I am suffering with Achilles pain. How do I know if it is an Achilles Tendinopathy or an Insertional Achilles Tendinopathy?
Achilles pain can be one of the most debilitating injuries you can sustain. It affects so many factors of your life, primarily being present every time you stand and walk. As a result it is probably stopping you from being able to complete many of the activities and sports that you enjoy as part of your everyday life. However, with careful management and a good treatment pathway you can settle down your Achilles pain and get back to the life you enjoy.
The team at Body Logic Health have worked through to put together an educational and informative information page on tendinopathy issues, discussing many of the treatment options for tendinopathies. These will be particularly relevant to Achilles tendinopathies and so will e worth reviewing through our resource page, www.bodylogichealth.co.uk/resolving-tendinopathies
As you can see there are two tendinopathy options around the Achilles region so we are going to discuss how you can identify which issue you may be suffering with currently. Although subtle this will help you begin the right treatment to settle your Achilles pain and get you on the right road to recovery.
Firstly, let’s look at an Achilles tendinopathy. The first and clearest difference will be the site of pain in the Achilles region, in this case the Achilles pain will be in the mid-section of the Achilles tendon about 2-3cms above the very top point of the heel bone at the back. Depending on how long you have had the problem you may find if you run your fingers up either side of the Achilles tendon you will feel and small palpable lump, which will possibly be tender to squeeze. This is the centre of your Achilles tendinopathy and is the point that the Achilles tendon has changes in the matrix which is driving your Achilles pain.
Don’t be concerned by this, it is normal for this type of injury and there are a number of treatments that you can undertake to improve this. Along with the direct point of the injury, you will find your Achilles pain will be an ache in the morning, quite stiff until you get moving but will not hurt to stretch it, nor will it be a problem to stand with your heel about 3cms off the ground and hold that once your morning stiffness has recovered. You will almost certainly find that the pain will settle after you start sport or activity but you will stiff once you have stopped for about 15-20 minutes if you start to walk again. Aside form this you will find your capacity for exercise is reduced, long walks or standing on your feet for long periods will create stiffness in the Achilles.
Secondly, we should look at the Insertional Achilles tendinopathy. This is not hugely different but there are two key points that will help you understand if this is your injury. The point of pain is different, you will find your centre of pain is located over the back of the heel bone, or calcaneum. This will have a sharp tenderness to it when you press as it is the bone along with the Achilles tendon that is affected, with bone having a greater number of nerve endings if the Achilles tendon is pulling on this bone it will become very tender and sensitive to pressure, even your shoes being put on and off might be painful.
The next obvious difference is the reaction to pain, and Achilles tendinopathy will not hurt when you stretch it, it may feel stiff but will not be painful as such, on the other hand an Insertional Achilles tendinopathy will be painful to stretch, as the tendon pulls on the inflamed bone insertion.
The video here goes through these differences in detail and helps you identify the exact areas in your Achilles that we are talking about helping you understand the best management for your specific Achilles tendinopathy.
Once you understand your problem more clearly you can then find the best person to help you recover from your Achilles pain, you are likely to need a professional to guide you through and progress your phases of treatment and exercises at the right time.
There are a number of different treatment options available and they are covered in more depth on our tendinopathy information page, allow you to understand the options for your treatment that may be covered, including shockwave treatment that can really help kick start your initial phase of treatment. Check out the information here for more details www.bodylogichealth.co.uk/resolving-tendinopathies
In terms of treatment you need to consider for the;
Insertional Tendinopathy
- Ice – to settle bone pain
- Isometric Double Leg loading – to build tissue capacity
- Assessing Hip range and stability – again reducing Achilles loading
- Changing activity levels – in the short term you need time for the bone to settle before you push activity and sports again, otherwise you will find your recovery frustrating
- Assess foot range and stability – the ankle and foot are integral to the success of changing the load on your Achilles tendon, this should be in the first teps addressed depending on your pain levels.
Achilles Tendinopathy
- Isometric retraining – static work to build tissue tolerance and muscle strength
- Concentric training – moving through range and with increasing loads to help remodel the Achilles tendon and build tissue capacity
- Shockwave treatment – can be super effective to settle pain and help improve Achilles tendon recovery
- Hip and ankle mobility & stability training – to improve the movement patterns and loading through the hip, knee and ankle regions
Achilles tendinopathy issues are complex however with the best treatment pathway in place you can move out of the pain phase and return to the activities and sports you enjoy. Building your foundation to maximise your long term success so you reduce the risk of recurrence being an essential part of the plan for an Achilles tendinopathy problem.