Achilles Tendinopathy In Older Athletes
Achilles Tendinopathy is a common overuse injury especially for older athletes, normally the issue becomes chronic (> 6 months) due to its difficult nature to treat, we see it a lot here at The Physio Movement.
Achilles Tendinopathy has been traditionally a difficult injury to treat because the underlying cause was seen to be an inflammatory response, which has caused conservative treatment to revolve around the “inflammatory response” where’s now Achilles Tendinopathy is correctly labeled as a Tendinopathy, changing the fundamentals in how is it dealt.
3 common ways in which a Achilles Tendinopathy will present
1. Tendinosis: Degeneration condition where the fibers within the tendon have changed structure (think cooked spaghetti vs uncooked spaghetti), development of blood vessels within the structure, poor healing response and lack of inflammatory cells
2. Paratenonitis: acute or chronic inflammation in the Paratendon, a structure of gliding membranes that enable the Achilles tendon to move freely with the surrounding tissues, characterized by significant fluid build-up with inflammatory cells and push
3. Partial tendon rupture: Large degenerative changes in tendon, blood vessels and paratendon.
One of the risk factors for Achilles Tendinopathy is incorrect loading of the tendon, generally seen through error in sports training or progression that is too rapid. There are other proposed risk factors but many of these don’t have a significant body of evidence to reproduce these findings.
Unfortunately this leaves a lot of ambiguity as to what to avoid. General advice would be to stick to classic periodization principles and have a qualified or experience sports trainer.
Currently the best form of conservative therapy (non-surgical) is a eccentric training program, while there is still not a set standard as to what is the correct frequency, duration and speed of the exercises what have been suggested in studies is approx. 12 week program, with the speed and intensity of the exercises to be reflective of the person’s activities and goals, therefore an eccentric exercise program would be seen to vary from a long-distance runner vs a sprint/jumper will vary.
Why are eccentric exercises an effective physical therapy for Achilles Tendinopathy?
The exact mechanism as to why eccentric calf raises are the most effective is still not completely understood; previous studies have suggested that there is greater tendon magnitude during eccentric vs concentric. A recent study interestingly found that throughout the movement the magnitude alone was not significantly different, and in fact found both magnitude and length change to be the same. What their study suggest that in fact it may be the fluctuations in force during the eccentric exercise that may be responsible, the implications of this they stated was that the faster the eccentric phase was the greater the fluctuations, potentially leading to eccentric exercises done at a certain speed for optimal results rather than very slow heavy loading.
