You’ve been lied to. Well technically they didn’t lie to you, they just didn’t know the truth about your condition and ended up telling you what they thought was true. The condition I am referring to is Achilles Tendinitis. I am sure you’ve come across this condition throughout your years as a runner. Either you’ve personally had a brief bout of achilles tendinitis or someone you know personally has had this annoying overuse injury.
And that is the point we’re trying to make, you see almost every single injury related to the achilles, bar a complete rupture of the tendon, gets diagnosed as Achilles Tendinitis.
However, that is technically a lie…This is: The Truth about Achilles Tendinitis (AT)
Some Background on AT
Achilles tendinitis or AT is a common overuse injury within the running community. It results from overtraining, a sudden spike in training intensity, sudden weight gain or any other factor that could potentially lead to an excessive overload in training.
It usually presents as chronic inflammation, discomfort and pain in the achilles area and limited range of motion of the ankle joint. If you want to catch up on this injury check out our previous article on AT here.
Back in the day most health professionals used the term Achilles Tendonitis to describe any tendon related injury.
The truth is, as straightforward as AT related injuries might be to the everyday runner, it’s equally much more complex than we’ve been made to believe. An achilles injury can be one or more of a multitude of overuse injuries:
So as you can see, despite most of these conditions sharing similar symptoms and at times they might even present almost identically. AT can no longer be used as a blanket term diagnosis to cover all the injuries related to the achilles tendon.
Because the truth is there is so much more to achilles tendon injuries.
Okay let’s get right into it…
Now this is an interesting curve ball when it comes to AT. Peritendinitis is essentially tendinitis of the connective sheath surrounding the actual tendon. This sheath serves as protection for the tendon as well as aiding the tendon during motion. The sheath may get inflamed as a result of overtraining. The signs and symptoms include slight to mild discomfort accompanied by stiffness and or limited range of motion.
In most cases peritendinitis is a precursor injury to full blown tendinitis. That essentially means that it's a “lighter” version of AT. When achilles peritendinitis goes untreated it usually progresses to achilles tendinitis.
Achilles tendonitis has a very specific pathology:
“It’s the acute inflammation of the achilles tendon due to micro trauma or tears in the tissue”
Tendinosis is different in the sense that it’s a non-inflammatory breakdown of the achilles tendon. This usually occurs over a much longer period than tendinitis between 3-6 months.
It usually affects the structural makeup of the affected tissue. It is characterized as the shift from an acute injury to a chronic condition.
Think of it like this:
When your car's engine overheats due to a lack of water or coolant your engine essentially has tendinitis. But if you were to keep driving despite the fact that your engine was overheating the engine will most likely break down. Your engine has now gone from having a tendinitis that can be “treated” quite easily and quickly. To now suffering from a severe case of tendinosis that will have your car out of action for quite some time. Make sense? Good.
Now let’s say you take your car to get fixed and the mechanic tells you it’s good as new. So you go on your merry long way only to see your heat gauge rising and smoke coming from your engine. Turns out your engine didn’t just overheat because of a lack of coolant. You take it back to your mechanic and he spends the next few weeks trying to figure out what the heck is wrong with your car.
That is when your tendinosis gets worse and becomes a tendinopathy. An achilles tendinopathy is a long term degenerative disease of the tendon. Experts describe it as a “chronic condition that fails to heal”.
This is something that you do not want to suffer from! No, really guys, an achilles tendinopathy is an insufferable condition that nine times out of ten, never fully heals.
It is the result of not treating minor symptoms and causing a relatively mild acute injury to progress into a chronic degenerative disease.
Achilles Partial Rupture
And lastly, when it comes to achilles injuries a rupture is not something I’d wish upon anyone. It’s arguably one of the most painful and debilitating injuries you can suffer from. It usually happens in an instant accompanied with a loud pop and a lot of pain. As a result of a sudden external force.
But sometimes the achilles only partially tears. This is where it gets a bit more complex. Because partial ruptures occur due to overuse rather than a once off accident. For runners, this usually happens when you overtrain. In short, you overtrain, your calf muscles get overworked and very tight. The excessive tightness places immense pressure on the achilles tendon causing microtears within the connective fibers. Over time these microtears compound forming a partial tear in the tendon.
Persistent pain is felt at the back of the lower leg as well as stiffness and limited mobility. Other symptoms include impaired balance and physical deformity or a slight “divot” visible on the back side of the leg.
How to Prevent All of These Conditions
When it comes to overuse injuries prevention is always better than a cure. All of the above injuries or conditions we just discussed can be attributed to one or more of the following issues or risk factors:
How to Treat These Conditions
Yes, that’s it. Not complicated at all. Nothing is stopping you from getting the help you need. The internet is full of helpful tools, articles and videos.
All in all the achilles tendon is one of the strongest connective tissue structures in your body. That’s because it plays a vital role in everything we do that requires us to move our lower body. Some of you might suspect that you have an acute flare up of AT or even a bit of peritendinitis. While others might be suffering for months with a condition that they just can’t seem to shake. Either way it might be time to take it a bit more serious from here on out. You have all the information you need regarding these conditions. And now that you know what is wrong, you know how to tackle it.
Wishing you all a speedy recovery!
And remember when it’s all said and done, we all just want to run.