Achilles Tendinopathy: Understanding a Tendon Injury

What happens to the Achilles tendon when you injure it?

Have you had a tendon injury and your recovery is like that of a yo-yo?  You think it’s better, so you head out to do a run to test it, or you wander out for a longish walk, only to find that the pain flares up and you’re back to square one!  If this is you then you’re not alone! Read on to learn more about why this happens and how you can prevent it from happening to you.

Let’s cut to the chase, a tendon injury such as achilles tendinopathy or plantar fasciitis (which technically isn’t a tendon – but it behaves like one) can be stubborn and recovering from these kinds of injuries can take weeks if not months.  

Exact reasons as to why you may develop tendon pain is unclear, but research has shown that doing ‘too much too soon’ in relation to exercise may be the reason.  It’s also found that a spike in the number of people with pain typically follows rapid increase in their physical exertion – for example in “start to run” programs or after basic military training.  Why does this happen, and how can you avoid it happening to you?

To best understand how a tendon injury occurs and how it behaves it’s best to demonstrate this using some visualisation.  A healthy tendon can withstand the right amount of load that is demanded of it. Imagine a bucket with water filled up to the brim.  The water signifies the load and the bucket signifies the tendon and it’s capacity to carry the load.  


Scenario 1:  A healthy uninjured tendon. If you do a long run or walk, you use up a certain amount of load – imagine the water (load) being used up or drained from the bucket but not completely. This is how a healthy tendon behaves.  The bucket (tendon) is holding a great capacity of load for you to do your exercises without causing injury.

Scenario 2: An injured tendon. When a tendon is injured, it’s capacity to withstand load diminishes.  You start out on your activity with a tendon that can only ‘carry’ half the amount of load (water) in the tendon (bucket).  The water in the bucket can drain completely before you finish your run, and that is when your tendon will likely reinjure and become painful.  This essentially means that you have used up the capacity of that tendon to bear load.


Scenario 3:  Best scenario. Your tendon is injured and can only have the capacity to bear a certain amount of load.  You need to be able to fill up that bucket with more water (load) gradually so that when you do your long run/walk it won’t be drained completely. 

Doing simple load bearing exercises over a period of time will fill up the capacity of your bucket to carry more water.  

Resting won’t achieve this so it’s not a good idea to rest.  

You need to couple your rehab exercises with a gradual return to exercise program. Doing this enables you to build up the capacity of your injured tissue to bear load, so that your return to activity is sensible and safe.  Click on this link to watch a great YouTube video that explains the relationship between load and capacity. 

Now that you understand the mechanics of your tendon and how it behaves, here are our top 3 practical tips for tendon rehabilitation.

Tip 1:

You need to be sensible with how much exercise you do.  Do a gradual and safe build up to exercise. What this is depends on how long you’ve been in pain for, and what your goals are.  

Tip 2:

Monitor your pain levels after exercising. 

Check to see:

  • If you have large increases in pain
  • Or if your pain stays increased for more than 24 hours after exercise

… You may be doing too much, too soon!  So avoid varied and rapid increases to your exercise which can lead to the development of ongoing pain

Tip 3:

Further guidance to knowing how much exercise to do and how quickly you can increase can be provided by your Podiatrist.  A tailored approach would be beneficial as each person’s goals and pain-levels are different. So get the help you need sooner rather than later to avoid the yoyo effect of injury relapse and get back to doing what you love injury free!

As well as offering In-Clinic consultations, our Podiatrists at The Footcare Clinic are catering to the needs of our community by also offering Online Consultations due many people choosing to stay at home.  Whichever method you choose, you can easily book your appointment online at this LINK.

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