Achilles Tendinopathy
Tendons are structures with viscoelastic properties that connect muscles to bones, allowing the transmission of force and joint mobility to the corresponding structure. Depending on its severity, Achilles tendinopathy can lead to long periods of inactivity, reduced performance and even withdrawal from sport.
The Achilles tendon is located at the back of the ankle and connects the calf muscles to the heel bone. It is mainly responsible for moving the foot towards the ground, a typical movement in the support phase of walking, in order to move up and forward.
The injury may occur as a result of a tear, contusion or overuse and may involve the tendon body, the non-insertion area or even the area where the tendon attaches to the heel bone. The acute injury (tear or contusion) can be caused by an excessive load on the tendon, which cannot cope with the force applied, while a “chronic” injury is caused by overuse of the tendon, which leads to a prolonged degenerative and inflammatory process due to repeated microtraumas.
Symptoms
In practice, it can be caused by a reduction in the joint range of motion of the foot, shortening of the entire posterior muscular chain, structural changes in the lower limbs or the use of inappropriate sports footwear.
Depending on how it happens and on the severity of the injury, patients often experience localised pain, muscle atrophy due to disuse, pain on active movement (climbing stairs), pain on stretching (proportional to the severity of the injury) and, in some cases, thickening of the Achilles tendon.
An ultrasound scan may be required as an additional diagnostic test.
Treatment
In terms of treatment, in the initial phase we reduce inflammation using electrotherapy and TECAR therapy, together with active mobilisation during physiotherapy to reduce pain and, gradually, mobilise soft tissues (tendons and muscles), and dynamic muscle strengthening of the glutes and isometrics of the calf muscles. Progressive deep traverse friction massage (DFM) is used to promote mobility and vascularisation of tissues, and eccentric muscle strengthening exercises can begin (essential and compulsory for any type of tendinopathy). Active mobility exercises to increase the mobility of the foot and the entire posterior chain should be carried out in order to regulate the entire movement pattern of these joints, as well as neurodynamic techniques.
All of this work should be carried out with individualised support during physiotherapy,
which is planned between the patient, physician and physiotherapist.
In certain cases, the physician may recommend viscosupplementation techniques, shock wave therapy or Platelet-Rich Plasma.
In the final phase of the rehabilitation process, plyometric exercises, running and specific technical movements are introduced according to the activity practised, with the option of physiotherapy or customised programmes.
This type of pathology can lead to a prolonged period of inactivity as it becomes incapacitating, thus compromising the person’s performance. Conservative treatment is extremely important for this type of injury, through an appropriate rehabilitation plan adapted to each case.
If you need treatment for Achilles tendinopathy, contact our physiotherapy clinics in Lisbon.
