Almost all sports will have you walking, running or jumping; if it’s not in the activity itself then it’s included in the warm up. This has the potential to turn into an achilles injury. It is not uncommon for people to think that they have an issue with the achilles tendon. However, it could in fact be a result of a different tissue in the area causing the problem such as a toe flexor or another muscle/tendon in the lower leg such as the tibialis posterior, both of which sit just in front of the achilles.
Achilles tendinopathy comes in two different types: mid portion tendinopathy or insertional tendinopathy. The difference between the two are simple. The mid portion tendinopathy sits above the attachment of the tendon. The Insertional tendinopathy sits at the calcaneus.
Tendinopathy can be caused by a number of different factors.
- Mechanical Stress
If we look at the causes of both types of an achilles injuries from a mechanical stress point of view, we get slightly different results. The research shows that mid portion tendinopathy is related to repetitive loading – the weight being applied to the tendon is too much and causes tissue damage. Insertional tendinopathy is related to the compression of the tendon against the Calcaneus – the compression occurs when the foot moves into dorsiflexion.
There are 3 basic stages of tendinopathy, which are:
- Tendon disrepair
The movement through these stages is not necessarily straightforward. It can move from reactive to degenerative and back again dependant on the loading placed on the tendon.
In the reactive stage, we see a thickening and stiffening of the tendon in a response to the load in an attempt to cope with it and reduce the stress. In this stage the load has often been increased too quickly for the tendon to deal with. However, with rest and a reduction in the load, healing will allow occur.
The degenerative stage happens with chronic overloading and is usually more common in the older athlete. In this stage we see further breakdown in the structure of the tendon and this is accompanied by cell death. In this state if it is left unresolved, it can result in tendon rupture.
When it comes to managing and treating this type of injury, in all stages it comes down to managing the load placed on the tendon. In the reactive and early disrepair stages we simply want to reduce the stress that is causing the issue, by catching it fast enough and simply allowing it time to calm down.