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Achilles tendinopathy – can you help?

By Hayley Leake Science and the world 20 Jun 2016

ankleTricky tendinopathy pain

If you are anything like me, and many of the people who read things from NOI, you will spend some time trying to work out why something hurts. Ever tried this with Achilles tendon pain? The pain of tendinopathy is a very tricky one to work out. In some ways it resembles a classic acute pain – pain on mechanical loading; pain confined to a discrete location. In other ways it resembles a classic chronic pain – pain not clearly related to evidence of tissue disruption; pain that eases off as you warm up but can ‘come back to get you’.

A complex problem

Some clinicians and the odd researcher here and there speak with great confidence about the cause of tendinopathy pain, but, when you look closely at the actual data, it is hard to conclude much at all except that it is complex and may involve mechanisms we have not previously thought of as classically nociceptive – see this reasonably recent review by Ebonie Rio and colleagues on this.

Lack of clarity

The lack of clarity about what causes tendinopathy pain is not matched by a lack of clarity about what helps it, at least in a broad sense. There is reasonable agreement that eccentric loading exercises are helpful, but they are painful to complete, which makes them pretty unattractive to most of us, particularly in season. Recent discoveries suggest that isometric exercises are at least as helpful as eccentric exercises and they are possibly more helpful for giving analgesic benefit. Critically, they are nowhere near as painful to do (here is another of Ebonie’s papers that gives the low down on this stuff).

Motor cortex activation

One question that remains here is ‘What is it about isometric exercise that gives pain relief?’ One possible answer is that it is because of motor cortex activation – we know that the motor cortex has potentially profound connections to ‘the drug cabinet in your brain’ and that working motor cortex may be analgesic in and of itself and, if so, it mightn’t matter how you work it as long as you do.

Afternoon run

So, imagine now, if you will, this scenario (and you may not need to imagine it if you are one of the millions of people who experience this!) – You are about to head out for an afternoon run, but you know that every time you push off you will have that pain in your Achilles.  Everyone tells you that exercise is great for it, but how are you meant to run if you are constantly in pain?! Isn’t there something you can do before hand that will reduce it?

So – satisfied that it is an issue worth considering?  Good. Well help us find out!

Everyone can help

The Body in Mind Research Group at the University of South Australia invites you to be part of a study investigating whether motor imagery exercises can reduce pain in people suffering from Achilles tendon pain. We are looking to recruit people with Achilles tendon pain to participate in a single short session of motor imagery training, done entirely online in the comfort of their own home. We are also seeking healthy pain free participants to serve as controls. So, if you have tendon pain or you don’t have tendon pain, you are potentially eligible. We think this covers everyone! We would dearly love you to alert anyone with Achilles tendon pain to this study. We would also dearly love you to alert anyone without Achilles tendon pain to this study. Get it? We need participants!


Use this link if you would like to know more and participate (or forward someone else on).


– Monique Wilson






We’re hitting the road and taking our NOI courses right across this great southern land:

Wagga Wagga 16-17 July Explain Pain

Gold Coast 30 Sept – 2 Oct Explain Pain and Graded Motor Imagery

Perth 15 – 17 October Explain Pain and Graded Motor Imagery


EP3 events have sold out three years running in Australia, and we are super excited to be bringing this unique format to the United States in late 2016 with Lorimer Moseley, Mark Jensen, David Butler, and few NOI surprises.

EP3 EAST Philadelphia, December 2, 3, 4 2016

EP3 WEST Seattle, December 9, 10, 11 2016

To register your interest, contact NOI USA:

p (610) 664-4465



  1. davidbutler0noi

    Hi Monique,

    Good to see a different research viewpoint for a problem area. I hope our readers support the project and call in all their mates.

    In a recent Graded Motor Imagery class, a participant with a problematic, chronic, left sided Achilles tendon pain had a visceral response and was almost ill when they were asked whether a left foot image (image included the tendon) was a left or right foot. There was no such response to viewing a right foot image.

    One doesn’t have to be too much of a sleuth to deduce from the anecdote that that something is going on!

    Maybe your research will shed some light?

    Join in – here is the link again-


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