Aquatic exercise boosts recovery of the
What is the Achilles tendon?
The Achilles tendon is the thickest in the human body. It serves to attach the gastrocnemius, soleus and plantaris muscles of the calf to the calcaneus (heel) bone. These muscles then act via the Achilles tendon, causing plantar flexion (downward motion) of the foot at the ankle.
Tendinopathy is characterised by pain in the back of the leg or heel which is usually intermittent, worse in the morning, and aggravated by activity or exercise. Tenderness, swelling, and crepitus (crunching) may be felt along the tendon. A feeling of stiffness is often reported and may occur in the morning or after a period of immobility, and ease with movement.
Physiotherapy management of tendinopathy involves the identification and appropriate management of underlying medical causes and contributory factors. Additionally, a biomechanical assessment may find a lower limb malalignment or muscle weakness that is potentially contributing to the injury.
Advice on an initial period of rest or relative rest (stopping high impact activities, such as running) until pain subsides. Exercise can be restarted gradually when pain allows and graded loading (strengthening) exercises to the Achilles is currently the best evidenced way of improving long term outcome. Symptoms normally take 12 weeks to resolve and simple analgesia (such as paracetamol) may be used for pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs such as Ibuprofen) may be useful for pain relief in the very early phases but are not recommended in the longer term.
Rupture of the Achilles tendon may be suspected if an audible snap or pop is felt during sport or running activity. This is usually followed by sudden, significant pain in the calf or back of the ankle and is often described as being hit by a racquet or kicked in the back of the leg.
Approximately a third of people with tendon rupture do not complain of pain after the acute pain of the rupture has eased. Usually there is an inability to walk or continue the precipitating activity and a limp is often present. However, in some cases the person may be able to walk, as plantar flexion of the foot involves muscles other than those related to the Achilles. If Achilles rupture is suspected, then urgent referral is needed for Orthopaedic assessment where surgical and non-surgical methods may be used as treatment.
Recovery after Achilles rupture is usually staged over a period of approximately 12 weeks depending on functional goals of the individual. An ‘accelerated rehabilitation’ approach has shown to give best outcomes where a protocol of early weight bearing is employed with staged amounts of dorsiflexion (upward ankle movement) allowed in a special boot.