Hi guys! In this video, I'm gonna explain why you can sometimes get a lump in your Achilles tendon,
which can be painful when you press on it. My name is Maryke. I'm one of the
physiotherapists from treatmyachilles.com. We are an online physiotherapy service where we
treat Achilles tendon pain via video calls. Check out the description of this video if
you wanted to find the link to our website. So, have you noticed a painful lump in your
Achilles tendon when you press on it? Now, that lump is often … if I can get my foot into the
shot … somewhere in the middle of the tendon there, and when you squash it, it hurts. Now,
that's usually a sign that you have Achilles tendinopathy or tendinosis, depending on what you
want to call it, or, it's also called tendinitis or tendonitis, quite a few different terms. Now,
that lump there is not swelling in the sense of the word that we normally understand swelling to
be. So, swelling in a joint is usually fluid that collects. That lump is caused by something else,
and I'll explain to you a little bit more about that in a minute. So, to understand how it works,
I think we should first look at what an Achilles tendon looks like when it's healthy. So, if you
look at an Achilles tendon under a microscope, you'll see that there are loads – thousands and
thousands – of little collagen fibres packed in next to each other, and they all run parallel
to each other. Now, think back to school. Did you guys do that thing where, when you have one
piece of string and you pull on it, it can snap quite easily, but if you put about ten pieces of
string next to each other, you pull and pull and pull, and you can't really break it. So,
Achilles tendons are extremely strong, and part of the reason is because these fibres are all
parallel to each other. Now, the other thing that you see under microscope is that there are tiny
little cells, but you can see there aren't that many of them – those are the little black things
you can see on that picture. And then there are tiny white spaces in between, but mostly those
fibres are really squashed together and nice tight packed. Now, if you do exercise that's
more than what the Achilles tendon can cope with ... So, for instance you go and do a really hilly
run or a really long run, or you do a heavy speed session, and your Achilles tendon wasn't prepared
for it or strong enough for it, then you can flare it up, and it becomes injured; it gets a lot of
micro trauma and it causes an injury. So, that's the beginnings of Achilles tendinopathy, and what
you see then if you look under a microscope is … Can you see that the white gaps between the fibres
are now much … there are a lot more of them, and there are actually a lot larger. So, these fibres
are being forced apart slightly, and that's part of the reason why it's now starting to be swollen
or look like a swollen tendon to you. Also, the other thing you'll notice is, there are loads of
little black dots or dark purple dots now, which are cells that's moved into the area to try and
fix the problem. So, the end result of this is that you're getting that lump forming now. Now,
if this goes on for long enough … Usually, if you come and see me at this stage, we can calm it down
with quite severe alterations in how active you are and things and managing the load through the
tendon and get it to calm down and recover within a few weeks. But now, if you ignore it because,
let's face it, we all do it sometimes, that you try and train on it or you give it a bit of rest
and then you train on it quickly again, then this is what can happen in the tendon. At this point,
you don't really notice which direction those fibres are running in anymore, and it's because
it's becoming a little bit mangled. So, because they're not parallel anymore, you're losing that
strength of the tendon, so the tendon becomes softer. You also now have fewer cells again,
but they are larger cells. And if you look at them even closer, they are actually of the wrong kind.
So, not the same type as a healthy cell or healthy tendon has in it. Now, this is how it looks under
a microscope. If you looked under ultrasound scan, you'll also notice small blood vessels
growing into the tendon. Now, healthy tendons don't have blood vessels growing into them,
only injured ones, and ones that's been injured for a long time, so, more than a month or three
months, have blood vessels growing into them. So, the end result of all of these changes is that you
now have a softer tendon that doesn't quite work as well as a healthy one, because healthy tendons
need to be stiffer, then they return your energy for you better when you're running. Now, how do
you get this to turn back? So, if you just rest, you'll calm the pain down in it, but it won't
actually change anything in the cell structure. Think about it: When you want to build big muscles
and things you go to the gym, and you exercise the muscle, and you see changes in the size and the
quality of the muscle. The same thing goes for the Achilles tendon: If you want the body to change it
back to healthy cells and healthy fibres, you have to actually exercise it to get that to
happen. But the exercises have to be exactly at the right level, so, not too much or too little,
so that you get the changes but that you don't actually cause more trouble and the injury to
be worse. Same thing with running: People often ask me, ‘Can I continue to run?’ Now, the answer
to that is, ‘It depends on your specific case of your injury.’ We always …At treatmyachilles.com,
we always try and keep you as active as we can. So, what we'll do is, we'll manage your load,
we'll see how much running can you do without actually aggravating the tendon. So,
you've got to have it at the right level for it. And then, as the tendon gets stronger,
it's a mixture between strengthening exercises and running that will get it back to full health. Now,
the other important thing is, remember, if you want to get a beach body in the gym,
you won't do the exercises for a week and expect big muscles. You need to do it for at least six
weeks before you start seeing changes in your body, and the same thing for a tendon: If you
want to get rid of this condition, it's six weeks before you start seeing good improvement, and then
it can be 12 weeks and often up to 24 weeks before you're back to full running. Normally, we can get
people back to some sort of decent running within 12 weeks, but again, it depends on your case and
your injury. I find that runners who consult us earlier rather than later tend to return to
running much, much more quickly. Now, have a look at our website. We do Achilles tendon treatment
via online consultations. So, we do it in front of … with a video app like Skype or Zoom or WhatsApp,
depending on what you prefer. And the nice thing about that is that I can see you move. So,
we'll do a full-on consultation where I get a full history of your training, how the injury started,
what your goals are for the next few months, and then I'll test everything. So,
your muscle strength in the rest of your body as well as your Achilles tendon, and then only do
I compile a training program for you. Because if you don't take everything else that's happening in
your life into consideration, the training program may be too heavy and actually strain your Achilles
tendon rather than help it. I popped a link in the description of this video to our website. So,
have a look, but there's also a blog post that I wrote about this topic, about the lump in your
Achilles tendon specifically. So, if you wanted to read that again and get a better understanding,
that link will be in there as well. Let me know if you've got any questions. Take care!