Achilles tendons can reaches forces up to 12.5 -17 times the body weight during running (Abrahams & Mistry 2009, Komi et al., 1992); such a force can cause injury to occur. It is simply the strongest tendon in the body.

There are two types of Achilles Tendinopathies; Midportion Achilles Tendinopathy and Insertional Achilles Tendinopathy. It is key to differentiate the two different types as they differ in response to treatment (Paoloni et al., 2004). Midportion Achilles Tendinopathies consists of inflammation and weakness to the tendon approximately 2-6 centimeters above the calcaneus (Prentice, 2004), whereas Insertional Achilles Tendinopathies occur directly on the calcaneus where the tendon attaches to the bone.

Kujala et al. (2005) states that 24% of competitive athletes sustain an Achilles Tendinopathy throughout their lifetime and 18 percent of those athletes are over the age of 45. Furthermore, in competitive runners the incident of an Achilles Tendinopathy increases to 40-50 percent of injuries sustained (Kujala et al., 2005). If a full rupture of the tendon occurs there is a 10 percent prevalence of athletes incurring further Achilles tendon problems (Leppilahti & Orava, 1998)

There are many signs and symptoms to be aware of when an Achilles Tendinopathy is suspected. Along with the main symptoms such as pain and tenderness on the Achilles tendon and thicken of the tendon in comparison of the non-symptomatic tendon some signs to look for would be “start up” pain. Start up pain regards to the pain that occurs at the tendon at the beginning of any exercise, which settles when the athlete is warmed up (Leach et al., 1981) Other signs to watch for would be stiffness of the

Achilles tendon, particularly following rest and intermittent pain that comes on with exercise and activity (Maffulli & Kader, 2002). With these signs there will also be a decrease in dorsiflexion range of motion (Kaufman et al., 1999) and weakness and a reproduction of the pain with planterflexion (Maffulli et al., 2003). The athlete’s calf muscle belly may also be taut on palpation.

An Achilles Tendinopathy is a chronic injury that comes on gradually and can be caused by one or more different mechanisms. Achilles Tendinopathies can be brought on by inappropriate training regimes, such as quickly increasing running distance, speed or gradient or the decrease in recovery time between training sessions. There can be extrinsic factors such as change in running surface, change in footwear or inappropriate footwear. Finally, this tendinopathy can be caused by biomechanical faults such as excessive pronation (McCrory et al., 1999), calf weakness, poor muscle flexibility (tight calf muscles), poor range or motion (restricted dorsiflexion) or genetic predisposition (Mokone et al., 2005).

Treatment protocol of this injury with a physiotherapist or sports therapist can consist of massage therapy to help loosen the calf muscle, transverse frictions (Gehisen et al., 1999) to decrease the pain on the Achilles tendon as well as electrotherapy modalities, such as therapeutic ultrasound, to help speed up the recovery process and decreases any inflammation. Acupuncture has also been seen to have a positive effect on the recovery of this tendinopathy as it helps bring blood to the injury site to help speed up the recovery process. Although, due to the hypovascularity to the area that exists within the tendon, healing and recovery time can be slow.

There is much debate as to the proper rehabilitation of an Achilles Tendinopathies. Whether, rehabilitation regimes should focus on strengthening or stretching, current research has found that strengthening eccentrically whilst incorporating stretching after is the best practice (Prentice, 2004 and Brukner & Khan, 2007). Eccentric training or loading refers to loading the muscles while it is in a lengthened position (Magnussen et al., 2009), which has shown to be very beneficial to the recovery of the Achilles Tendon. Brunker & Khan (2007) and Prentice (2004) have shown eccentric exercises in the form of heel drops have shown to have the largest benefit in the rehabilitation of the tendon. Alfredson et al. (2005), found that incorporating two different types of heel drops were more beneficial to the recovery of the tendon. The first protocol consists of dropping the heel whilst keeping the knee straight, which focuses on the gastrocnemius muscle, the second protocol consists of a similar heel drop whilst bending the knee which incorporates the soleus muscle, both of which strengthen the Achilles tendon. Stretching is also key, in the rehabilitation of the tendon as it helps keep the tendon flexible.

In conclusion, an Achilles Tendinopathy is the inflammation of the tendon sheath. There are two different types of Achilles Tendinopathies; Midportion and Insertional Tendinopathies. It is a very prevalent in running athletes with an incident rate of 24%. The main signs and symptoms are stiffness of the tendon and localized pain along the tendon; pain should decrease with the start of easy activity. Massage therapy, therapeutic ultrasound and acupuncture have been shown beneficial in the treatment of Achilles Tendinopathies. Rehabilitation consists of eccentric strengthening of the tendon as well as stretching.

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