Written by: Øyvind Ville Sæter, Physiotherapist at Volvat Medical Center

Achilles tendons.
The Achilles tendon is one of the body's strongest tendons, and connects the large calf muscles to the heel. Large forces equivalent to several times your own body weight are transmitted through the tendon for each step as you run. It is therefore exposed to overload in runners, and accounts for 5-12% of all running injuries.

Various causes of pain from the Achilles tendon.
There are many different causes and mechanisms that can cause Achilles pain. Some injuries come acutely, others develop over time. The cause of the pain can also be in different parts of the tendon. It is very important that the correct cause of the pain is revealed so that the right measures can be initiated. Different Achilles ailments require different approaches in treatment and rehabilitation. First advice is therefore; If you have ailments from the Achilles tendon, start by getting a thorough examination by a physiotherapist or doctor who has experience with such ailments. In this article, it will be Achilles tendinopathy that is discussed. This means pain due to a gradual degeneration (wear) of the tendon, as a result of overload over time. This is probably the most common cause of pain from the Achilles tendon we see in the clinic.

Symptoms.
The main symptom of Achilles tendinopathy is pain, and it is usually a gradual onset of pain. The symptoms can be divided into four phases. In the first phase, you will feel pain mainly after activity, which in turn disappears after some rest. In the second phase, you will feel a slight pain during activity, but which does not necessarily limit the activity. The third phase is characterized by activity pains that are so severe that they hinder normal training / activity. In the fourth phase, there is constant pain, that is, also pain at rest. There are smooth transitions between the different phases. Another typical symptom is a strong feeling of stiffness in the Achilles tendon in the morning.

Treatment.
Which treatment measures are initiated depends on which phase you are in, while correction of underlying causes is important regardless of which phase you are in. This can involve everything from correcting stress patterns, to restructuring training programs. In the early stages, many will have good results with relief, as well as anti-inflammatory drugs. Later in the course, anti-inflammatory drugs will have little or no effect, while active rehabilitation has a well-documented effect and will be essential to regain a healthy and strong tendon. An active rehabilitation regimen will consist of systematic training of the Achilles tendon with static, eccentric and eccentric / concentric exercises. Pressure wave therapy (ESWT) can be an effective supplement in the rehabilitation of long-term Achilles ailments.

Prevention.
If you have developed an Achilles tendinopathy, you will in all probability have to adapt your training for a longer period, and thus put, for example, a planned training program on hold. Therefore, it is important to prevent. Simple steps you can do yourself are to vary the training load and intensity. Run on varied surfaces. Wear good footwear. Get enough recovery between sessions, far too many fall into the classic trap; «Too much, to soon, to fast».

Written by: Øyvind Ville Sæter, Physiotherapist at Volvat Medical Center