Having witnessed two Achilles ruptures in person I’d gladly never see one again, if you have heard the spine tingling scream you know what I mean. One possible cause of a rupture is gradual decrease in tendon health which can be due to a tendonosis or a tendonopathy which are both terms for degeneration of the tendon. Achilles tendonosis is the acute version and arguably the wrong label as there is in fact no inflammation with tendon injuries, this is one of the reasons I believe they can be stubborn injuries to recover form. Achilles tendonopathy being the name for the chronic condition if you’ve had it for a while.
Achilles tendonopathy can start off as a mild discomfort in the Achilles area, the characterising symptoms of a chronic Achilles tendonopathy is an insidious onset of pain and dysfunction in the Achilles tendon. You may also note a lump on the tendon that is not on the other one, this is yet another sign it’s the Achilles that is the culprit of your pain. Achilles tendonopathy is normally secondary to repetitive use from your sport or that you are not getting enough rest for the amount and intensity with which you use it. This amount of rest or recovery needed will vary based on your level and sport. A sprinter for example will need to rest there Achilles more from their maximum efforts than a javelin thrower who would need to think more about their shoulder and back recovery. The pain and dysfunction in your Achilles may improve as the activity goes on and you warm up which can lead people to thinking the problem is only minor and it will just go away if you carry on as normal, or worse, just sit there and wait (atrophy; reduction in muscle mass due to inactivity).
This however is not true, if the degeneration continues to worsen the tendon as a unit will become weaker and therefore more prone to tears as there is literally less there to absorb the high level of forces sent through it. When we jump and run we send forces ranging from 2-7 times body mass through our legs, so for me that is from 170-595KG. Think of it like pulling an elastic band apart, when it’s whole and you pull on it the band snaps back. If you make a tiny cut it and pull it repeatedly the band will continue to snap back but will also make that cut in the band bigger, and the more force you pull the band with, or the faster you run, higher you jump or more weight you squat the more that tear will increase. Leading to the inevitable Achilles tendon!
If your Achilles tendonopathy has occurred following high amounts of exercise, you will need to adapt the level of activity you are doing. Further, because it is a degenerative condition, it needs stimulus and rest to get better. If it were a muscle tear the muscle would heal over time, but with degenerative conditions we need to manipulate the body to ‘generate’ again. Tendons notoriously don’t have good blood flow, which is where manual techniques such as cross fibre frictions, medical acupuncture and instrument assisted soft tissue mobilisation come into their own. Although they may seem aggressive techniques, they help to promote blood flow and thus spark healing in the area which will reverse the degeneration seen. Provided you follow the recommended exercise adaptation and rehabilitation exercise program they will get you back to your sport far quicker than sitting around waiting for it to get better by itself (if it ever will).
I however prefer to prevent injuries in the first place rather than fixing them once they have stopped me from playing the sports I love. Intrinsic factors are those that can be assessed with only you, such as strength and flexibility. Functional or extrinsic factors are not going to be included in this article. Signs that you are prone to Achilles tendonopathy are;
Weak calves (gastrocnemius,