This is a question often posed to us by those that are either currently experiencing Achilles tendinopathy, or may have in the past. So what does a thick tendon mean?
Our response to this question is: "It's our bodies' amazing ability to adapt!"
You see when a tendon undergoes tendinopathic changes, the core of the tendon may be in disrepair, but the body responds to this by layering new tissue around it, & thereby thickening the tendon. This is what tendon researcher Sean Docking refers to as "the donut & the hole" analogy. Optimal management for tendinopathy then focuses on building up the "donut" & not worrying so much about the "hole".
In the first image above, we see thickening of the right tendon in both patients, the second image shows an ultrasound of a tendinopathic tendon which demonstrates this "donut" appearance.
Interestingly, a recent study by Corrigan et al earlier this year, found that those with thicker Achilles tendons had WORSE symptoms & calf muscle function at 1 year after imaging.
Our take on this? It's important to recognize that tendon thickness is something that is NOT used to determine progress. Your pain & function are more important than what your tendon looks like. So to summarize, don't worry about the thickness of the tendon, but ensure you properly rehab it :)
If you need help with your Achilles issues, please don't hesitate to contact us!
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References
Corrigan, P., et al. (2020). "Tendon Morphology and Mechanical Properties Are Associated With the Recovery of Symptoms and Function in Patients With Achilles Tendinopathy." Orthopaedic Journal of Sports Medicine 8(4): 2325967120917271.
Docking, S. I. and J. Cook (2019). "How do tendons adapt? Going beyond tissue responses to understand positive adaptation and pathology development: A narrative review." J Musculoskelet Neuronal Interact 19(3): 300-310.