Achilles Tendon Pain: Rehab, Pain Management & The Severs Sleeve
Achilles tendinopathy is a common condition that affects the Achilles tendon, a thick band of tissue connecting your calf muscles to the heel bone. As a condition most often caused by repetitive stress, it frequently occurs during and after activities such as running, jumping, and repetitive walking. The stress to the tendon results in an inflammatory response that can't be regulated effectively by the body's healing system.
Identifying the Cause
The condition occurs when the tendon, which lacks blood vessels and nutrient supply, is used beyond its capacity, and the natural internal repair mechanisms can't keep up with the demand placed upon the tendon. This often occurs when there is a greater than 10% increase in exercise over a short period of time. This repetitive stress causes collagen (the body's intracellular glue-type material) to be deposited in inflammation cycles, which can lead to thickening, but not strengthening. Over time, the tissue becomes hard and scar-like, losing the ability to absorb and distribute the tension applied to it.
Diagnosis of Achilles Tendinopathy
A diagnosis of Achilles tendinopathy typically involves your physiotherapist or podiatrist performing a physical and biomechanical examination of the affected area.
Common signs and symptoms include pain during or after exercise, aching and stiffness when stationary for long periods or after sleeping and tenderness to touch at the middle of the tendon or the attachment to the heel bone. Walking on the toes or stretching may help relieve pain, but the benefit is often temporary.
Your health professional may also recommend imaging tests, such as an ultrasound or MRI, to confirm the severity and grading of the pathology.
Stages of Achilles Tendinopathy
It's commonly understood that there are three stages of Achilles tendinopathy.
Reactive tendinopathy, as the name suggests, occurs as a reaction to a sudden increase in activity load to the tendon. The tendon is unable to manage this increase effectively, leading to inflammation and pain. Pain most often arises two weeks after an increase in activity.
Dysrepair tendinopathy commonly develops between 6 and 12 weeks of unregulated loading of a painful tendon. The pain and stiffness will ease initially with exercise, but worsen again as you continue. Pain is likely to persist after exercise, even into the night. The Achilles will take longer to warm up after periods of rest, making it stiffer and more painful.
Degenerative tendinopathy occurs when the condition has been mismanaged for 3-6 months. All activities cause pain, including standing and walking. If not well managed, sudden onset or dynamic movements could cause the tendon to tear or rupture.
This infographic, taken and modified from Dr Jill Cooke’s research on tendinopathies, demonstrates how a tendon responds to excessive and suitable loading.
Bracing Challenges and The Solution: The Severs Sleeve
Bracing solutions for Achilles tendinopathy have been a challenge due to the tapered shape of the calf and the variation in people's calf sizes. The best option, until now, has been rigid strapping tape. However, repetitive use of rigid strapping tape irritates the skin, which negatively impacts Achilles tendinopathy rehabilitation.
A good brace should be comfortable, assist the healing phase of the inflammatory tissue response, deload the tissue to reduce pain, and facilitate an earlier return to pain-free activities. That's where the 'Severs Sleeve' comes in. This product addresses all the pain points of conventional solutions. Its patented design allows users to comfortably adjust the brace to offload the Achilles tendon to varying degrees, depending on their daily pain level, exercise and movement requirements. Most importantly, as the Achilles tendon progressively heals, the 'Severs Sleeve' is designed to be required less. Its primary function is to provide support in the early stages of recovery, allowing for a faster integration back into desired activities. As time goes by and your tendon strengthens, you'll find yourself needing the 'Severs Sleeve' less and less. For more information on 'The Severs Sleeve', please click the link and find out if it's the right choice for you.
The Path to Recovery: Exercises for Achilles Tendinopathy
Different exercise strategies are crucial to facilitate your body's natural healing of the Achilles tendon. Below, we outline a few beneficial exercises and provide guidelines for safely incorporating them into your recovery plan. As with any online advice that is non-specific, always consult a registered health practitioner such as a physiotherapist or podiatrist.
Isometric Exercise: A timed and sustained tissue contraction, such as a body-weighted calf raise. This controlled strain force prompts the tendon to recondition at a more tolerable load for sustainable periods. A good starting point is three sets of 45-second holds with a 2-minute rest between each set, performed once to twice daily.
Eccentric Exercise: A slow lengthening of tissue while it contracts against force, such as lowering your heels down from a calf raise. This exercise places greater strain on the tissue, prompting it to recondition to a greater degree than with isometric exercises. It is often recommended after isometric exercises are tolerable, as it increases the micro-tear ratio per repetition, which builds tissue size. A common program involves three sets of 15 repetitions, with a 2-minute rest between each set, performed once to twice daily.
Concentric Endurance Exercise: The shortening phase of tissue contraction, used over many repetitions, aims to build endurance and oxygen utilisation in the tissue. Standard protocols involve three sets of 15 calf raises on a flat surface, with a 2-minute rest between each set, performed once to twice daily.
Plyometric Exercise: A rapid stretch and rebound contraction exercise, such as jumping from a box to the ground, and immediately jumping forward to land as far forward as you can. These should only be incorporated when the tendon can tolerate the high load and speed of plyometric activity without pain.
Returning to Sports/Full Exercise
Your health practitioner will test the capacity of the Achilles tendon to help determine when you should return to sport/exercise. This may involve various tests such as the 'Knee To Wall' test, Pain-Free Squatting, Pain-Free Countermovement Jumps, and Single Leg Hops. To return to training, the test results should indicate that there is less than a 20% difference between the injured and non-injured side. To return to sport, the test results should indicate less than a 10% difference.
In conclusion, navigating Achilles tendinopathy can be a challenging journey. However, with the right knowledge about the condition, an effective treatment plan including a well-planned exercise regimen, and supportive aids like the ‘Severs Sleeve’, you can successfully rehabilitate your Achilles tendon and return to your regular activities. Remember to engage with a healthcare professional to guide you on your path to recovery.
From Pain to Performance, the journey is yours to undertake.
The Orthopaedic Sleeve Society (TOSS)