Achilles tendinopathy and osteopathy

Achilles tendinopathy represents a major clinical challenge and a subject of growing interest in the field of sports medicine and rehabilitation. Characterized by pain, swelling and stiffness around the largest tendon in the human body, this condition affects a wide cross-section of the population, from elite athletes to individuals active in their daily lives. The emergence of Achilles tendinopathy as a prevalent health problem underscores the importance of a thorough understanding of its epidemiology, underlying mechanisms, and most effective prevention and treatment strategies. This article aims to explore in depth the prevalence and epidemiology of Achilles tendinopathy, highlighting the intrinsic and extrinsic risk factors that contribute to its development. By delving into the nuances of this complex condition, we aim to provide a solid foundation for clinical management, highlighting current and innovative therapeutic interventions, such as therapeutic exercise, orthotics, manual therapies, and kinesio taping. Through this review, our aim is to demystify Achilles tendinopathy, offering valuable insights to improve patient outcomes and move towards more personalized and effective treatment approaches.

Achilles tendinopathy is a common condition, especially among athletes involved in sports involving running or jumping, but it can also affect the general population. It is characterized by pain, swelling and stiffness in the Achilles tendon, the tendon connecting the calf muscles to the heel. Prevalence in the general population varies, but studies indicate that it can reach up to 6-18% in amateur and professional runners(Lopes AD et al.).

The causes of Achilles tendinopathy are multifactorial, often involving a combination of intrinsic (patient-related) and extrinsic (environmental or activity-related) factors. The main causes of this condition are as follows:

• Age: Achilles tendinopathy is more common in middle-aged adults, probably due to tissue degeneration with age.
• Gender: Some studies suggest a male predominance, possibly linked to differences in physical activity or muscle strength.
• Biomechanical abnormalities: Imbalances or abnormalities in foot alignment (such as flat foot or hollow foot) can increase stress on the Achilles tendon.
• Medical conditions: Systemic diseases such as diabetes or certain forms of arthritis can alter tendon structure or function.
• Genetics: There are indications that susceptibility to Achilles tendinopathy may have a genetic component, although the precise mechanisms remain to be determined.

• Activity overload: A sudden increase in the intensity, duration or frequency of physical activity, particularly sports involving running or jumping, can overload the tendon.
• Inappropriate equipment: The use of inadequate or worn-out sports shoes can alter running mechanics and increase the risk of tendinopathy.
• Practice surfaces: Running or training on hard or uneven surfaces can increase stress on the Achilles tendon.
• Inadequate training techniques: Poor technique during sports can increase the forces exerted on the Achilles tendon.
• Climate change: Cold temperatures can reduce tendon elasticity, increasing the risk of injury during physical activity.

Understanding these factors is crucial in the prevention and treatment of Achilles tendinopathy, underlining the importance of a personalized approach tailored to each patient's characteristics and lifestyle.

Clinically, Achilles tendinopathy manifests as :

• pain on palpation of the tendon, often exacerbated by physical activity.
• Pain is typically localized 2-6 cm above the insertion of the tendon on the calcaneus.
• Patients may also report morning stiffness or limited mobility.

Diagnosis is mainly clinical, but may be supported by imaging such as ultrasound or MRI to assess the extent of lesions(Khan KM et al.).

Treatment of Achilles tendinopathy is multifaceted, involving a combination of interventions to manage and reduce symptoms. Here's a detailed overview of the different approaches mentioned:

• Activity modifications: This may include reducing or adjusting activities that aggravate tendinopathy symptoms, such as running or jumping. The idea is to reduce the load applied to the Achilles tendon to allow healing without completely stopping all physical activity.
• Relative rest: Active rest, which involves avoiding specific pain-causing activities while remaining generally active to promote healing, is often recommended. Total rest is rarely recommended, as it can lead to tendon deconditioning.

Management of Achilles tendinopathy needs to be tailored to the individual, taking into account the extent of the injury, the level of activity, and the patient's specific goals. What works for one person may not be appropriate for another, hence the importance of a personalized assessment and treatment plan by healthcare professionals.

In short, the management of Achilles tendinopathy is a complex process that often requires a combination of approaches to achieve effective and lasting healing.

Exercise-based treatment for Achilles tendinopathy focuses on movements designed to strengthen the tendon and improve its ability to handle loads. One of the most renowned protocols for this is the so-called "Stanish protocol" for Achilles tendinopathy.

• Eccentric exercises

  These exercises focus on strengthening the Achilles tendon and calf muscles by lengthening the muscle under load, which is different from the traditional concentric approach where the muscle shortens under tension. The idea behind eccentric exercises is to provoke a positive adaptation in the structure of the tendon, making it more resistant to future stresses.

Manual therapies and osteopathy are often used as complementary treatments in the management of Achilles tendinopathy. These approaches can include gentle manipulation techniques to improve joint mobility, tendon mobilization techniques, and specific strengthening exercises.

Kinesio taping, or the use of kinesiology bands, has become a popular method in the management of Achilles tendinopathy, offering complementary support to traditional treatments such as exercise, physiotherapy and activity modification. These specific elastic bands are applied to the skin in strategic configurations to support the Achilles tendon, promote circulation and reduce pain. One of the key features of kinesio taping is its ability to provide support without restricting mobility, enabling patients to continue engaging in their daily activities and rehabilitation exercises with less pain and better function. By increasing proprioception (sensory awareness of body position and movement) and reducing pressure on the tendon, taping can help reduce inflammation and facilitate the healing process. Although the effectiveness of kinesio taping may vary from person to person, many practitioners consider it a useful addition to the overall treatment plan for Achilles tendinopathy, underlining the importance of a multidisciplinary approach to recovery.

Achilles tendinopathy is a common pathology that can significantly affect quality of life. A multifaceted treatment approach, combining rest, therapeutic exercises, and sometimes manual therapies or osteopathy, can be beneficial. As always, accurate diagnosis and patient-specific management are crucial for optimal results. Further research is needed to better understand the underlying mechanisms and optimize treatment strategies.