Achilles tendonitis, tendinosis or tendinopathy is a very common condition caused by a multitude of physical things we do such as walking, running, jumping or dancing.

It is often seen in sports that require extensive running such as football, racquetball, soccer, tennis, volleyball as well as long distance running.

The most commonly known and used term – tendinitis – merely implies that the tendon is inflamed. In modern medicine the term tendinitis is viewed as less accurate in describing the condition.

Based on newer research the term Achilles tendinopathy is much preferred over tendinitis or tendinosis, which describes that there are actual deteriorative changes going on with the tendon.  The deterioration occurs through very small tears in the tendon and surrounding tissue mostly caused by overuse.

Unfortunately physicians often use these terms synonymously and frequently misdiagnose the condition of tendinopathy as tendonitis.

In addition, as more and more aging baby boomers are retiring while still trying to live an active lifestyle, a fair number of these seniors tend to be affected by this frequently painful and potentially debilitating disorder.  Achilles tendinitis often occurs when individuals do not ease into new athletic activities slowly and with the proper conditioning.

In younger people, a sudden or vigorous increase in athletic and/or physical activity resulting in overuse of the involved muscles and tendons is often the most likely cause of Achilles tendinitis.

For middle aged and older folks, on the other hand, arthritis commonly seems to be the culprit for an inflamed Achilles tendon, which can be further aggravated by a bone spur or other type of growth in the heel area.

Risk Factors that can Increase the Likelyhood of Achilles Tendinitis:

• Poor physical condition.
• Weak calf muscles and low endurance.
• Overweight condition.
• Stiff joints (possibly due to arthritis).
• Diabetes:  Diabetics are at an increased risk of developing Achilles tendonitis.
• Increasing Age (middle aged or older).
• Men tend to be more at risk than women.
• High intensity running athletes (training too hard, too fast or going too far too soon).

What is the Achilles Tendon?

It is the largest and strongest tendon of our body. It connects the calf muscles to the heel of the foot. Pain or discomfort in this area is most often caused by overuse rather than injury.  Pain can be felt in the entire area where the tendons are located or only along one affected tendon.

The majority of tendinitis injuries are caused by overuse, where the tendon actually rips away.  This can happen suddenly and may be felt as a popping sensation at the outside of the ankle area.  Surprisingly nearly one out of four cases of ruptured Achilles tendons are first misdiagnosed.

How Can You Tell if You could be Suffering from Achilles Tendinitis or Tendinopathy?

The majority of individuals with Achilles tendinopathy report symptoms of stiffness upon rising in the morning, which can usually be remedied with walking it off.  Most people also complain about tenderness when touching the affected area.

Some will feel a tender lump or a noticeable “clicking” when they are trying to rotate their ankle.  People always experience pain with this condition, which can vary in its intensity with each case. Sometimes the pain can also be more intense after a period of rest.

Examples of Tendinopathy, Tendonitis or Tendinosis Type Injuries:

• Achilles Tendon Rupture, Tendonitis or Tendinosis
• Adductor Tedinopathy
• Bicep Tendonitis
• Carpal Tunnel Syndrome
• Gluteal Tendinopathy
• Golfer’s Elbow
• Muscle Strain/Pain
• Injuries from Overuse
• Patella Tendinitis (Tendinopathy)
• Rotator Cuff Inflammation or Tear
• Repetitive Strain Injuries
• Shoulder Impingement or tendinitis
• Swimmer’s Shoulder
• Tennis Elbow

Characteristic Symptoms of Tendinopathy

• Stiffness, pain and weakness in the area of the affected tendon(s).
• Pain worsens with use of the tendon.
• Crunchy or clicking sound when using the tendon.
• Swelling, tenderness, redness or warm feeling if an inflammation is present.

Treatment for Tendonitis or Tendinopathy

Depending on the various degrees of inflammation, injury and degenerative damage, the plethora of treatment options for tendinopathy goes well beyond the intended scope of this blog post.

We will therefore only provide a list of the most common treatment options and focus more specifically on the potential benefits of compression and support therapy as one of the viable treatment options.

Some of the Most Common Treatment Options for Tendinopathy

• Avoiding H.A.R.M. factors (heat, alcohol, running and direct massage)
• Importance of early treatment of an injury
• Stabilization exercises
• Soft tissue injury treatment
• Acupuncture and Dry Needling
• Stabilization Exercises
• Gait Analysis
• Active Foot Posture Correction Exercises
• Proprioception and Balance Exercises
• Balance Enhancement Exercises
• Biomechanical Analysis
• Eccentric Strengthening Program
• Sport-Specific Exercises
• Medications
• Brace or Support
• Heat Packs
• Soft Tissue Massage
• Kinesiology Taping
• Running Analysis
• Strength Training
• Stretching Exercises
• Joint Mobilization Techniques
• Supportive Taping and Strapping
• And last but not least Compression Therapy

How can Compression be Helpful in the Treatment of Tendinopathy Pain?

Compression can provide a two-fold benefit.  Compression bandages, wraps or stockings can help to reduce swelling and possible bleeding in the area of the Achilles tendon.

Just as importantly, compression garments or wraps provide the necessary support for the ankle area and the lower part of the leg. It is recommended to use elastic compression bandages that are wide and firm to get good coverage of the lower leg and ankle.

According to the Mayo Clinic, wraps or compressive elastic bandages are best to compress the area until swelling has stopped because swelling can result in loss of motion in an injured joint.

The most often recommended and well-known early treatment approach for tendon injuries is the so-called R.I.C.E.R. treatment:

“R” represents resting the affected tendon. The rule of thumb is to avoid things that will reproduce the pain for at least two or even three days. Beyond three days it is usually recommended to start some type of movement exercises as recommended by a physiotherapist or other specialist.

“I” stands for ice, which is the most urgent part of the treatment because the early application of ice helps to reduce swelling, pain and possible bleeding.

“C” stands for compression.  This involves applying compression to the affected area with an elastic bandage, wrap, sleeve or compression stocking to help reduce soreness, swelling and inflammation.

“E” stands for elevation of the affected leg.  To prevent swelling it is most helpful to rest the injury above the level of the heart.  In some cases that may not be possible or detrimental depending on the injury, so proceed with common sense and under the guidance of a physician or specialist.

“R” stands for a referral to a qualified specialist and/or therapist.  If in doubt, always seek medical attention, especially in the event of more severe injuries such as snapped, torn or dislocated tendons.  In some instances surgery may become necessary to repair the tendon damage and possibly the supporting structure of the foot.  Surgery is considered if physical therapy and bracing will not strengthen the muscle and tendon to a point where the range of motion is improved and restored.

What you could be Risking if You Do Nothing About Your Injury?

Medical research has shown that untreated injuries have a tendency to take much longer to heal.  They can also cause persistent and ongoing pain and are more likely to happen again.

Injuries that are not addressed early on and treated properly can leave you with muscle weakness, stiffness in the affected joint and the formation of abnormal scar tissue.

Last but Noteworthy – Some Helpful Tips for Training and Exercise:

Training should be varied by incorporating different times, speeds and distances during the training.

This conditions the tendons to adjust to the different load levels that are applied.

Training and exercise should also be fun.

Cross training between different sports like swimming, cycling, pilates, weight exercises, rowing, aerobics, circuits and spin classes as well as other alternative sports  can help to distribute the strain and load put on the body while lowering the risk of injury at the same time.

Pace yourself with increasing performance (e.g. lengthen running distance by 10% each week).

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