What pain means and how pain levels can help us manage an Achilles tendinopathy

One of the main drivers for patients to contact us is the level of pain they are experiencing in their Achilles tendon, which in turn is stopping them from doing the activities they love. This article explores what that pain really means and how you can use it to help guide you in what to do next.

In this article:

1. Why do I have pain in my Achilles tendon?

2. How can I use this pain response to help me?

3. How we can help

I've also explained it in a bit more detail in this video:

Why do I have pain in my Achilles tendon?

Culturally, we have been brought up to believe that the more pain we have, the more damage has happened. This is actually very inaccurate.

Research has repeatedly shown us that pain levels don’t correlate to harm or damage. In fact, they are more like our bodies’ alarm system, so the pain you feel does not correlate to the severity of the injury.

When we develop an Achilles tendinopathy, ongoing pain is a common symptom. It is a sign that our alarm system (nervous system) is getting more sensitive. If we continue to train through this pain, the nervous system becomes more and more sensitive and starts to shout louder because it feels that you’re not listening to it. The injury isn’t necessarily getting worse, but the pain may reach a level that stops you from training and even hampers your daily activities. That’s why it’s not useful to ignore your injury.

If you were to stop training and rest, it just calms the alarm system down – it doesn’t rehabilitate or change the structure of the tendon. In order to change the structure of your tendon, you need to stimulate the tendon to produce normal strong cells and collagen fibres by completing specific exercises that relate to you, your fitness levels, and the sports/activities that you do.

How can I use this pain response to help me?

Remembering that the amount of pain does not indicate the amount of harm is a great start. This helps us to view our tendon injury as something we can start to control and not something that is controlling us.

Calling this pain “a pain response” is a good way of doing this. Some of the current thinking in tendon rehab is that a little discomfort can be a positive thing when completing your specific exercises and activity management.

How to tell what is an acceptable pain response varies between people. A good guideline is to aim for “a niggle level” only; so, something that doesn’t make you wince, limp, or feel pain for a while after.

Tendon pain can commonly be described as latent pain. This means it may have been fine during the activity but later on or the next morning you then get a pain response. Therefore the niggle level guide is for both during the activity and for 24 hours after activity.

Using this as a guide, you may be able to find an acceptable level of training and activity while you are doing your specific rehabilitation. This is something we can help you with at TreatMyAchilles.com.

Research points to using a Visual Analogue Scale (VAS). Some people prefer using this method rather than “a niggle level” thought process. A VAS is simply a score out of 10 of your pain and the research points to 3 or less out of 10 being acceptable for a pain response for people with Achilles tendinopathy, 4-5 /10 is OK and 6-10/10 is too much.

In summary

• Pain does not correlate to harm;

• Pain is a response from our in-built alarm system;

• Finding a level of activity that is 0-3/10 or only a niggle level can help monitor our pain response and dampen down the alarm system.

• There is no substitute for rehabilitation and activity management when it comes to the best treatment for Achilles tendinopathy.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author:

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram or Twitter.

References

1. Silbernagel KG, Thomeé R, Eriksson BI, et al. Continued Sports Activity, Using a Pain-Monitoring Model, During Rehabilitation in Patients With Achilles Tendinopathy: A Randomized Controlled Study. The American Journal of Sports Medicine 2007;35(6):897-906. doi: 10.1177/0363546506298279