tendon
2. Specific strength exercises for your Achilles tendon and calf muscles
3. Screening and correction of the mechanics of your leg, hips, pelvis and spine that may be contributing to your injury. This may include working on joint mobility, muscle length, strengthening and modification of your training program. If you are a runner, having a running gait assessment is also very effective to decide if your running style may be a factor in your injury.
4. Progressive return to sport and activity, including sport-specific strengthening for a safe return to all of your normal lifestyle and exercise activities.

We know how frustrating it is when injury means you can’t do your normal sport and exercise, so whenever possible we keep you active and running as much as we can while you recover. This is based on solid evidence showing that maintaining activity and tendon loading at the right level, even though there might be some discomfort, is safe and is actually beneficial to your recovery. Your physiotherapist will regularly discuss how to maintain the right level of exercise and loading with you during your course of treatment.

Returning To Sport, Running And Activity

The important last stage of your treatment program involves you transitioning back to your full range of sport and exercise, as well as other lifestyle activities. Every activity is different and therefore puts different demands on your Achilles, so this stage is very individualised to target your personal goals and exercise of choice. We focus on maximising your resilience and performance through functional strength and conditioning. If you are a runner your physiotherapist may recommend that you complete a RunRight running coaching program to optimise your running mechanics, or an exercise physiology program to maximise your strength and movement control.