Achilles Tendinopathy: Understanding the Cause of Your Heel Pain and How Osteopathy Can Help
Pain in the back of your heel or along your Achilles tendon can be a significant setback for active individuals. Known as Achilles tendinopathy, this condition involves the thick, powerful tendon that connects your calf muscles to your heel bone. It's a common injury that, without the right approach, can become persistent and frustrating.
Osteopathy offers a comprehensive and evidence-informed approach to managing Achilles tendinopathy. We focus not only on the painful tendon but on the entire musculoskeletal system to identify and correct the underlying factors that led to the problem.
Key Facts About Achilles Tendinopathy
A Degenerative Condition: Achilles tendinopathy is primarily a condition of failed healing and degeneration within the tendon, rather than acute inflammation (which is why the older term "tendinitis" is less accurate).
Common in Active Adults: It frequently affects runners, court-sport athletes, and "weekend warriors" between 30 and 50 years of age.
Load-Related: It is fundamentally a condition of mismatched load—when the stress placed on the tendon exceeds its capacity to recover.
Common Causes and Risk Factors
Achilles tendinopathy is typically an overuse injury. Key contributing factors include:
Sudden Increase in Activity: A rapid uptick in running volume, intensity, or frequency, or a return to sport after a period of inactivity.
Poor Biomechanics: Issues such as weak calf muscles, poor hip stability, or excessive foot pronation (rolling in) can alter how forces travel up the leg and increase strain on the tendon.
Tight Calf Muscles: Reduced flexibility in the gastrocnemius and soleus muscles places excessive tension on the Achilles tendon.
Inappropriate Footwear: Shoes with poor cushioning or support, or a sudden switch to minimalist footwear.
Training on Hard or Uneven Surfaces: Consistently running on concrete or cambered roads can contribute to overload.
Systemic Factors: Certain medications (e.g., some antibiotics) and medical conditions can sometimes influence tendon health.
Common Signs and Symptoms
Pain and Stiffness: Pain along the tendon (2-6cm above the heel bone) or at its insertion on the heel, which is often worst upon taking the first steps in the morning or after periods of rest.
Localised Swelling and Thickening: The tendon may appear thickened and be tender to touch.
Pain with Activity: Pain that worsens during or after activity, particularly with running, jumping, or pushing off on the affected leg.
Warmth: The area may feel warm due to increased blood flow associated with the healing process.
How Can Osteopathy Help with Achilles Tendinopathy?
Osteopathic management is tailored to the stage of your tendinopathy. The primary goals are to manage pain, gradually restore the tendon's load-bearing capacity, and correct the biomechanical faults that contributed to the injury.
During your initial consultation, we will:
Take a detailed history of your pain, training habits, footwear, and daily activities.
Perform a physical examination to assess the tendon's health, your calf strength, and ankle range of motion.
Conduct a biomechanical assessment of your posture, gait (how you walk/run), and the function of your feet, knees, and hips.
This holistic assessment is vital because a problem in your hip or foot can directly increase strain on your Achilles tendon.
What Does Osteopathic Treatment Involve?
Using a range of gentle, hands-on techniques, we aim to:
Reduce Pain and Muscle Tension: Soft tissue massage and myofascial release techniques are used to relax tight calf muscles and improve circulation around the tendon.
Improve Joint Mobility: Gentle mobilisation of the ankle, foot, and even the knee and hip joints can restore normal mechanics, ensuring forces are distributed evenly up the leg.
Address Contributing Factors: We treat dysfunctions in other areas that are altering your movement, such as stiff joints in your foot or poor pelvic stability.
Provide Personalised Advice and Rehabilitation: This is the cornerstone of recovery. You will receive guidance on:
Load Management: How to modify your activity to allow the tendon to heal while maintaining fitness.
Tailored Exercise Program: A progressive, evidence-based rehabilitation program is essential. We will guide you through specific exercises, such as eccentric heel drops, to gradually strengthen the tendon and restore its capacity to handle load.
Footwear and Orthotic Advice: Recommendations for supportive footwear and, if appropriate, discussion on the potential role of heel lifts or orthotics.
Stretching and Strengthening: A balanced program to address muscle tightness and weakness throughout the lower limb.
When to Seek Immediate Medical Help
It is crucial to get a correct diagnosis. Please consult your GP or seek urgent care if you experience:
A sudden "pop" or "snap" in the back of your calf or heel, which may indicate a tendon rupture (often accompanied by an inability to stand on your toes).
Severe pain and an inability to bear weight on the leg.
Signs of infection, such as fever, significant redness, warmth, or swelling around the tendon.
Numbness or tingling in your foot.
Your GP can confirm the diagnosis and rule out other conditions, such as a partial or complete tendon rupture, which requires different management.
Take the Next Step Towards Recovery
Achilles tendinopathy can be a stubborn condition, but with a structured and patient-centred approach, recovery is highly achievable. Osteopathy provides a safe, non-invasive pathway to not only alleviate your pain but also to address the root causes and empower you with a long-term strategy for tendon health.
Click here to schedule an appointment with one of our experienced osteopaths. Let us help you get back to moving with strength and confidence.
References
*Martin, R. L., Chimenti, R., Cuddeford, T., et al. (2018). Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018. Journal of Orthopaedic & Sports Physical Therapy, 48(5), A1-A38. [Link: https://www.jospt.org/doi/10.2519/jospt.2018.0302]*
*Silbernagel, K. G., Crossley, K. M. (2015). A proposed return-to-sport program for patients with midportion Achilles tendinopathy: rationale and implementation. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 876-886. [Link: https://www.jospt.org/doi/10.2519/jospt.2015.5885]*
Australian Institute of Health and Welfare (AIHW). (2020). Musculoskeletal conditions. [Link: https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions]
Disclaimer: This blog post provides general information only and is not intended as a substitute for professional health advice, diagnosis, or treatment. Always consult a registered health practitioner, such as your General Practitioner (GP) or osteopath, for diagnosis and treatment of health conditions. The information provided is based on the best available evidence at the time of publication but should not be relied upon as a sole source of information. Individual results from osteopathic treatment may vary based on the individual’s specific condition and response to care. The exercise rehabilitation component, particularly progressive tendon loading, is crucial for managing this condition, and adherence to a tailored program is essential for optimal outcomes.