Achilles Tendinopathy (Achilles Tendonitis)

This is another of those injuries that was thought to be related to inflammation, but turns out to be a degenerative tendinopathy. I’ve had no experience with this at all, but post with your experiences and we can collect the best advice up here.

I will recommend that anyone dealing with this condition watch this talk by Jill Cook of La Trobe University, where she talks about what’s really going on in a tendinopathy.

Although it’s no longer up to date (Cook talks about how eccentric exercises are insufficient), the Running Writings Injury Series has two pages on this condition as well.

Jill Cook’s group is probably the leading research group in the world on tendinopathy, specifically in the lower limb. It’s now theorized that most cases of chronic tendon pain are related to this “degenerative” tendinopathy, and acute cases are “reactive” tendinopathies. The actual “why does it hurt?” is also still pretty debatable, but it’s theorized that small tendon cells die off in an inflammatory process initially and their cell matrix becomes disorganized. Chemicals in this disorganized matrix basically communicate with nerves when tension or compression is placed on the tendon. Insertional tendinopathies can be more symptomatic in positions with compression on the tendon. For the Achilles, that’s basically stretching into end-range dorsiflexion or the classic hanging off a step stretch. Tendons need tension to improve their load tolerance, so a heavy loading program for tendinopathy is currently the gold standard. Eccentric vs isometric vs concentric doesn’t seem to matter as long as the load is heavy and it isn’t making the tendon more symptomatic in a 24 hour window.

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