A Case of Achilles Tendinopathy

Do you suffer from Achilles Pain?

At school drop off one morning a mom friend Louise was asking for some advice about her Achilles pain she was getting. She had started running again after a long break and was really enjoying it. She used to run middle distance back in the day, and also played hockey at junior national level.

Since the kids and with work, her exercise life was more about fitting it in. Running was a big release for her, she could just go when she wanted, didn’t have to book a class. It was also a great endorphin release to help with the stresses of modern life (kids really!). More importantly she was about to get a dog and really wanted to run with it.

As we talked from the school gates to my car, I briefly tried to get an idea of how the tendon was behaving.

Tendons

Tendons can be categorised into two main stages, they can either be irritable or stable. If you have a STABLE tendon like Louise seemed to have this meant that she could run but there was some discomfort probably a 3/10 on the pain score (10/10 being worst pain possible). The pain was there at the start of the run and then it was a little tender afterwards but not for long.

As we parted I suggested that what she needed to do was start some strength work on the Achilles gave her a quick demo of the exercises and drove off.

So fast forward a few months..

Louise sporadically did her exercises and kept running. She was getting really hooked on the running, and so had started some sprint sessions with a friend.

The Achilles

The achilles was now causing her more problems. When we finally sat down together to discuss it properly, the pain was now there all the time! It was worse in the mornings causing her a lot of problems. She had to stop the running now and was very frustrated.

Louise’s story is quite typical, and shows what can happen to tendons. So now Louise’s tendon had become IRRITABLE and was stopping her from running. This is the time people normally arrive in my clinic. They have struggled with the Achilles for a while but only when it stops them from exercising do they seek help.

So; there are a number of learning steps in this tale..

Firstly, the exercise, I think it’s very hard to get a thorough idea of what you need to be doing. Either by a one-off chat or say from the internet or a sheet of exercises given by the GP.

In my opinion, it is hard for you to work out how hard you need to be working. It’s also hard to know whether you are doing them correctly and therefore may not have good faith in the exercises.

I have seen many people who are given the right exercises but often say ‘I didn’t know how long to do them for’ so I stopped or I wasn’t sure what I was doing so I stopped.

Exercise Prescription

Exercise prescription is the key to success with tendons, and this why I find them great to work with. As a clinician, you need to work out what stage the tendon is at and prescribe the right exercises for that stage. If the exercises are too much for the tendon then the pain will get worse.  Conversely if you don’t apply enough load to the tendon the minimal changes will be seen.

Teach you Exercises

The other big factor is to teach you how to manage the exercises. How long and how often to do them so they are strict with themselves. If all these things are working then you will see improvements.

So even though the exercises can be fairly standard for Achilles problems actually the management is an individual one and if you are not getting anywhere by doing a bunch of exercises off the internet then it’s definitely worth visiting a physio or more precisely me!

The other big lesson to learn is to do something about your Achilles before you get to the stage when you must stop the sport that you love. Managing tendons can take up to 12 weeks and the programme is one of constant progressions and if you stop at any stage you may risk going backwards.

Finally, a note about tendons…. Once a tendon,  always a tendon. You will probably need to keep up with some sort of exercise to keep the tendons functioning even when you can run again. Hopefully if you have a good physio then they will have designed you a programme that works on the whole kinetic chain and has created something that you love doing.

Once we did sit down and discuss the management properly Louise did finally improve and got back to her running.