Revolution Physical Therapy

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Achilles Tendinopathy: Morning stiffness? Pain at the start of your run?


What is it?
Achilles tendinopathy is a nagging lower leg injury, often seen in runners or athletes whose primary sport involves jumping. Tendinopathies occur when the tissue breaks down as a result of the ‘tissue load’ being greater than the ‘tissue capacity.’ Example: Taking a 3-week break from running, and then resuming your workout/running regimen where you left off. Yes, the property of a tendon can change within 3 weeks-time. And NO, the tendon will not always be painful. 66% of degenerative tendons have no symptoms prior to rupture.

To understand how to treat a tendon, we must first be able to recognize the signs/symptoms of this condition and understand it’s genetic make-up. Morning stiffness and pain at the beginning of a workout are a few common symptoms felt by patients. Tendon tissue is not very cellular, and nearly avascular. Therefore, they don’t require a lot of blood supply to remain healthy. Tendinopathies do not experience classical inflammation.

Who does it affect?

Typically, runners, jumpers, weekend warriors, or any activity that requires a power component. Patients that also take medications such as statins, fluoroquinolones (Cipro and Levaquin), or corticosteroids. Caveat: steroids can be useful for “reactive tendons” but terrible for degenerative tendons.

Do I need imaging?

Most likely not, as pain and pathology are poorly correlated. Nor is it useful in monitoring rehab results as the imaging outcomes are not parallel with clinical outcomes.


Treatment
What does this mean for our treatment approach? We need to LOAD the tissue. Tendinopathies do NOT get better with rest, rather activity modification. However, this needs to be done appropriately. Exercise choice makes a difference! A combination of light and heavy isometrics is a great start, with progressive loading as the underlying driver of your rehab. Watch starting your rehab with eccentrics, especially if you are in the midst of your season. Appropriate amount of rest between workouts is of importance because tendons take longer to recover than muscle. Stiff joints and quality of movement makes a difference in the tissue breakdown. Why else would only one Achilles’ be sore if they both take the same number of steps in a run?

1. Tissue Specific Exercise. The Manual Therapy Institute PLLC: 2018
2. Van Ark M, Cook J, Docking S, Zwerver J, Gaida J, van den Akker I and Rio E. Do isometric and isotonic exercise programs reduce pain in athletes with patellar tendinopathy in-season? A randomized controlled trial. J Sci Med Sport.2015;

3. Bley B and Abid W. Imaging of tendinopathy: a physician’s perspective. JOSPT 2015;Vol 45 No 11

4. Couppe C, Svensson R, Silbernagel K, Langberg H and Magnusson P. Eccentric or concentric exercises for the treatment of tendinopathies? JOSPT. 2015; Vol 45 No 11

5. Ganderton C, Cook J, Docking S, Rio E, van Ark M and Gaida J. Achilles tendinopathy: understanding the concepts to improve clinical management. Australian Musculoskeletal Medicine . 2015;Vol 19

6. Andres BM and Murrell GA. Treatment of tendinopathy: what works, what does not and what is on the horizon. Clin Orthop Relat Res 2008