Achilles Tendonitis or Achilles Tendinosis?
Achilles Tendonitis (or its other spelling – Achilles Tendinitis) is an acute flare up of tissues around the tendon and is short lasting – only a few days.
Achilles Tendinosis is a chronic degenerative condition lasting for ever!.
It’s a bit like a puppy – not just for Christmas but for LIFE!
Once you’ve got it I’m afraid to have to tell you that you’ll never be without it!
However that doesn’t mean that you have to stop running or exercising – in fact quite the opposite but I’ll come back to that later.
Tendinitis or paratenonitis is an inflammatory reaction in the body of the Achilles Tendon itself or more commonly in the paratenon that can surround the tendon.
The inflammatory response is a reaction to micro tears and this produces pain and swelling locally in the paratenon and surrounding soft tissue structures such as an associated bursa. The bursa is a small fluid filled sac found at the base of the tendon as it attaches to the heel bone.
Tendinosis is non-inflammatory condition which is as a result of degenerative changes in the structure of the tendon. These degenerative changes produce thickening of tendon and compromise the integrity of the tendon itself.
Normally there is a constant cycle of breakdown and repair in the tendon but now due to chronic inflammation of the paratenon this has led to more “breakdown” than “repair”.
In the repair phase the collagen fibres (the main fibres of the tendon) that are laid down are not of a good enough quality and strength to produce effective healing.
If you were to examine a tendon at this stage, you would see varying amounts of dead tissue, small tears running along the length of the tendon and perhaps calcium deposits in the tendon. All of this weakens the tendon and makes the possibility of rupture more likely.
The good news is that recovery is possible.
In severe or persistent cases it may be necessary to have surgery to strip the paratenon off and clear away the dead areas and remove the calcified areas in the tendon before starting on a rehab program.
The key to recovery is relative rest – that is avoiding the activities that were aggravating the problem in the first place WHILE starting activities that promote stronger and more effective healing.
Exercises that progressively load the tendon produce the correct type of collagen fibres in the repair phase which in turn produces a stronger and healthier tendon. [Find out more here]
Remember however that when you stop exercising that the degenerative process still continues. As you take a break and do nothing your tendon gradually weakens and it will not be able to withstand the same forces when you start back.
This happened to me a few years ago. I had rehabilitated my tendon well and built up to running a few half-marathons. I took 3-4 weeks off due to increased work commitments and my Achilles pain came back within a mile when running downhill!!
So be warned keep doing your exercises when you stop running.
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