Achilles Tendinopathy
Achilles tendinopathy is a common condition characterized by pain, stiffness, and swelling in the Achilles tendon, typically resulting from overuse, poor biomechanics, or inadequate recovery following physical activity. The condition can be classified into two types: insertional tendinopathy (where the tendon attaches to the heel bone) and mid-portion tendinopathy (occurring higher up the tendon). Achilles tendinopathy affects approximately 2-3 per 1,000 people annually in the general population. It is a significant issue among athletes, particularly those involved in activities that require running and jumping.
Symptoms include:
- Pain and stiffness in the Achilles tendon, particularly in the morning or after periods of inactivity.
- Swelling and thickening of the tendon.
- Pain that worsens with activity, especially running or jumping.
- Limited range of motion in the ankle.
Causes of Achilles Tendinopathy
Achilles tendinopathy is primarily a result of mechanical overload or repetitive microtrauma to the Achilles tendon. Several factors contribute to the onset and progression of this condition, including intrinsic tendon-related factors, extrinsic factors related to activity and training, and systemic conditions:
- Repetitive Overuse and Mechanical Load, such as Chronic overload or sudden increase in activity
- Biomechanical Abnormalities, including abnormal foot mechanics, leg length discrepancies and poor ankle dorsiflexion
- Age-related degeneration including tendon degeneration or creased healing capacity
- Training Errors and Inappropriate footwear
- Previous Injury and Tendon Weakness
Interventions
Treatment Options include Physical Therapy, exercises and conservative treatments. Medical and Surgical Modalities such as (NSAIDs), Corticosteroid Injections or Platelet-Rich Plasma (PRP) Therapy can be recommended as part of a treatment plan. Prolotherapy involves injecting an irritant solution, typically dextrose, into the tendon to stimulate the body’s healing response. The goal is to promote tissue regeneration and strengthen the tendon over time.
SHOCKWAVE THERAPY
There are a variety of studies supporting the use of ESWT in the treatment of Achilles tendinopathy. A study by Stania et al (2023) aimed to subjectively and objectively determine the therapeutic efficacy of radial shock wave therapy (RSWT) and ultrasound (US) therapy in non-insertional Achilles tendinopathy. The findings were that RSWT provided significantly greater improvement of VISQA-A scores than US therapy and also more efficient postural control in standing. Paantjens et al (2022) carried out a systematic review of Randomised Control Trials to consider the outcomes of using Shockwave Therapy for both mid portion and Insertional Achilles tendinopathies. The findings showed that there is moderate evidence supporting the effectiveness of Shockwave Therapy in addition to a tendon loading program in mid-portion tendinopathies. Evidence supporting the effectiveness of Shockwave Therapy for Insertional Achilles Tendinopathies is still unclear.
High Intensity
Photobiomodulation Therapy (PBMT)
This has been shown to be very effective in addressing pain and improving function in a variety of conditions. A study by Tumilty at al (2016) considered the use of High Intensity PBMT when combined with eccentric exercise for Achilles Tendinopathy. The conclusion was that the best results were obtained when a combined protocol of twice a week eccentric exercise plus high intensity PBMT were prescribed.
Ultrasound Therapy
Therapeutic ultrasound is used to deliver sound waves to the Achilles tendon, which can help increase blood flow and reduce inflammation, promoting faster healing. Ultrasound therapy is often combined with other treatments, such as stretching and strengthening exercises.