Achilles Tendinopathy: An Injury For Life?

It is no accident that the Achilles tendon is so named. The term for the thick sinewy tendon running down from calf to foot is a permanent reminder of its vulnerability. The Achilles heel, for those whose Greek mythology needs a little recap, derives from the legend in which Achilles’ mother, the sea nymph Thetis, dipped her baby son into the River Styx to render him invulnerable, protecting him against his many foes. He became a great hero, but was finally felled by an arrow through his heel – the spot where his mother had held him while she dipped him in the river and therefore his sole spot of vulnerability. Thus we have “Achilles’ heel” to indicate someone’s weak spot….

It is, and for all athletes should be, a constant reminder to treat the Achilles with great respect. If you don’t, as our writers in SIB underline this month, you could gain an injury for life.

Remember just a few short months ago, the sad images of the wonderful Chinese hurdler Liu Xiang, as he hobbled away from the track, bowing out of his Olympic challenge? It turns out that Liu had been battling with his Achilles tendinopathy on and off for years, and it had flared up at exactly the wrong moment.

It’s not just Olympic hurdlers who are at risk. As our authors write: “Achilles tendinopathy is a common injury in running, jumping, tennis and other racquet sports, and in team sports such as football. It has a lifetime cumulative incidence of 50% among elite endurance athletes.”

Which all adds up to a lot of Achilles injury.

All the more surprising then, that it has taken a long time for sports medicine to get to grips with the true nature of tendinopathies. We have come a long way from the days when we talked in terms of swollen tendons (tendinitis) being treated with a hot pack and stretching. Yet, even though we know much more about what is going on, neither the science nor the prescriptions are as yet definitive. So the sports therapist needs to remain on top of this subject.

As Chris Mallac explains in our in-depth coverage in the new SIB, there are two good reasons why an Achilles tendinopathy is no short-term injury:

* it is adaptive changes within the tendon -- new collagen growth and blood vessel invasion – that cause the pain, so by the time the athlete is aware of the problem, most of the damage has already been done;
* the damaged tissue will be functionally weaker and will remain permanently “Type 3” collagen; thus it is more susceptible to reinjury than the original Type 1 collagen fibres it replaces.

Our spotlight on Achilles tendinopathy this month brings you a clear explanation of exactly what medical science now knows about this injury and the pain it causes, as well as Chris’s practical advice for therapists on how to manage their athletic clients’ rehab. Once you’ve read SIB on tendinopathies, you’ll never again talk about “tendinitis” or recommend simple calf stretches as the way to go. Chris Mallac’s practical guide covers aspects such as:

* essential information the therapist should share with their client
* why morning stiffness is such a pain for Achilles tendinopathy
* why ice beats heat for relief
* why and how eccentric-loading exercises work in rehab…
* …and the limitations of this treatment
* self-massage techniques for the injured client