Basketball fans around the world were recently sickened by the footage of basketball
star Kevin Durant’s Achilles tendon rupturing during a game.
But while many think it’s only elite athletes who suffer from Achilles tendon issues, a
fifth of the over-50 population actually suffers from Achilles tendinopathy (pain). And
while very few of these will be ruptures, the pain can be frustratingly persistent and
limit our ability to exercise and enjoy life.
What is Achilles tendinopathy?
The Achilles tendon is one of the strongest tendons in the human body. It attaches
the calf muscles to the heel bone of the foot, helping you to run fast, jump high, and
change direction quickly. During these types of exercises the tendon acts like a
spring that propels you forward more efficiently.
We know words are extremely powerful and influence what treatment you think you
need. For example, would you do the exercises your physiotherapist gave you if you
believed your tendon was hanging on by a thread? Probably not.
Research ha found a painful tendon is not like a torn rope at all. It’s more like
doughnuts stacked on top of each other. Even though changes in tendon structure
are seen as a “hole” in the middle of the tendon, there is still a lot of delicious
doughnut (in other words healthy tendon) surrounding the damaged area.
The tendon adapts by getting thicker, making it stronger and allowing you to
Critically, pain poorly reflects damage. Tendon pain is not present because the
tendon is damaged, weak or hanging on by a thread.
Who gets it?
Achilles tendinopathy can affect athletes who participate in sports that involve
running or explosive movements. Most players do not miss competition as a result of
Achilles tendon pain.
However most people who experience this type of pain are aged 40-64 years.
That’s because the Achilles tendon bears the brunt of activities like running, playing
golf, walking the dog, and stepping off the kerb throughout life. Being overweight,
having diabetes, and high cholesterol all increase the risk of developing Achilles
Overcoming tendon pain
The good news is that painful Achilles tendons rarely rupture. Some 80-90% of
people who rupture their tendon have never had Achilles tendon pain. Your brain is
clever as it uses pain to protect your Achilles tendon by changing your behaviour.
But it’s easy to become overprotective.
Completely resting the tendon, either by using crutches or a walking boot, is one
thing that should be avoided. This is because of the “use it or lose it” principle. With
even two weeks’ rest, your tendon and calf muscles become weaker, meaning a
longer recovery time.
Just like muscles, tendons get stronger with exercise. Starting exercise that
produces no or minimal pain and progressively increasing the intensity of exercise is
by far the best option, based on research.
Your physio should be able to guide you through a graduated pain free exercise
program. But interventions such as surgery or injections are often ineffective, costly,
and can be harmful and take longer to recover from!