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.
1. Paratendonitis: involving a crepitus (crackly) feeling in the tissues surrounding the tendon. 2. 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. 3. 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. 4. Enthesis: inflammation of the insertion to the heel - associated with children during their growth spurts.
Some injuries can display symptoms of all of the first 3 subtypes. Signs and symptoms
1. 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. 2. Palpable tenderness, crepitus (cracking) and sometimes thickening in the region of pain. 3. Morning stiffness/pain on rising. 4. Sometimes preceded by evidence of tightness in the calf muscles.
NB: Symptoms don't always relect the extent of pathology. Seek advice early! Management can include:
1. Icing - daily. 2. Massage along the calves and into the tendon (with Difflam). 3. Calf stretches with the foot in a supinated position (arch up) to acheive an even stretch in the muscle. 4. 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.
5. Taping, orthotics and running shoes with stability properties in the rearfoot and midsole can help control pronation. Correct fitting is also very important. 6. 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. 7. Cross training such as cycling, swimming or aqua jogging.
- Reference: C. Purdam, July 1995. Lecture notes NSW Sports Physiotherapy News Letter pp15-20.
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