From the Guidelines
Achilles tendonitis and Achilles tendon strain are distinct injuries that require different treatment approaches, with tendonitis being an inflammatory condition and strain being an acute injury involving partial tearing of tendon fibers. The treatment for Achilles tendonitis includes rest, ice, NSAIDs like ibuprofen (400-600mg three times daily with food for 1-2 weeks), heel lifts, stretching exercises, and physical therapy 1. In contrast, the initial treatment for Achilles tendon strain includes RICE protocol (rest, ice, compression, elevation), followed by gradual rehabilitation 1. It's essential to note that while NSAIDs can provide pain relief, they should be used with caution, and alternative analgesics may be considered 1. Additionally, imaging studies such as ultrasonography and MRI can be helpful in diagnosing and monitoring the progression of both conditions 1. The recovery timelines for these conditions differ significantly, with tendonitis potentially improving within weeks and strains, especially severe ones, taking months to heal completely 1. Persistent symptoms beyond 2-3 weeks warrant medical evaluation to prevent chronic issues or complete rupture. Some key differences between the two conditions include:
- Onset: Tendonitis develops gradually, while strain is an acute injury
- Pain: Tendonitis causes pain that worsens with activity and improves with rest, while strain causes sudden pain and possible audible pop
- Treatment: Tendonitis treatment focuses on reducing inflammation and promoting healing, while strain treatment involves RICE protocol and gradual rehabilitation
- Recovery: Tendonitis may improve within weeks, while strains may take months to heal completely It's crucial to prioritize proper footwear and activity modification for both conditions to prevent further injury and promote recovery 1. Overall, accurate diagnosis and treatment are essential to prevent chronic issues and promote optimal recovery for both Achilles tendonitis and strain.
From the Research
Definition and Diagnosis
- Achilles tendonitis, also known as Achilles tendinopathy, is a clinical term describing a non-rupture injury of the Achilles tendon where the patient presents with pain, swelling, and reduced performance and symptoms exacerbated by physical activity 2.
- The diagnosis of Achilles tendinopathy can be made using patient self-reports of morning stiffness and/or pain in the tendon area, pain on palpation of the tendon, and detection of Achilles tendon thickening 2.
- Imaging modalities such as ultrasound and magnetic resonance imaging (MRI) can be useful in assisting in diagnosis, with MRI providing slightly better sensitivity and specificity 2.
Comparison with Tendon Strain
- Tendon strain, such as gastrocnemius strain, is a different condition that can cause pain and discomfort in the Achilles tendon area 3.
- While Achilles tendonitis is a degenerative condition characterized by cumulative tissue microtrauma, tendon strain is typically an acute injury caused by sudden stretching or tearing of the tendon fibers 4, 3.
- The treatment and management of Achilles tendonitis and tendon strain may differ, with Achilles tendonitis often requiring a more gradual and progressive rehabilitation approach 2, 4.
Treatment and Management
- Conservative treatments for Achilles tendonitis include nonsteroidal anti-inflammatory medication, eccentric exercise, stretching, orthotics, bracing, and injection therapies 2, 5.
- Eccentric exercise and shock wave therapies have been shown to be effective in the treatment of Achilles tendonitis 2, 5.
- The addition of anti-inflammatory treatment to physical rehabilitation in the early phase of Achilles tendinopathy has not been shown to have an additive clinical effect 6.
- Prevention strategies for Achilles tendonitis, such as balance training and shock-absorbing insoles, may be effective in specific populations 2.