CSA Physio Blog

I have Achilles Tendonitis! (No you don’t. And stop stretching)

Posted on: April 21st, 2019 by Jeffrey Begg

Tendons are phenomenal structures. Our understanding of them has grown immensely in the past 25 years. In fact the proper care for tendon injuries has changed more in that time than perhaps any other injury that is commonly seen in physiotherapy. The Achilles tendon is particularly unique and notoriously difficult to treat when injured. Here are a few points worthy of note if you are suffering from Achilles tendonitis / tendinosis.

  1. Swelling is rarely a factor. Tendonitis indicates inflammation is involved. That is only the case if your tendon took a direct blow (like a hockey stick to the back of the ankle: ouch!) More often, the tendon hurts without any significant trauma to it. And inflammation is not the key problem.
  2. Most cases involve degenerative changes in the tendons that are more properly termed tendinosis. That means the tendon is unhealthy, but not primarily because of inflammation.
  3. “So what?” Well, there is no need to apply ice to a case of tendinosis. Keep those ice packs in the freezer.
  4. “But my tendon is way thicker than the other one.” Well, yes, but that thickening is due to a collection of fluid and cells within the tendon, not inflammation. You need to manage it differently than inflamed tissue.
  5. Achilles tendinosis is always due to overload: you’ve done something to apply more strain than the tendon can bear. Perhaps climbing way too many stairs in one day, a long hike uphill, or too much running mileage all at once. The problem never comes out of nowhere.
  6. It is not”tightness” of the tendon that is the issue: it’s overload. So removing the load on the tendon is the most important thing, not stretching it
  7. “So I should keep load off my tendon from now on? How?” Well, yes, when it is flared up there are certain things to avoid. But once it settles, you have to start to apply load to the tendon to train it back to normal. That part take some specific advice on exercises.
  8. “You mean eccentric exercises?” Well, yes, sometimes, and no other times. It depends on which of the two types of tendinopathy you have. If this is starting to sound complex, you’re right. It is. And this is where your physiotherapist comes in.

The key to resolution of Achilles tendonitis / tendinosis is a thorough examination and appropriate treatment plan, individualized to you, being the unique individual that you are. Managing painful tendons often takes good physiotherapy advice. What are you waiting for?

Jeff

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