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The most common running injury to affect the lower limb other than knee pain is Achilles tendon pain. Achilles tendon problems do tend to affect runners more than the average population and as the training for the marathon ramps up Achilles tendon problems can become more frequent.

There are 2 types of Achilles problems that I see in practice:

  • Acute reactive tendinopathy
  • Chronic overload tendinopathy

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Acute reactive tendinopathy

This type of tendon is an acute swelling within the tendon sheath that is a response to sudden increased loading. There is usually no structural degeneration within the micro structure of 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 irritation with 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.

Chronic overload tendinopathy

A typical presentation of Achilles 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 fails to adapt to the loads that is put through it the collagen fibres within the tendon become weak and disorientated and somehow this creates pain. 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 all in agreement that exercise is the best treatment and management strategy. There are specific eccentric exercises that can help Achilles pain and I would advise you to speak to a physiotherapist to find out what these are and if they are appropriate for you.

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.

Physiotherapy will include IASTM to the tendon, massage to the calf, acupuncture into the tendon (to create a small inflammatory response and new healing). Other treatment strategies include high volume injections into the tendon ( to try and disrupt the neo-vessel growth into the tendon) and shockwave therapy. This is a mechanical radial shockwave design to irritate the tendon (mush like acupuncture)and stimulate a new healing response. Speak to your GP or physiotherapist about whether any of these treatment strategies are appropriate for you.

About Wandsworth Physiotherapy

At Wandsworth Physiotherapy and Osteopathy we are focused on getting you out of pain and back to what you love doing. Whether it's playing with your kids or simply being able to sit on the train comfortably; whether it's being able to get back into the gym class or to run 5k again; whether it's to banish the Tena Lady or being able to lift your child without pain our expert physiotherapists and osteopaths are here to help.