What You Need to Know About New Achilles Tendon Research
New research is constantly emerging in the treatment of Achilles tendon pain. Staying up to date with Achilles tendon research enables the transition of breakthrough treatments from research to clinical practice. So what’s new in the treatment of Achilles tendon pain?
Isometrics
Isometric exercises, although not the newest treatment around, have a growing body of new evidence supporting their effectiveness in treating Achilles pain. Isometric exercises occur when force develops in the muscle without movement at the joint and the contraction is then sustained (isometric hold). Isometric exercise can be used for painful tendinopathies in an early stage. These are those Achilles that become painful following a burst of unaccustomed or increased physical activity (1). Each individual Achilles tendon is likely to be different, however often isometric holds of 40-60 seconds, repeated 4-5 times are greatly beneficial (1). In addition, reducing pain can often occur through the minimising of compressive loads on the tendon, ie no calf stretches for Achilles pain close to heel (insertional achilles tendinopathy).
Corticosteroid Injections
Mixed evidence exists surrounding the efficacy of tendon injections. There is evidence that in an acute reactive tendinopathy, corticosteroid can be effective in reducing pain, where a quick recovery is needed (1, 2). Corticosteroid injection can have strong short-term effects on reducing symptoms however these are often short lived (2).
Central Mechanisms
Research surrounding persistent pain illustrates that hypersensitisation of the nervous system can occur long after tissue damage and healing has occurred. Additionally, pain can also be related to protection and not only the activation of peripheral nociceptors (pain threat detectors). There are thoughts that this could hold true for stubborn Achilles tendinopathy. So what’s all that really mean? This means there could also be neural contributors to tendon pain – not just the tendon itself (3).
PRP Injections
Platelet-rich plasma injections have shown favourable effects on pain and functioning for stubborn chronic Achilles tendinopathies. See our previous post (HERE) for more information on how PRP Injections can benefit Achilles pain.
Lewis Craig (APAM)
RELATED POSTS:
1. A Physio’s guide to PRP injection therapy HERE.
2. What is tendonopathy? HERE.
REFERENCES:
1) Cook, J. L., & Purdam, C. R. (2014). The challenge of managing tendinopathy in competing athletes. British Journal of Sports Medicine, 48, 506-509.
2) Wetke, E., Johannsen, F., & Langberg, H. (2014). Achilles tendinopathy: A prospective study on the effect of active rehabilitation and steroid injections in a clinical setting. Scandinavian Journal of Medicine Science and Sports.
3) Rio, E., Moseley, L., Purdam, C., Samiric, T., Kidgell, D., Pearce, A. J., & Cook, J. (2014). The pain of tendinopathy: physiological or pathophysiological?. Sports medicine, 44(1), 9-23.
4) Rio, E., et al. (2013). Exercise intervention to reduce tendon pain: A comparison of isometric and isotonic muscle contractions and effects on pain, cortical inhibition and muscle strength. Journal of Science and medicine in sport, e28.
