Problem
Achilles tendinopathy is pain swelling in the heel cord at the back of the ankle. The onset is usually gradual, relating to small minor injuries or microtrauma.
Sometimes the tendon feels stiff and sore at the start of a run but eases with use. You get out of bed and hobble for the first few steps.
Firstly how bad is it?
If your pain is only a 2-3/10 and settles within 72 hours then rest is not the answer. A pain scale is 0 = no pain and 10/10 = excruciating, worst pain ever. If the tendon has been niggling for a while, then the tendon is not inflamed but in poor condition. The tendon improves by steadily increasing the loading – you may have just battled on making it worse until you can’t function properly.
Stiffness
Test for ankle stiffness by standing facing the wall pressing the knee forward over the foot towards the wall. Are right and left the same?
Strength
Can you stand on one leg and raise your heel high for 10-15 repetitions evenly right and left?
Solution
This problem is usually a combination of a few factors. The treatment programme for this is a specialised strengthening programme carried out over 12 weeks to allow the tendon to improve. Activity can be introduced or maintained alongside this, using the guidance of 2-3/10 on a painscale and allowing the tendon to settle between activityies. If the tendon pain is aggravated for longer than 72 hours, you did too much – distance, speed or terrain.
