Ask A Physical Therapist
- 08 Feb - 14 Feb, 2025
Q: Doctor please guide about Achilles Tendinopathy.
A: Achilles tendinopathy is a condition characterized by a series of pathological changes in the Achilles tendon, primarily resulting from overuse and chronic stress. This condition can affect both athletes and non-athletes alike, highlighting its broad impact. The Achilles tendon, located at the back of the ankle, connects the calf muscles to the heel bone and plays a crucial role in walking, running, and jumping. When subjected to repetitive strain or excessive load, it can undergo degenerative changes, leading to Achilles tendinopathy.
One of the critical factors contributing to the development of Achilles tendinopathy is a lack of flexibility or stiffness in the Achilles tendon. When the tendon is not sufficiently flexible, it cannot adequately absorb the stresses placed upon it during physical activities, increasing the risk of injury. This condition may or may not be associated with a partial or complete tear of the Achilles tendon, further complicating the diagnosis and treatment.
When surgical specimens of affected tendons are examined, they reveal a range of degenerative changes. These changes include disorganization of collagen fibers, increased ground substance, and the presence of abnormal blood vessels and nerve fibers. These pathological changes can weaken the tendon, making it more susceptible to further injury. Several known risk factors are associated with the development of Achilles tendinopathy, including:
Obesity: Excess body weight places additional stress on the Achilles tendon, increasing the likelihood of injury.High blood pressure: This condition can affect blood flow to the tendon, impairing its ability to heal and recover from stress.
Rapid changes in load: Sudden increases in physical activity or changes in exercise intensity can overwhelm the tendon, leading to injury.Type II diabetes: This metabolic disorder can affect the health of tendons and other connective tissues, making them more prone to injury.Prolonged steroid use: Long-term use of corticosteroids can weaken tendons and increase the risk of tendinopathy.
Family history of tendinopathy: A genetic predisposition to tendon injuries can increase the likelihood of developing Achilles tendinopathy.Other contributing factors include wearing inappropriate footwear, which can alter the mechanics of the foot and increase stress on the Achilles tendon, and aging, as the tendons become less elastic and more prone to injury with age.
Morning pain is a hallmark symptom of Achilles tendinopathy. This pain occurs because the Achilles tendon must tolerate a full range of movement, including stretching, immediately after getting up in the morning. The pain is typically localized to the tendon and the immediate surrounding area, making it easier to identify the affected region.
While swelling and pain are less common symptoms, the tendon may exhibit subtle changes in outline, becoming thicker in both the anterior-posterior (A-P) and medial-lateral (M-L) planes. These changes can be detected through physical examination or imaging studies, such as ultrasound or MRI.
In individuals with Achilles tendinopathy, a sensitive zone within the tendon may be present. This zone, combined with intra-tendinous swelling, can move along with the tendon and exhibit varying sensitivity depending on the amount of pressure applied. When this sensitivity increases or decreases with pressure, it strongly indicates tendinosis, a specific type of tendinopathy characterized by degenerative changes within the tendon. The affected side of the tendon often shows a larger diameter, higher stiffness, and lower strain compared to the non-affected side, further confirming the diagnosis.
Effective patient counseling in physical therapy for Achilles tendinopathy should address several key elements:Theories supporting the use of physical therapy and the role of mechanical loading: Educating patients on how physical therapy can help alleviate symptoms and promote healing through controlled mechanical loading of the tendon.
Modifiable risk factors, including body mass index and footwear: Emphasizing the importance of maintaining a healthy body weight and selecting appropriate footwear to reduce stress on the Achilles tendon.
Typical time course for recovery from symptoms: Providing realistic expectations regarding the duration of recovery and the importance of adhering to the prescribed treatment plan.By addressing these aspects, physical therapists can help patients manage their symptoms more effectively and reduce the risk of recurrence.
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