Achilles tendinopathy

Tendinopathy is an umbrella term implemented in medicine to describe a complex multifaceted pathology of the tendon, typically characterized by pain, decreased functioning and reduced load capacity of the structure. This condition is characterised by a series of physiological changes that occur within the tendon and that can lead to significantly different symptom presentation among subjects based on several factors, such as the stage of the condition (usually categorised in a continuum model presenting 3 different stages), the patient physical status, the performed sport, etc. The Achilles Tendon, located in the posterior aspect of the leg (connects the calf muscle to the calcaneus) is the thickest tendon in the human body and it can withstand high levels of tensile forces. Due to its paramount function, the Achilles tendon is typically subjected to high-level strains throughout daily life and sport, making it one of the most commonly affected tendons by tendinopathies. This condition typically arises from an excessive cumulative load to which the calf complex has been exposed over days, weeks and months preceding the onset of the symptoms. Risk factors for developing this condition include increased tendon compression, calf-complex overuse with spikes in training loads, lack of Achilles tendon and calf flexibility, increased foot pronation, decreased foot intrinsic muscle strength, and other potential metabolic and genetic factors. Patients affected by this condition typically complain of pain during sports and functional activities of daily living (e.g.: walking, going down the stairs, squatting, etc.), especially in the morning or when resuming movement after staying stationary for an extended period. Pain is typically reported in a “dose-dependent” fashion, meaning that more load or faster rates of loading, typically lead to higher sensitivities.

MANAGEMENT

Non-surgical management is the most implemented rehabilitation approach with most of the cases resolving in this way. In some cases, where conservative treatment has not yielded satisfactory results, or when the condition is in advanced stages with severe symptoms, surgical management may be considered. Our strong recommendation regarding tendinopathies is to not delay seeking medical attention as the condition tends to degenerate over time and a prompt diagnosis coupled with early non-surgical management is vital for successful rehabilitation outcomes. Different strategies to temporarily “off-load” to then “re-load” the tendon can be implemented throughout the rehabilitation process with the final goal of enhancing the tendon’s resilience and ability to withstand higher stresses. In the literature, an array of interventions including the use of pharmacologic intervention, injections and exercise medicine (e.g.: overcoming and yielding isometrics, eccentric training, restoring muscular imbalances, etc.) have been recommended, however, it is important for the plan to be successful to be directed by competent staff. In Isokinetic, after being assessed by one of our specialised doctors through physical examination and imaging (e.g.: ultrasound), you will be prescribed a rehabilitation plan tailored to your specific condition. Together with the rehabilitation team you will gradually resolve your symptoms and reload the tendon to increase its tolerance. After having optimised your mobility, and restored your muscle strength, you will progress in our movement analysis and retraining room to enhance your movement quality. Finally, you will complete your rehabilitation with our on-field rehabilitation service where you will be able to completely restore your loading tolerance and return to your practised sport, optimising your performance and minimising the risk of relapse.

Achilles tendinopathy

Achilles tendinopathy

MANAGEMENT

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