Achilles Tendon issues

So often the dread of anybody who gets it achilles tendon issues normally start as a slight tug felt on the back of the achilles itself. Sometimes people tend to feel not pain but a pulling sensation on the top of their heel. Real achilles tendon issues start to manifest after periods of prolonged tension and tightness in which the tendon begins to pull on the periosteum ;inflaming the attachment site and coupled with that some microtearing of the tendon fibres will occur. This is Actually know as tendonitis. Basically in layman's terms an inflammatory injury of the tendon. If the problem persists without attention or is ignored the person runs the risk of developing a “tendinopathy” or a chronically inflamed tendon. Ignore your bodies further and something called a tendinosis can set in which is really something that nobody wants. 

What causes a tendon injury?

A lot of people tend to point the finger and play part in the blame game to blame a certain factor that has caused a tendon to become inflamed. Most of the time you'll hear people say “the hard ground is killing me” or “training on that astro has my achilles tight”. While hard ground and astroturf can impact the level of force through the tendon it's important to remember it's not the sole cause of the issue. Astroturf pitches are a great modality to allow us to train during the winter months and ultimately in the height of summer when the balls flies and the pitch is hard are the best conditions to play most field sports. 

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Firstly, as with most injuries, load is a critical factor and exposure to load when training. Wen training load is ramped quicker than the tissue can tolerate or the recovery rate does not match the rate of breakdown we are going to run into some problems. You can analyse your recovery like your sleep, nutrient intake and stress management etc but if you are training really hard and or “too much too soon” tendon injuries are a real possibility. Recently i've seen a big spike in tendon injuries with the return of the GAA to pitch based sessions from Gym based sessions. In the GAA at times there is an attitude to bulk and improve power during the off season and then “ put it to good use” when you get to the pitch. If the Gym based programme being followed doesn't develop the plyometric abilities of the athlete alongside this there's a fair chance of a tendon issue developing as well. Plyometric Training by its nature engages the fascial system and the achilles is The biggest fascial “spring” in the body. If not regularly trained and then abruptly over trained the achilles will take the brunt of the punishment. Plyometric training 3x10 once a week is also a very poor guide. We should be hitting hundreds if not thousands of these reps in the gym if we are not actively running/Pitch training or rehabilitating an injury prior to the return to the pitch.

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When your foot hits the floor the achilles will absorb the downforce and provided the fascial system is adequately performing and the movement is performed with adequate pace the system can store and use this force like a spring during push off phase of gait. 

This is extremely simplified but its a nice way to visualise a huge function of the achilles tendon.

One cant look at an injured tendon without looking at the system it is a part of. Thomas myers coined the term Anatomy train lines and other terms exist such as fascial trains , fascial systems , kinetic chains etc but in plain english these are the tissues that are connected to the achilles. One such kinetic chain is the posterior chain.

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As you can see above the posterior chain consists of the Plantar fascia , achilles tendons, Gastroc/soleus complex, hamstrings, Sacrum and associated ligaments, Erector spinae up into the neck. B is a subsystem which also has interactions notably the Lats and glutes. ( If hamstring trouble is your nightmare always check the Lat on the opposite side). 

SO as you can see if you feel a pulling sensation on your achilles potentially this might be coming from further away than you think. I don't like the idea of trying to pinpoint the exact restriction that is causing a tight achilles or the methodology of saying things like “Its all coming from your shoulder”. It is at the end of the day a tensional system and should be treated like so. If the system has adapted in such a way where there is too much tension being applied to the achilles during Gait or when loading problems will arise. 

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What actually happens in the Achilles’ tendon when inflamed ?

When the tendon becomes sore, generally stiff in the mornings and some pain on initial loading is a tell tale sign there’s some inflammation on the tendon. When we put load and force through a tendon it behaves similarly to a muscle. It can break down and heal to become stronger and just like a muscle it can break down and become damaged. If there is excess tension through the tendon be that because of a ramp in training or a biomechanical issue the tendon will continually pull on the periosteum on the calcaneus where the tendon attaches. This can lead to both becoming inflamed. Inflammation is a vital part of the healing process and can be demonised however excess or chronic inflammation can be a sign that the healing process has stalled. If the healing process is stalled and the tissue remains damaged this can lead to a more chronic issue called tendinosis in which the structural collagen matrix has become dysfunctional and scarred. This is why people who have long term tendon issues generally find it as something that can “flare up” as the initial issue was ignored or not sufficiently dealt with. When the healing process has stalled a number of inflammatory cytokines such as IL-1B , TNF-A and IL-6 can remain until the issues impeding healing are resolved and the tension is evenly distributed.

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N.B : Please see a physio,physical therapist or NMT if you are in any doubt about the health of your tendons 

Treatment options - 

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The traditional Way of treating a tendon Injury varies hugely. Some Physios take the approach of breaking it down further to attempt to make it stronger. While adequately loading the tissue is really important if overload occurs it's going to make it worse and more problematic. Others will suggest rest, This will prevent further damage but also glides past the points that the tendon will not be doing what it's designed to do. Healthy adequate loading of the tissue is a huge factor. 

The simple fact of the matter is that tendons do not heal as fast as muscular tissue. Which always lends to the person engaging too quickly often out of frustration to get back to what they want to do. Whether that's train GAA, Run, play five aside it doesn't matter.

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What's lacking is a clear plan of progression. If you're doing the same list of 4 exercises for the last 4 weeks and resting and nothing happening that's probably because nothing is.

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For more information on tendon rehabilitation you can contact me.

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The key to recovery -

Heal - energetically and physically and don’t rush 

Retrain - sometimes simple is best , if the tissue isn’t able or isn’t used to performing a movement it needs repetition to become comfortable in that movement.

Pace - slow things down. More often than not injuries like their head out when we are pushing ourselves. Sometimes slow, steady and planned is the easiest way to gradually get our bodies to play ball with us.

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If we are getting back into training we should model our training not on what we want to do but what we have done. If we haven’t done a whole pile for a few months, the goal shouldn’t be to jump straight into a class or run 5k 5 times a week. Start small and slow and build. 

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