Case Studies

What is Achilles tendinopathy?

Achilles tendinopathy is a condition where the patient complains of pain/dysfunction in one or both Achilles tendons. It often happens after a change in the tendon loading which could be a change of training surface or a change in intensity or volume of training. It is often called tendinosis or tendinitis although these are slightly different aspects of the same issue. Tendinopathy can be sudden onset (‘reactive’) or a gradual onset which is often referred to as ‘chronic’.

The Problem

Our client, a female, keen triathlete, in her late 20’s, presented with pain in her Achilles’ tendon which came on a couple of days after she had increased the intensity of her running and had introduced some hill-runs. She had never injured her Achilles before and was very anxious as she had a race in 3 months time.

This is a common presentation and one that recovers well.

The Solution

In a patient suffering their first episode of Achilles pain it is important to reassure them and educate them on why it may have happened. Following assessment, we had to deal with the immediate issues of a painful, slightly swollen tendon that was affecting her walking. She was educated on ‘what not to do’ which is often important in patients who have been doing the wrong things to settle their problems. She was told ‘no stretching and no direct massaging of the tendon’ and also advised that complete rest was not the answer. She was advised, via her GP, to begin a short course of Ibuprofen and was shown daily isometric (static) heavy loading for her tendon which she found pain free and immediately helpful. From there she was shown a graduated slow-heavy strength programme as she had a deficit in her calf capacity on the injured side and educated on progressing to hill-runs slowly.

The Result

After 3 weeks she was pain free and had moved to her slow-heavy programme. As her issue was a ‘reactive’ tendinopathy, she was able to settle it quickly and getting prompt advice made a big difference. She got back to her running programme in 7 weeks and this time she very gradually introduced changes to her volume/intensity as well as knowing she had addressed the underlying strength issue. She competed in her race on week 12 with no reaction.

Achilles’ tendinopathy can present in a variety of ways in different cohorts of people, whether they are a good level athlete or not. Early assessment is always advised from a qualified clinician.