Physiotherapy Management for Achilles Tendinopathy: An Evidence-Based Approach

Mar 18

A frequent condition known as Achilles Tendinopathy affects the big tendon that connects the calf muscle to the heel bone and is located at the back of the ankle. People may find it challenging to go about their everyday activities due to this condition's potential for causing discomfort, edema, and decreased movement in the affected area. Physiotherapy is a popular non-surgical treatment for Achilles Tendinopathy and has been proven to be successful in symptom reduction and function enhancement, leading to a full recovery.

Here we shall examine the most recent manual therapy techniques, exercise, and other complementary physiotherapy strategies for the care of Achilles tendinopathy in this article.

Firstly, Let’s Better Understand Tendinopathy

Tendinopathy is a condition in which a tendon, the component that connects muscle to bone, is damaged or degenerated. Tendinopathy is caused by a complex interaction of variables such as mechanical stress, inflammation, and changes in the cellular and extracellular matrix components of the tendon.

Tendons are composed of collagen fibres, which give the necessary tensile strength to withstand the stresses generated by muscle contractions. Repetitive or severe loading of a tendon, on the other hand, can cause micro-injuries that accumulate over time, causing damage to the collagen fibres and other tendon components.

This damage causes an inflammatory response, resulting in the production of cytokines and growth factors that recruit immune cells to the afflicted location. While this response is required for healing, prolonged inflammation can aggravate tendon damage and interfere with its capacity to mend itself.

Moreover, tendinopathy can cause alterations in the tendon's cellular and extracellular matrix components. For example, there could be a decline in the number and activity of tenocytes, which are the cells that generate collagen and other extracellular matrix components. The number of non-collagenous matrix components, such as proteoglycans and glycosaminoglycans, may also rise, altering the mechanical properties of the tendon.

Overall, tendinopathy physiology is a complicated and multidimensional process including mechanical, inflammatory, and cellular alterations in the tendon. To manage symptoms and improve healing, treatment usually consists of a combination of rest, physiotherapy, and, in some situations, medication or surgery.

Learning About Achilles Tendinopathy

Achilles tendinopathy is the condition that develops when the tendon is repeatedly stressed and harmed, resulting in discomfort, swelling, and decreased mobility. All ages can be affected by this ailment, which has a number of potential causes, such as overuse, excessive physical activity, improper biomechanics, especially when running and underlying medical issues. There are two main categories of Achilles Tendinopathy, Insertional (“A” in the image below) and non-insertional or mid-portion Achilles Tendinopathy (“B” in the image below) are the two primary kinds.

Non-insertional tendinopathy develops in the middle of the tendon, whereas insertional tendinopathy happens where the tendon connects to the heel bone. The important thing to note here is they both need to be treated differently and your Physiotherapist can guide you through this.

Physio treatment of Achilles Tendinopathy with Physiotherapy

The major objectives of physiotherapy treatment are to lessen pain, increase mobility, and avoid further injury. Physiotherapy is extremely important in the care of Achilles Tendinopathy. It's not simply enough to reduce the pain, we want to make the tendon resilient and able to tolerate load better, so as to prevent the injury from coming back.

Physio prescribed exercises for Strengthening and Stretching

Exercises that involve stretching and strengthening are a crucial component of physiotherapy for Achilles Tendinopathy. While strengthening activities serve to increase the strength and endurance of the calf muscles, stretching exercises aid to increase flexibility and lessen pain in the injured area, however, it is also important to note, that stretching isn't ideal in the early stages of your recovery.

Heel raises, plantar fascia stretches, and calf stretches are some of the most frequently suggested stretching exercises for Achilles tendinopathy.

Calf raises, single-leg heel raises, and resistance band exercises are a few examples of strengthening exercises that typically target the calf muscles. However, in the early stages of the condition, isometric and eccentric loading may be a more suitable option.

Manual Physio Treatment

For those with Achilles Tendinopathy, manual treatment, such as massage and joint mobilisation, can help with pain management and mobility enhancement. Joint mobilisation can help to increase the range of motion and lessen pain, while massage can help to relieve muscular tension and promote circulation in the affected area.

Supplemental Therapies

For the treatment of Achilles Tendinopathy, a number of adjuvant therapies may be suggested in addition to physical therapy, stretches, and strengthening exercises. These could include:

- Dry needling, which uses acupuncture needles to create minor tissue trauma and bleeding to endorse the body's natural healing.

- Collagen supplementation, this has a growing amount of research supporting its use to promote collagen synthesis (building), especially when combined with a Physio prescribed specific loading program.

- Podiatry, if there are biomechanical considerations to the onset of Achilles tendinopathy, a review with your Podiatrist may be required.

Now Let’s Wrap All This Up

In summary, physiotherapy is a successful non-surgical method for treating Achilles Tendinopathy. Using a combination of strengthening and stretching exercises, manual therapy, and complementary therapies, the main objectives of physiotherapy treatment are to alleviate pain, enhance mobility, and avoid further damage.

Achilles Tendinopathy patients should collaborate closely with their physiotherapist to create a personalised treatment plan that takes into account their unique requirements and objectives. Achilles Tendinopathy patients might anticipate considerable improvements in their symptoms and general function with the appropriate physiotherapy care.

It's also critical to remember that treating Achilles Tendinopathy calls for a thorough, interdisciplinary strategy that may also involve other medical specialists including orthopaedic surgeons and sports medicine experts.

The greatest outcomes for those with Achilles Tendinopathy depend on early diagnosis and treatment. It is crucial to consult a physiotherapist as soon as you can if you are feeling symptoms including pain, swelling, and restricted mobility in the affected area.

In conclusion, physiotherapy is very important in the treatment of Achilles Tendinopathy since it can help patients feel better, move better, and avoid further injury. Achilles Tendinopathy sufferers can resume their regular routines and favourite hobbies with the correct treatment plan and dedication to their rehabilitation program. Contact Aevum Health today to see how we can help you live pain free!

References

1. Alfredson H, Cook J. Mid-portion Achilles tendinopathy management: novel therapeutic ideas. 2005;35(9):765-776. Sports Med

2. Cook JL, Khan KM, Taunton JE, and Bonar F A new paradigm for a challenging clinical problem: overuse tendinosis, not tendinitis, Part 1. Sports Medicine Physician 2000;28(3):38-48.

3. Sayana MK, Mobasheri A, and Bisset L. Review of current treatment for achilles tendinopathy and suggested future research. 2015;6(2):202–212 in World J Orthop.

4. Verhaar JA, Tol JL, Koes BW, and Van de Water AT. Surgical and non-surgical treatments are available for Achilles tendinopathy. 2013;(12):CD006857 in Cochrane Database Syst Rev.

Aaron Babb