When an acutely overloaded tendon produces pain, we term the condition a ‘reactive tendinopathy’. The historical term ‘tendonitis’ implies that an inflammatory response is present, however current research suggests this may not be correct.

Whether inflammation is present or not, the fact is that the tendon has been overloaded and is reacting in an unpleasant manner. It is crucial to respect the tendon’s reaction and rest or unload the tendon. The longer you push on, the more severe the reaction and the longer your recovery period. An accurate diagnosis by an experienced Physiotherapist is essential in order for the correct management to be prescribed. Incorrect management can be disastrous for a tendinopathy.

In my case, similar to many of my clients, I didn’t respond to the warning signs of discomfort and ‘tightness’ early enough. By the time I accepted my injury, an extended period of unloading or rest was essential.

So what did I do after ‘that’ moment in Noosa, when I reluctantly accepted that my Achilles tendon required more formal management? First, I cursed myself for overloading my tendon and not following the advice that I so frequently provide to others.

Then I stopped running and sought physiotherapy treatment from my colleagues. Physiotherapists are experts at assessing for contributing factors to tendinopathies and providing the appropriate treatment. Load management, environmental conditions, footwear, foot type, muscle strength, muscle tension, muscle length, joint flexibility and lumbar spine health are all factors that can contribute to tendinopathies.

My treatment consisted of:

• Dry needling to reduce calf muscle tension
• Myofascial release (massage) to reduce calf muscle tension
• Stretches for lower limb muscle tightness
• Taping to unload the Achilles tendon
• Heel lifts to reduce the strain on my Achilles tendon
• Advice on loading/unloading

No one enjoys being told to rest from an activity that they enjoy and trust me when I inform you that it’s one of the hardest components of our job. We will only prescribe rest if it’s absolutely required. I had to swallow my own medicine because I knew that continued loading (running in my case) would undoubtedly lead to chronic tendon pain.

Fortunately, resting from one activity enables us to participate in other activities and I’ve used this opportunity to dust off my bike, spend more time in the gym and continue to learn to surf.

I was able to gauge the healing response of my Achilles tendon by gently squeezing the tendon and noting my pain response. This helped to guide my return to running and strengthening.

In my case, it took four weeks for my tendon reactivity to settle enough to commence a reloading program. It’s important to note that simply because my Achilles tendon was no longer painful to squeeze, it was not capable of returning to pre-injury activity levels. Following a period of unloading, tendon quality as well as ligament, joint, cartilage and muscle quality deteriorate. For more information, read my previous blog on load management.

Initially, I commenced a structured and progressive strengthening program. For me, this consisted of single leg calf raise exercises on the edge of a step. Although there was no pain during the exercise, I was well aware that the tendon would react for up to 72 hours following the exercise. It is essential to act conservatively and carefully monitor the response of the Achilles tendon before progressing the load.

These exercises were performed on alternate days and I was able to perform isometric holds (static holds) on my rest days. Isometric holds are very effective for temporary pain relief and assist with tendon loading.

The next step was to finally recommence running… Stay tuned for part 3 of my Achilles tendinopathy experience.