Pain is a symptom. Symptoms are the feedback that the body generates when it faces problems with its delicate internal balance (homeostasis). Without symptoms like pain, thirst, nausea and fevers, it would be very difficult for us to maintain a healthy body in the same way that it would be hard to drive a car safely with no dashboard display.
What is Achilles Tendinopathy?
Many people experience problems with their Achilles tendon. 24% of athletes suffer Achilles injuries at some point in their lives. As we progress in age, we are more prone to Achilles issues, and men are three times more likely to have an Achilles rupture than women. The Achilles is a common tendon, and it is one where three different muscles merge, gastrocnemius, soleus, and the lesser known plantaris. It is the strongest tendon in the body, and works a bit like a spring. When it is stretched during running as the heel hits the ground, it stores energy that is released as we push off the foot minimising the work the muscles have to do.
Causes of Achilles Tendinopathy
The most common issues that cause Achilles tendon pain are insertional tendinitis, mid-body tendinitis, and paratenonitis.
Insertional tendinitis refers to pain around the Achilles attachment to the heel bone, the calcaneus.
Mid-body tendinitis affects the Achilles tendon further up, closer towards the calf muscles.
The paratenon is a thin sheet of elastin rich cells surrounding the tendon, bundling the tendon collagen fibres into a unit that still allows movement in between.
This is where paratenonitis occurs. When it gets inflamed, excess fibrin causes adhesions. In a chronic condition, this is a form of scar tissue, less of the healthy collagen type I and too much scar-like collagen III.
How Can I Help Achilles Tendinopathy?
Traditional management of Achilles pain includes reducing activity, non-steroidal anti-inflammatory drugs, physiotherapy (eccentric stretching exercises, progressive tendon loading), change of aggravating footwear.
Extracorporeal Shockwave Treatment
Extracorporeal shockwave treatment has proven to reduce pain by 60% in persistent tendinopathies without the side effects and risks of surgery. Nevertheless, surgery does have its place in extreme circumstances and is the recommended form of treatment if the tendon is ruptured by at least half. Surgical Therapy has about 80% of success but also depending on the study, up to 40% complications.
Early treatment of Achilles tendon pain promises better outcomes.
Extracorporeal shockwave was initially used to break up kidney stones and has since shown impressive outcomes for musculoskeletal complaints, including achilles and other tendinopathies. It is also commonly used to treat tennis or golfer’s elbow, rotator cuff tendinopathy, plantar fasciitis, and Morton’s neuroma . Shockwave therapy improves blood flow to the painful area, breaks up adhesions, facilitating the natural healing process. Another affected pathway is on the pain perception through activating serotoninergic systems increasing the pain threshold on a chemical level. See Effectiveness and Safety of Shockwave Therapy in Tendinopathies here
In clinical practice, as a rule of thumb, we believe the longer you leave it and put up with your pains and niggles, the longer it will take to get rid of them. Seeing an expert early, and not giving up if the physio exercises did not get you the promised result will more than likely eventually get you over the finish line.
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John is one of those rare gentlemen who has continued to play competitive soccer well into his late 50s. He is in really good shape, which you need to be to play football at that age—good shape except for his left leg. His left leg is not in good condition at all. In fact, once you get to know his left leg a bit better, it becomes apparent that it’s miraculous that he’s able to run at all, Let alone the type of running required to play competitive soccer against younger men.