Achilles tendon pain
What is Achilles tendon pain?
Achilles tendinopathy is very common among people involved in running and running sports with about 50% of middle and long-distance runners experiencing it at some point in their lifetime. It is also common among those who are less active, affecting all ages and backgrounds, with a high prevalence in people between 40-60 years old. 1 in 3 people with achilles tendon pain report symptoms affecting both legs.
Achilles tendon pain can have a profound impact on quality of life, affecting one’s ability to simply walk without pain, undertake social activities, work and hobbies. The good news, however, is that the condition is very rarely serious and there are things that you can do to set you up for a successful recovery.
The Achilles tendon is the combined tendon of the two calf muscles, the gastrocnemius and soleus. Despite being the strongest tendon in the body, it can sometimes be irritated, which causes discomfort and pain.
Symptoms may include:
- Pain at the bottom of the calf muscle, along the actual tendon, or lower down near the heel bone.
- Stiffness and swelling on the back of the heel.
- The tendon might be tender to touch, swollen or thickened in appearance.
- The area will also often feel stiff first thing in the morning or after a period of inactivity (for example when arising after sitting for a while.)
- Activities such as walking or running may be painful.
- Pain, felt when starting an activity, often eases but then can increase if continued or when finished.
Factors that may play a role in the development of achilles tendon pain include:
- A sudden increase or change in activity levels. For example, this may be an increase in running training volume or walking (e.g. longer, faster or hillier walks)
- Tight or weak calf muscles
- Certain health conditions such as diabetes and high cholesterol
- Being overweight, particularly weight around the middle
- Menopausal changes in women aged 40 to 60.
- An inactive, sedentary lifestyle
- Smoking
- Tendon pain can be triggered by life changes, including periods of stress, illness or the feeling run down.
Call 999 or go to A+E if:
- You cannot bend the foot downward or “push off” the injured leg when walking.
- You cannot stand on the toes on the injured leg.
- You heard a popping or snapping sound alongside immediate pain.
- It felt like you’d been kicked in the calf at the time of injury.
- Your calf is red, hot, swollen or tender to touch.
- You have achilles pain and feel generally unwell and have a high temperature or feel hot and shivery.
6 facts about Achilles tendon pain
Rupture among people with Achilles tendon pain is rare. The majority of people who tore their achilles tendon, never had achilles tendon pain. Tendon rupture and tendon pain are 2 different things, affecting different groups of people. Tendons are strong and even though it feels painful, it is not fragile.
It is ok for it to be sore during exercise as you are training a sore area. Tendons need time to adapt to new activity. Be regular and patient with training and gradually building up over time.
Tendons love heavy and hard progressive loads. Evidence shows that loading the tendon (strengthening exercises which challenge the tendon) is the best treatment for this condition.
Research shows that forced cessation of sport activity for 6 weeks does not improve pain compared to those who continued their sport. In fact, those who stopped their sport, not only failed to see improvements in pain but were also less physically fit as a result. Clinical guidelines, therefore, recommend continued activity within acceptable pain limits rather than complete rest.
Tendon related pain is a “clinical diagnosis”, i.e. one that is made in clinic with you and the physiotherapist, taking a careful history and testing the area. Routine scanning of the area is therefore not required. Scans also don’t predict how much pain you feel, and image findings are often unchanged when people do get better. Scans are usually only needed if you have had a traumatic injury (fall) or hear a snap and suddenly lose power.
Research shows that up to 80% of people with no symptoms and no history of Achilles tendon pain have Achilles tendon ‘abnormalities’ such as ‘tears’, ‘thickening’, ‘degeneration’ or similar on an ultrasound scan. Although these terms sound scary, we now understand that they are the natural signs of the tendon adapting to various loads in our lifetime rather than a problem to treat. This informative video goes into greater detail: 03 Common Load Based Adaptations in Achilles Tendinopathy (youtube.com)