Chronic Achilles Tendinopathy: A Common and Frustrating Injury

Added by Katie Boushie on January 14, 2013.

Aptly named, the Achilles tendon can be a major source of frustration and weakness for many athletes. The tendon connects the muscles of the calf, the gastrocnemius and soleus muscle complex, to the calcaneus bone in the heel. As with all tendons, the Achilles acts as a connection between muscle and bone and helps absorb forces to limit muscle damage. An incredible amount of weight is placed on the Achilles during every day activity; over twelve times body weight while running, over four times while walking and two times body weight while biking. Movement within the tendon allows it to absorb force, but it can only recover up to a certain point. When the Achilles tendon is repeatedly stressed or placed under an unusual amount of force, injury will occur.

Injuries to the Achilles tendon may be chronic or acute. An acute injury is caused by an excessive amount of force placed on the tendon and may result in a tear, while a chronic injury will occur over a period of time.  In this article I will focus on chronic injuries. Chronic injuries may be due to body weight, foot anatomy, ankle instability, muscle dysfunction, poor technique or a change in training. The Achilles will react to chronic stress with inflammation, degeneration or both. Chronic Achilles tendon injuries present with pain during exercise and swelling.

Treatment of chronic Achilles tendinopathy can sometimes be a long and frustrating recovery. The first step is to address any mechanical issues. This may include changing training techniques, improving any muscle imbalances with strength training, and correcting any anatomical problems with orthotics. Additionally, activity should be modified. Because more body weight will increase stress on the tendon, biking would be a good swap for running.  In addition to changing mechanics, chronic Achilles tendinopathies respond well to ice and eccentric training exercises. Ice helps calm inflammation and decrease pain and is helpful following exercise or activities that stress the injured tendon.  Eccentric movements are exercises that the tendon is lengthening while also strengthening. An example is slowly lowering from a heel raise; the tendon is increasing in length while simultaneously still supporting the weight of the body and assisting the calf muscles. All rehabilitation components combined, an improvement should be seen in Achilles function and a decrease in pain and swelling. Athletes that do not see any improvement to conservative treatment within three to six months may be a good candidate for surgery.

As with most injuries, early recognition will greatly benefit recovery. Addressing any anatomical problems, gradually increasing training and overall being aware of how your Achilles tendon responds to training will help decrease your chances of tendinopathy.