Achilles Tendonosis (formerly Tendonitis)
by: Phil Parle
Achilles Tendonosis is a common running injury with a reported incidence of 6.5% amongst runners. It occurs as a result of repetitive overload and breakdown of the Tendon which attaches the calf muscle to the heel.
There are 4 types of Achilles injury.
- Paratendonitis: involving a crepitus (crackly) feeling in the tissues surrounding the tendon.
- Proliferative Tendonitis: acute and reactive response to overload of the tendon structure (i.e. following a heavy hill session) causing a fusiform thickening of the tendon.
- Degenerative Tendonosis: slow onset chronic and recurrent response where inevitably the tendon never regains its former structure and therefore is always sensitive to a load.
- Enthesis: inflammation of the insertion to the heel - associated with children during their growth spurts.
Signs and symptoms
- Pain in the region of the Achilles (grade 1): that occurs after running, (grade 2): during warm up/cool down, (grade 3): gets worse as you run, or (grade 4): constant pain.
- Palpable tenderness, crepitus (cracking) and sometimes thickening in the region of pain.
- Morning stiffness/pain on rising.
- Sometimes preceded by evidence of tightness in the calf muscles.
Management can include:
- Icing - daily.
- Massage along the calves and into the tendon (with Difflam).
- Calf stretches with the foot in a supinated position (arch up) to acheive an even stretch in the muscle.
- Relative rest:
Recommendations from the Australian Institute of Sport - based on the severity and chronicity of the injury:Proliferative Degenerative Grade 1 Modify Training* Normal (warning sign) Grade 2 Short Rest Modify Training* Grade 3 Long Rest Long Rest / Surgery? Grade 4 Surgery Surgery (Rehab 6-12 months) *Modify training = correct the extrinsic errors which contributed to the injury.
- Taping, orthotics and running shoes with stability properties in the rearfoot and midsole can help control pronation. Correct fitting is also very important.
- Strength exercises such as heel raises off a step are useful in cases where there is a demonstrated strength defecit and the tendon is relatively asymptomatic and stable. Advice should be sought before proceeding with this program.
- Cross training such as cycling, swimming or aqua jogging.
Phillip Parle
Manipulative and Sports Physiotherapist
M.A.P.A. M.M.P.A.A.
City Physiotherapy Centre
Shop 3 Simpson House
135-137 Crown Street
Wollongong
Telephone (02) 4226 1015
Fax (02) 4225 2260
Phillip Parle, Cool Running Australia, 04.09.97
