ACHILLES TENDONITIS 
Bondi Junction, Eastern suburbs Physiotherapy 

WHAT’S IN A NAME

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Tendonitis - tendinitis - tendonosis

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The suffix ‘itis’ means inflammation; therefore, tendonitis literally means inflammation of the tendon.

At some point, people started to use tendinitis as well, which is exactly the same, only with a different spelling. With tendonitis or tendinitis, the tendon is overloaded due to an acute injury causing pain and swelling from tears in the injured tissue.

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TENDONOSIS

Sometimes also referred to as tendinosis - occurs from failed healing or repetitive trauma to a tendon. This microtrauma leads to a loss of collagen continuity with micro tears in the tendon. As a result, there is a loss of strength and further injury will happen when continuing to (over)use the tissue. However, inflammation is generally NOT present with tendonosis (or tendinosis), whatever writing you prefer.

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In rare cases, chronic degeneration with or without pain may result in a rupture of the tendon.

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CAUSES

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"Active people and athletes are at a higher risk for developing disorders of the achilles tendon."

A sudden increase in training (too much too soon) is a classic example where individuals will put too much stress on their ankles and feet. Foot position also has an impact on this tendon, such as people with a flat foot or overpronation. Due to the greater demands placed on the tendon when walking and running, there is a higher chance of getting tendonitis or tendonosis.

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SYMPTOMS

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The most common symptoms are an achy pain, stiffness or soreness along the tendon or just below the calf muscle. Often the pain is worse in the morning or after periods of rest and then improves with movement but later worsens with increased activity.

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TREATMENT​

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"Tendonitis or tendinitis, where inflammation is present is best treated with the simple RICE principle (rest, ice, compression and elevation) to reduce the inflammation and to allow healing."

Physiotherapy is very helpful at this stage as well; with specific hands-on treatment and guided exercises. The tendonitis should heal in about 6 weeks and can also benefit from anti-inflammatory medicine and sometimes with a cortisone injection.

With Tendonosis, (no inflammation present at this stage) anti-inflammatory medication and cortisone injections are not appropriate, because they inhibit collagen repair. Tendonosis healing time is normally between 3 and 6 months once it becomes chronic. Studies show that it takes up to 100 days to rebuild collagen. The primary treatment plan for tendonosis is to break the injury cycle and to reduce the stress on the tendon with relative rest (or altered physical activity), proper ergonomics/biomechanics and physiotherapy.

Our physiotherapist will first determine what has caused the condition to arise, as mentioned ‘too much too soon’ is typical of tendinosis, so the first step is adjusting your training load if you're an athlete or your employment load. We can set manageable loads of work through your week with modifications to your tasks that will provide the tendon with relative rest. Upon settling the episode of pain in the tendon we will gradually build the tolerance within the tendon using specific exercises to strengthen the tendon whilst not triggering a relapse in the condition.

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DOES DRY NEEDLING HELP WITH ACHILLES TENDONITIS?

It sure can. As mentioned before, there is too much stress on the tendon due to various reasons. The muscle can be too tight and cause the tendon to get thicker or inflame. Releasing the muscle will reduce the pulling on the Achilles tendon and therefore reduce the pain or inflammation. Dry needling is a great way to release muscle tightness fast and effectively. To learn more about dry needling, click here.