Where is the cause of the pain in the Achilles tendon?
Achilles tendon pain is often a burning problem for runners, preventing full-fledged training. These difficulties can develop gradually or appear suddenly after a major workout or inappropriate sharp movement. The problem in the Achilles tendon often develops over a long period of time, long before we start to feel pain. It has been proven that tendon ruptures occur mostly on the basis of advanced degenerative changes. Similarly, the sharp, uncoordinated movement that triggers Achilles tendon pain is often the last straw, when the pain is subliminal until then, increases and we begin to perceive it. Chronic Achilles tendon pain is mainly degenerative changes, not the mostly reported chronic inflammation. The so-called sterile inflammation can be accompanied by degenerative changes in acute microtraumatization of tendon fibers or overload of tendon sheaths. In these cases, there is swelling around the Achilles tendon, possibly redness and a local increase in temperature.
We must not forget the cases when the Achilles tendon hurts, but this pain does not come from the tendon itself, but it is a so-called transferred pain. This pain can arise from surrounding structures, such as the soft tissues between the Achilles tendon itself and the tibia bones. Painful bursa at the tendon tendon and bone protrusion on the heel bone referred to as Haglund’s heel can be manifested by tendon pain, but often occur together with Achilles tendon involvement. Pain can also be transferred from the triceps itself, i.e. the calf muscle, where there may be places of increased muscle tension, the so-called trigger points.
If it is a problem directly in the Achilles tendon, we can recognize it with these symptoms:
- Achilles tendon pain, in lighter cases it appears only at the beginning of the load, in the morning, in the worst case it appears even after the load and in the most severe case it is even during normal daily activities or even at rest
- Stiff Achilles tendon most often in the morning and during running or only at the beginning of the run
- swelling of the Achilles tendon, most often in its middle third, which forms as if a ring around the tendon, or the thickened surface of the tendon in a certain part of it
- burning pain when pressing on the tendon can be both in the tendonmus transition, in the middle third of the tendon, and tightly when attaching to the heel bone
- burning pain when pressing on the tendon can be both in the tendonmus transition, in the middle third of the tendon, and tightly when attaching to the heel bone
We successfully treat achilles pain.
Of course, the Achilles tendon of runners is very strained. But why do only some runners have these problems, and why do people with a sedentary lifestyle suffer from these difficulties? The reason is unlikely to be just in the excessive load, training surface or in shoes.
Modern physiotherapy deals with the function of the musculoskeletal system. More precisely, the work of muscles in harmony, in their coordination. It is the muscle interplay that is decisive for the position of the individual segments relative to each other, i.e. for the position in the joint. The ideal position in the joint is one where there is as much distribution of forces as possible. It is therefore the position biomechanically most advantageous in terms of the load on passive structures – i.e. joints, tendons and ligaments. In this case, we are talking about functional centering of the joint. If muscle coordination is not optimal, i.e. when certain muscles have the upper hand, are in increased tension and others in attenuation, there is a disadvantageous position in the joint. Forces are not evenly distributed, some structures are overburdened, and thus painful irritation and premature degeneration occur. Impaired muscle coordination can occur due to various influences, for example, as a result of an injury, unilateral overstrain, or this coordination did not develop well in early childhood.
In this way we can understand the emergence of many painful problems of the musculoskeletal system. Thus, pain and degenerative changes in the Achilles tendon. Certain functional disorders of the musculoskeletal system lead to an increased or uneven load on the Achilles tendon and thus predispose it to traumatization and the development of degenerative changes. The extent of these changes and difficulties is then probably due to functional disorders and other influences, such as the type of physical activity performed, shoes used, age, hormonal changes, etc. This is also the answer to the question of why painful conditions of the Achilles tendon concern only someone. The disorder of movement stereotypes causes only small force changes in the load, for example, just certain parts or the entire Achilles tendon, compared to the forces that act on the tendon, for example, during sprints, jumps, or endurance running, but their huge importance lies precisely in their constant action.
According to a pilot study on a group of patients, mostly runners, we found that individuals with painful Achilles tendon share a more or less similar disorder of muscle coordination that affects the whole body. By therapy of this so-called functional disorder, the difficulties were reduced relatively soon to their complete disappearance. It is important to note that this method directly treats the cause of the problems, so it is not a therapy that only relieves symptoms, such as procedures focused locally only on the Achilles tendon and therefore the results of the therapy are long-term. If we treat only the symptoms, that is, pain, swelling, stretching the calf muscle and Achilles tendon, applying ultrasound, laser, shock wave, maybe these symptoms will go away for some time, but we can be sure that they will appear again. The cause remains hidden in the musculoskeletal system.
Mgr. Dagmar Lisá (Mostecká)