Achilles Tendinitis/Tendinosis/Tendinopathy...?

I was unsure of what to title this article due to the confusing nomenclature when it comes to achilles tendinopathies. (Tendinopathies= umbrella term for an injury process at the tendon.) Achilles tendinitis is a misleading term because it implies that there is inflammation in the achilles tendon. Studies have shown that there is actually no inflammatory process within the achilles tendon, but instead a degenerative process affecting the tendon fibers. So for this reason, the term “achilles tendinitis” is inaccurate. Achilles tendinosisrefers to chronic degeneration of the tendon’s collagen in response to overuse—without inflammation. So achilles tendinosis or tendinopathy is much more accurate. We should use these terms so that runners can have a better picture of what is going on in their bodies.

Now that we’ve cleared that up, let’s take a look at the some of treatment options available for achilles tendinosis. These include: eccentric strengthening, concentric strengthening, deep tendon friction, ultrasound, PRP injections, and acupuncture. Eccentric strengthening refers to loading the muscle in lengthening and concentric is loading the muscle in shortening. A systematic review of the current research looked at studies that assessed how effective these treatments were.

When eccentric strengthening was compared to concentric strengthening, eccentric strengthening showed greater pain reduction and increased plantar-flexion (the movement that your achilles is responsible for) endurance. These are the results we are looking for in achilles rehabilitation. It is important to do early functional movement instead of completely resting—which is what is often the runner’s initial instinct —you want your tendon to remodel the collagen fibers in an organized and efficient way. 

Deep tendon friction refers to that uncomfortable massage technique that a physical therapist will use at your achilles tendon. The research showed that this technique was effective, but more so when used in combination with eccentric exercise.

There was no significant change in symptoms and function with PRP injections. Acupuncture, however, showed promising results. When used in conjunction with eccentric training, patients had a greater decrease in pain and increase in function than with eccentric training alone.

So, to summarize: eccentric training is better than concentric training. Even better is eccentric training plus deep tendon friction and acupuncture. PRP injections did not show any significant change.

Since achilles tendinosis is so common among runners (11-29% of running injuries!), this is some critical info. We need to be using the most effective treatmentsto get runners back to their A-game and to prevent injury recurrence. 

Cathlin Fitzgerald, PT, DPT, CSCS

Samantha LaBarbara