Achilles tendinopathy: What does not work, what might work, and what definitely works!

As with all things sports medicine, classifying "Achilles tendinopathy" is no easy task.

And it is made more difficult because, in relation to Achilles tendon pain, we deal with 2 main subsets, insertional Achilles tendinopathy and mid-substance (or non-insertional) Achilles tendinopathy. The treatment for each condition in isolation may be quite different although sharing some similarities. For the purpose of this discussion, we shall limit ourselves to the more common, and arguably easier to treat mid-substance variant, and leave insertional Achilles tendinopathy for another day!

So in this, the first of 3 in a series looking at the management of Achilles tendon pain, we investigate what treatments are currently out there, ones you might be using right now, that actually do not work, and have no scientific evidence!

Rest

When we all began our journey in sports medicine, except for the lucky few who have recently entered the discipline, we had the acronym RICE beaten into us from the outset.

Of course, RICE stands for Rest Ice Compression and Elevation, and foremost of these was rest in the management of acute sports injury, including Achilles tendinopathy. Over the years, many letters were added, but somehow Rest and Ice remained, and we now know that not only will rest not assist in the healing of damaged or degenerative tendon, but it will actively delay the healing process.

Likewise, the role of ice, with its presumed antiinflammatory role has been discounted, and now should be viewed as having some role in analgesia, but that is all.

Tendon tissue plays an essential role in transmitting muscle contractile forces to produce movement and is therefore uniquely designed to withstand considerable loads.

During locomotion, the Achilles and patellar tendons may see forces up to approximately 8 times body weight. Repetitive loading of a tendon often results in overuse injuries, including tendinopathy, which is a clinical condition characterized by pain in the area of the tendon during activity, localized tenderness on palpation, local swelling of the tendon, and impaired performance.

Simon Bartold
Director of Bartold Clinical

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