The most common lower limb running injury other than knee pain is Achilles tendon pain. Achilles tendon problems tend to affect runners more than the average population and as training volume for a marathon ramps..
There are 2 types of Achilles problems that we see at Wandsworth Physiotherapy:
- Acute reactive tendinopathy
- Chronic overload tendinopathy
Acute reactive tendinopathy
This type of tendon injury is brought about by a sudden increase in tendon loading. This causes an acute swelling within the tendon sheath. There is usually no structural degeneration within the tendon itself. It will present as an acute painful tendon that stops you from running accompanied by a slushy swelling in the tendon and a creaking feeling in the tendon as you walk or move your foot.
This type of tendon problem will respond to rest, ice and anti-inflammatory medication. You should still be able to exercises such as cycling but will need to rest from running for a couple of weeks. Physiotherapy will consist of massage and ultrasound and guidance on progressive strengthening exercises for the tendon as the pain and swelling subsides.
Chronic overload tendinopathy
This type of tendon injury usually develops after chronic excessive loading. A typical presentation of chronic overload tendinopathy would be morning stiffness that tends to wear off in the first half an hour or so, tenderness and a fusiform thickening to touch in the mid portion of the Achilles, and pain on the commencement of exercise that seems to ease during exercise but then stiffens up again after exercise.
The most commonly accepted and up-to-date belief of Achilles tendon problems is that they are not inflammatorily conditions, hence why they are no longer called Achilles “tendinitis”. What is now referred to as Achilles tendinopathy is thought to be a degenerative process that takes place in the tendon. As the tendon is excessively loaded it maladapts to the loads that is put through it and the collagen fibres within the tendon become weak and disorganised in orientation. This causes the tendon cells to produce more fluid within the tendon that can lead to a fusiform bump developing. New nerves and blood vessels then grow in to the tendon creating pain.
Unfortunately, if you have this fusiform thickening in the tendon with pain and dysfunction medical experts suggest that it can take between 18 months to 4 years before your Achilles pain can resolve.
Although medical experts may not all agree on the underlying pathology at play in Achilles pain, we are in agreement that there are type forms of treatment that are very effective to manage chronic overload Achilles tendinopathy. Namely, shockwave therapy and exercise. Shockwave therapy is a mechanical radial shockwave design to irritate the tendon, create micro trauma and stimulate a new healing response within the tendon Speak to your physiotherapist about whether shockwave is appropriate for you.
At the same time as you are having shockwave you need to strengthen the tendon. There are specific eccentric exercises that can help Achilles pain and speaking to a physiotherapist to find out what these are and if they are appropriate for you is a good idea.
You can also get insertional tendinopathy also called enthesopathy, where the tendon inserts into the bone and may sometimes be associated with retro-calcaneal bursitis. This type of tendinopathy does not like loaded eccentrics and will respond to isometrics exercises.
Other physiotherapy modalities will include IASTM to the tendon, massage to the calf, acupuncture into the tendon (to create a small inflammatory response and new healing). Other non-physiotherapy treatment strategies include high volume injections into the tendon to try and disrupt the neo-vessel growth into the tendon.