What is the best treatment for achilles tendon pain?

What Causes Achilles Tendon Pain?

Achilles tendon pain is common in runners and those who have recently increased their exercise duration or frequency. The pain of an achilles tendon injury often appears at the start of a run and then eases out as the running  (or walking) progresses. For this reason, people often assume that continuing to run is harmless, or even helpful in alleviating the pain. Unfortunately, continuing to train through the pain frequently gives rise to more severe and intractable pain. The longer the pain is present then the longer it takes to heal.

What is the best treatment for achilles tendon pain?

Does Running Technique Impact on Achilles Tendon Pain?

A biomechanical and running assessment is a vital component of assessing an achilles injury. There are two types of foot strike that are generally discussed in the literature: these are a forefoot and a rearfoot strike. A forefoot strike is where the runner lands on the ball of the foot with the heel off the ground. A rearfoot striker hits with the heel and then pushes off through the forefoot

How does Foot Strike Impact Achilles Loading?

A toe or forefoot strike, for example, is associated with higher loading of the achilles tendon. Excessive loading of the achilles tendon is the main stimulus for injury and therefore modifying the loading through modification of the overall training load is vital to recovery. A cycle of tendon overload, followed by inadequate repair and degenerative changes forms the basis for the condition. Recovery from injury will prove challenging unless the running technique element is addressed fully.

A heel strike tend to transmit greater loads through the knee and has been linked to runner’s knee. Most recreational runners have been shown to be heel strikers. A forefoot stike creates greater forces on the achilles and calf and can predispose to achilles overload and pain.

The evidence for foot pronation as a cause of achilles tednon pain is weak, although patients consistently mention this as their perceived potential cause of their pain.

Other running technique factors such as overstriding has been linked to heel and knee pain. This is where the runner, in an attempt to take a long stride, stikes the ground with their heel and transfers significant ground reaction forces up through the leg.

Some simple tips for improving running technique include:

  • Increasing your step rate (research on Olympic athletes suggest that a step rate of 180 per minute was optimal for reducing impact forces)
  • Decreasing stride length
  • Striking the ground with the foot directly under your hip

What is the best treatment for achilles tendon pain blog

Walking Re-Education in Achilles Tendonitis Management

Any negative thoughts regarding pain can give rise to limping. This may be rationalised as “taking pressure off my heel”. Continuing with this movement pattern can give rise to wasting of the muscles and tendon and can prevent recovery if the person does not relearn how to walk properly again.

In terms of running technique, if you have been largely injury free then you are best to maintain your current foot strike pattern. Messing with your running technique can give rise to unnecessary injury. If you really feel the need to change your technique then it should be done on a very gradual basis.

Research on Exercise Rehabilitation for Achilles Tendinitis

There has been a lot of talk about eccentric resistance training for managing achilles tendon injury. Eccentrics involve slowly lowering the heel from a raised position to create tension on the achilles tendon.

A recent randomised controlled trial compared the effectiveness of 12 weeks of eccentric training (ECC) and heavy slow resistance training (HSR) among 58 patients with Achilles tendinopathy of greater than 3 months.

The authors concluded that both eccentric and regular resistance training were equally effective in the management of achilles tendinopathy

How effective is Acupuncture for Achilles Tendinopathy?

Recent research published in the journal Physiotherapy Practice and Research examined the effect of acupuncture in treating achilles pain in  twenty-two patients. The participants were randomised to receive either acupuncture or the control sham acupuncture treatment

The authors concluded that an acupuncture protocol could be used as a second line treatment alongside a physiotherapy guided exercise rehabilitation programme.

This corroborates the findings of Zhang et al. (2012) who reported significant functional improvement and decreases in pain in individuals undergoing acupuncture


Zhang BM, Zhong LW, Xu SW, Jiang HR, Shen J. Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Chin J Integr Med. 2013;19(12):900-904. doi:10.1007/s11655-012-1218-4. https://pubmed.ncbi.nlm.nih.gov/23263998/

Kishmishian, Berj, Richards, Jim, and Selfe, James. ‘A Randomised Feasibility Study Using an Acupuncture Protocol to the Achilles Tendon in Achilles Tendinopathy’. 1 Jan. 2019 : 59 – 67.

For further information on achilles tendon pain visit our achilles page at: https://www.physioclinic.ie/conditions/achilles-tendon-injury/

Should I worry about “abnormalities” found on my MRI scan?

Should I have an MRI scan to help diagnose my lower back pain?

In the majority of cases of low back pain, MRI scans, and especially x-rays, are not helpful in treating low back pain. Most people are under the false impression that an MRI scan will identify the cause of their pain. The general comment that I hear from patients is: “if I can just get a scan done then I can figure out what is wrong and get it fixed.” However, in reality, a scan shows a lot of structures with varying degrees of abnormalities that are present both in those with and without back pain. This is the reason that medical guidelines are very consistent in stating that imaging for low back pain does not improve one’s pain, function, or quality of life.

About 55 percent of individuals with no back pain will have a disc bulge when an MRI of their back is performed.

Do I need an MRI to diagnose a disc bulge in my low back?

Many people believe that once they have been diagnosed with a disc bulge they need an MRI to confirm it and to assess the extent of the damage. The issue with this is that once a diagnosis of a disc bulge has been made clinically then an MRI scan will not change the diagnosis or physiotherapy management of that condition. I will often get calls from patients saying that they are holding off physiotherapy treatment until they have the results of their MRI; however, the scan generally has no influence on the treatment provided for their lower back pain. Patients are often not very receptive when it comes to being persuaded of the lack of utility of MRI scans in the management of their back pain. This is where a GP, physiotherapist, or chiropractor can agree to refer for a scan even though they know it is unlikely to be of any real benefit.


Science becoming more aware of risks of MRI scans

Healthcare practitioners such as physiotherapists and chiropractors are becoming more aware of the limitations of scans in aiding back pain recovery. However, convincing a client that they do not need a scan can prove challenging. I know from having injuries myself that you are naturally curious and there is a part of you that wants to see the area and identify ‘what is wrong’, even if the research suggests it is not beneficial. Despite medical advice to limit such imaging, research published in the British Journal of Sports Medicine in 2019 shows that MRI’s and other scans for lower back pain have increase by 53.5 percent between 1995 and 2015.

Worryingly, more recent findings in the literature have identified negative effects of having back scans. Research shows that those who undergo MRI scans can actually end up with more back pain. This is because after the MRI is performed a report of the findings will be written up by a radiographer. The report will often contain findings of areas where there is bony growth or discs bulging to varying degrees. The problem is that because such findings are present for most people and can therefore be deemed normal. However, the fact that they have been written onto a medical report suggests to the patient and physician that they are abnormal and therefore are a serious issue that should be a cause for concern. This is why MRIs can frequently lead to unnecessary surgeries and can fail to alleviate symptoms as they may not target the source of the symptoms.

If considering a spinal x-ray, it is important to be mindful of the radiation exposure from such imaging. X-rays are recognised as causing cancer in humans. The average radiation from a spinal x-ray is 75 times greater than that of a chest x-ray.

Are my MRI findings really abnormal?

Unlike other medical reports which primarily focus on abnormal findings, MRI scans can report deviations from the ideal spine that can be deemed normal. The MRI report refers to deviations relative to the ideal spine of a young person with perfect spinal curves. The problem here is obvious: most people going for MRI scans are not in this age bracket and therefore the supposedly “abnormal” findings are in fact normal for that age group. This fact is key in understanding the confusion that arises when interpreting the results from MRI scans. After the introduction of MRI and CT scans in the 1970s, medics began using the scans to make a diagnosis as opposed to using them to confirm or refute an uncertain diagnosis.

Questions to ask when you have a back scan:

The main questions you should ask your physiotherapist or chiropractor is this:

  • Can the finding on my MRI report explain all of my symptoms?
  • If the findings from the MRI report are the sole cause of my symptoms then why do my symptoms fluctuate?
  • Those with a previous diagnosis of a disc bulge should ask their physiotherapist why their symptoms disappeared or improved before returning again. Given that a disc bulge as viewed on an MRI does not tend to change position when someone is suffering from a flare in before and after the onset or eradication of symptoms

The linking of symptoms to findings on MRI scans are often illogical

These elements are difficult to explain based on MRI findings alone. These “abnormalities” reported on scans can create serious concern for patients. Things such as bulging discs have seriously negative connotations for patients and can create a degree of panic, even though these things may not be the cause of their symptoms at all.  This diagnosis can lead to fear avoidance of activity  and exercise which can create more back pain in the medium to long-term.

In most cases, the identification of a serious disc injury or other spinal conditions of concern is more accurately performed by a clinical assessment carried out by a Physiotherapist or Chiropractor who specialises in back pain. They can identify quite readily those relatively rare cases where patients  actually do require onward referral for an MRI scan.

Got to homepage at: https://www.physioclinic.ie 



Sleep Quality: The positive impact of exercise

Exercise has an immediate impact on sleep that night

New research shows that the amount of exercise that a teenager gets on a given day can have an immediate impact on the quality of their sleep that night. Getting more exercise than normal helped induce sleep faster, and for longer than normal. A reduced level of exercise, on the other hand, caused the participants to take longer to go to sleep and have a poorer sleep quality.

The researchers reported that for every additional hour of moderate-to-vigorous exercise, participants fell asleep 18 minutes earlier and slept 10 minutes longer. Their sleeping quality also improved. In contrast, participants who had been more sedentary during the day fell asleep and woke up later but also slept for a shorter overall period of time.

sleep by Naas Physio Clinic

The participants wore accelerometers on their wrists and; therefore, the activity measurement was more accurate than other studies using self-report methods. The findings of this study correlate with the findings of a meta-analysis which found that individuals who participate in regular physical activity over months and years are more likely to have adequate sleep duration, improved sleeping continuity, and experience less frequent daytime sleepiness (Kredlow et al. 2015).

Positive Impact of Running on Sleep Quality

In a randomised-controlled trial by Kalak et al. (2012) it was found that student participation in a 3-week running group (vs. a group seated during this time) significantly improved subjective sleep quality, shortened objective onset latency, improved mood, reduced daytime sleepiness, and increased proportion of slow-wave brain wave pattern while sleeping.

sleep and exercise by Naas Physio Clinic

What is the impact of Prolonged Sitting?

It would be interesting to analyse the impact of prolonged sitting, which mimics the daily routine of most people, on sleep quality. Add to a work shift, several hours commuting and it may well not only rob you of your time during the day but also rob you of your sleep quality at night.

The irony is that because people feel fatigued from prolonged sitting during the day they lack the motivation to exercise. This impacts on the quality of nighttime slumber and creates a viscious cycle of fatigue and sleep deprivation. If you want to achieve restorative sleep then exercise and movement should form a key element of your daily routine.

Journal References:

  1. Lindsay Master, Russell T. Nye, Soomi Lee, Nicole G. Nahmod, Sara Mariani, Lauren Hale, Orfeu M. Buxton. Bidirectional, Daily Temporal Associations between Sleep and Physical Activity in AdolescentsScientific Reports, 2019; 9 (1) DOI: 1038/s41598-019-44059-9
  2. Kredlow, M. A., Capozzoli, M. C., Hearon, B. A., Calkins, A. W. & Otto, M. W. A meta-analytic review. Journal of Behavioral Medicine38, 427–449, https://doi.org/10.1007/s10865-015-9617-6 (2015).
  3. Kalak, N. et al. Daily morning running for 3 weeks improved psychological functioning in healthy adolescents compared with controls. Journal of Adolescent Health51, 615–622, https://doi.org/10.1016/j.jadohealth.2012.02.020 (2012).

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