The achilles tendon at the back of the ankle is one of the  the more commonly known tendons in humans, it connects the calf muscle to the heel bone.  Tendons connect muscles to bones.  Pain and dysfunction in a tendon is known as tendinopathy (previously known as tendonitis.) So, how do tendons become injured? Every tendon has a certain capacity to bear load and when this capacity is exceeded, the tendon can become injured and painful.  This capacity varies from tendon to tendon and between individuals.  There has been some very exciting research in this field over the last number of years, and it is known that under the microscope painful tendons look different to normal tendon.  A type of protein, known as collagen, which forms part of the structure of tendons becomes altered and disorganised, changing the micro architecture of the tendon.  We now know that complete rest is detrimental to the tendon and surrounding muscle and does not aid long term recovery.   Research strongly supports the use of a gradual strengthening programme, over passive treatments (painkillers, electrotherapy, injection) in the rehabilitation of tendon injuries.  A good rehabilitation programme reduces pain and improves the tendon’s capacity to bear load again, allowing you to return to your activity.  Take home messages:

  • If you suddenly increase your activity, so that a tendon is taking more load than it’s capacity, is is more likely to become injured.
  • Complete rest is detrimental to a tendon in the long term.  Reducing the load (but not complete rest) initially is advisable (for example, perhaps walking instead of running.)  Use it or loose it!
  • Don’t have an injection into the tendon without trying a good strengthening programme first.