Achilles tendon pain conditions are quite common issues among individuals at various fitness levels. On a population level, Achilles tendon pain (mid-portion tendinopathy) affects an estimated 6.2–9.5% [2], of which approximately 35% are physically active [3]. Often, Achilles tendon pain arises when runners pull out their sneakers as the snow melts and start their running routine "again." This is often seen in clinics around the beginning of summer when the client's condition has escalated to the point where the pain is no longer manageable. In this example, the running routine was initiated with too much intensity and speed, causing the tendons to not have sufficient time to recover. In other words, Achilles tendon pain is strongly associated with relative tendon overload. Achilles tendon pain is referred to as Achilles tendon tendinopathy. Tendinopathy refers to tendon-related pain, often associated with a decrease in performance, such as pain during force production [1]. Previously, terms such as tendonitis or tendinosis were used for Achilles tendon pain, but these terms are no longer in use today. [4]
Causes
The development of Achilles tendon tendinopathy is strongly influenced by both internal and external factors.
Internal factors include aging, increased body weight, genetics, previous injuries in the Achilles tendon area, diabetes, or high cholesterol levels. External factors include excessive relative increases in load, training environment, or certain shoe choices. As mentioned above, with the relative overload of the Achilles tendon, the tendon's ability to recover decreases, leading to structural changes in the Achilles tendon. These changes may contribute to pain and weaken the tendon's ability to transmit forces during performance. However, it is important to remember that in cases of long-standing pain, tissue damage may not fully explain the pain, as the issues lie in the central nervous system's pain processing. [4].
How can Achilles tendon pain be treated?
The focus of treating Achilles tendon tendinopathy is gradually progressing therapeutic exercise. In the early stages of treatment, it may be beneficial to cease activities that provoke pain and focus on performing other exercises that load the Achilles tendon (such as calf raises). Various variations of calf raises can primarily load the Achilles tendon. For example, performing calf raises with bent knees can specifically load the broad calf muscle. Weakness in this muscle has been observed in individuals with Achilles tendon tendinopathy.
However, if managing Achilles tendon pain proves difficult, it would be advisable to seek the help of a competent healthcare professional such as an osteopath, physiotherapist, or naprapath. During the consultation, the nature of the problem is determined through interviews and functional tests. Additionally, a treatment plan is established to help the client reach their own goals.
Joonas Virtanen
Osteopath & sports massage therapist
Flexus Terveyspalvelut
Book an appointment at www.flexus.fi/ajanvaraus
References
[1] Xu et al. 2008. The Basic Science of Tendinopathy. Clinical Orthopaedics and Related
Research.
[2] Murphy et al. 2018. Rate of improvement of pain and function in mid-portion Achilles
tendinopathy with loading protocols: a systematic review and longitudinal meta-analysis.
Sports Medicine.
[3] Jonge et al. 2011. Incidence of midportion Achilles tendinopathy in the general
population. British Journal of Sports Medicine.
[4] Martin et al. 2018. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion
Achilles Tendinopathy Revision 2018. Journal of Orthopaedic and Sports Physical
Therapy.
[5] Cardoso et al. 2019. Current trends in tendinopathy management. Best Practice and
Research Clinical Rheumatology.
[6] O`Neill et al. 2019. Plantarflexor strength and endurance deficits associated with mid-
portion Achilles tendinopathy: the role of soleus. Physical Therapy in Sport.