↓↓English Below↓↓
皆さんこんにちは！！東京都千代田区 麹町駅と半蔵門駅の間 新宿通り沿いのビル2階・3階にある整形外科クリニック“One Clinic 麹町(ワンクリニック麹町）“院長の栗本です。
今回はアキレス腱の炎症に関する文献を少し整理して書いてみたいと思います。
アキレス腱の痛みは、以前はまとめて「アキレス腱炎」と呼ばれることが多くありました。しかし、長く続く痛みでは、強い炎症だけが原因ではないことが分かってきています。多くの場合、使いすぎによって腱の組織が少しずつ傷み、修復が追いつかなくなる「アキレス腱症」という状態が関係します。つまり、腱が「これ以上の負担はつらい」と知らせているサインと考えると分かりやすいでしょう。
ランニング、ジャンプ、坂道や階段の上り下りでは、アキレス腱に大きな力がかかります。通常は休むことで回復しますが、急に練習量を増やしたり、痛みを我慢して運動を続けたりすると、損傷が積み重なります。体重の増加、糖尿病、脂質異常、加齢、ふくらはぎの硬さなども、腱に負担をかけたり回復を遅らせたりする要因になります。
痛みの原因を見分ける
アキレス腱の周りが痛む場合でも、原因は一つとは限りません。腱の中央が腫れて押すと痛い場合、腱を包む膜がこすれて痛む場合、かかとの骨の出っ張りや滑液包が刺激されている場合などがあります。治療法は原因によって変わるため、痛む場所、朝のこわばり、運動中と運動後の痛み方を確認します。必要に応じて超音波検査やMRIで、腱の厚み、傷み具合、部分断裂の有無を調べます。
治療の基本：負担を調整しながら腱を強くする
治療の中心は、完全に動かさないことではなく、痛みを見ながら負担を調整し、リハビリで腱を少しずつ強くしていくことです。
痛みが強い時期は、走る距離やジャンプを減らし、坂道や硬い路面を避けます。
靴のかかとを少し高くするヒールリフトを使うと、アキレス腱にかかる力を一時的に減らせることがあります。
痛み止めや湿布は症状を和らげる助けになりますが、それだけで腱が強くなるわけではありません。治すためには、負担を減らす時期と、少しずつ鍛える時期をうまく分けることが大切です。
リハビリと補助療法
リハビリは、アキレス腱症の治療でとても重要です。よく行われる運動に、かかとの上げ下げをするカーフレイズがあります。最初は両脚で行い、痛みが落ち着いてきたら片脚、ゆっくり下ろす動作、軽い重りを持つ運動へと段階的に進めます。
運動中の痛みが軽く、動きが崩れず、翌日に痛みや腫れが強くならないことが目安です。運動後に痛みが長く残る場合は負荷が強すぎるため、回数や強さを下げます。
ストレッチも役立つことがありますが、強く伸ばしすぎるとかえって痛みが増えることがあります。特に、アキレス腱の付け根が痛いタイプでは、段差を使って深く沈み込む運動が刺激になる場合があります。
痛む場所や腱の状態に合わせて運動を選ぶことが大切です。不安がある場合は、理学療法士にフォームや負荷量を確認してもらうと安全に進めやすくなります。
数か月リハビリを続けても改善が乏しい場合は、補助的な治療を検討することがあります。体外衝撃波治療（ESWT）は、腱やその周囲に刺激を加え、痛みの軽減や修復反応を促すことを目的とした治療です。もう一つの選択肢にPRP療法があります。PRPは、ご自身の血液から血小板を多く含む成分を取り出し、痛みのある部位に注射する治療です。血小板には組織の修復を助ける成分が含まれており、腱の回復を後押しすることが期待されています。
PRPは、保存療法だけで十分に良くならない慢性的なアキレス腱の痛みに対して、選択肢の一つとして相談されることがあります。研究結果にはばらつきがあり、誰にでも確実に効く治療とは言えませんが、痛みの軽減や機能改善が期待できる可能性も報告されています。大切なのは、PRPだけに頼るのではなく、診断、負荷の調整、リハビリを組み合わせて考えることです。費用、通院回数、注射後の一時的な痛みや腫れなども含めて、主治医とよく相談して決めましょう。
治りにくい場合
半年以上リハビリを続けても日常生活やスポーツに支障が残る場合、腱の傷みが強い場合、部分断裂を伴う場合などでは、手術を検討することがあります。手術では、傷んだ組織を取り除いたり、腱の周囲の癒着をはがしたりします。最近は、症状や部位によって小さな切開で行う体への負担が少ない手術が選ばれることもあります。ただし、手術をしてもすぐに元の運動へ戻れるわけではなく、術後のリハビリがとても重要です。
再発を防ぐために
痛みが引いても、急に元の運動量・練習量(負荷)へ戻すと再発しやすくなります。まずは歩行や階段で痛みがないことを確認し、その後に軽いジョギング、スピード練習、ジャンプ動作へと段階的に進めます。ふくらはぎの筋力、片脚での安定性、ジャンプや着地の動きも確認ポイントです。練習量は週ごとに少しずつ増やし、痛みが戻った場合は一段階前に戻りましょう。「少しずつ戻す」ことが、結果的に早い復帰につながります。
おわりに
アキレス腱の痛みは、体からの大切なサインです。完全に休み続けるだけでも、痛みを我慢して運動を続けるだけでも、うまく治らないことがあります。まずは原因を見極め、負担を調整しながら、腱が耐えられる力を少しずつ高めていくことが大切です。ESWTやPRPなどの補助療法、手術などの選択肢もありますが、基本となるのは状態に合った治療計画です。主治医や理学療法士と相談しながら、焦らず段階的に回復を目指しましょう。
アキレス腱に限らず、お身体の不調を感じた際にはいつでもお気軽に当院にご相談ください。引き続きクリニック一丸となって1人でも多くの方に「明日を楽しみに」して頂けるよう努力してまいります。
お気軽にお問い合わせいただきますようお願い申し上げます!(^^)!
Introduction
Achilles tendon pain was once commonly referred to collectively as “Achilles tendonitis.” However, we now understand that persistent pain is not necessarily caused by inflammation alone. In many cases, it is associated with a condition called Achilles tendinopathy, in which repetitive overuse gradually damages the tendon tissue faster than it can repair itself. In simple terms, the pain can be viewed as a signal from the tendon that it is being subjected to more stress than it can currently tolerate.
Running, jumping, and walking or running uphill and downhill place substantial loads on the Achilles tendon. Normally, the tendon recovers with adequate rest. However, suddenly increasing training volume or continuing to exercise despite pain can lead to the accumulation of small-scale tissue damage. Other factors, including weight gain, diabetes, dyslipidemia, aging, and tight calf muscles, may also increase stress on the tendon or delay its recovery.
Identifying the Cause of the Pain
Pain around the Achilles tendon does not necessarily have a single cause. For example, the middle portion of the tendon may become thickened, swollen, and tender to the touch. Pain may also arise from irritation caused by friction around the tendon, or from irritation of the bony prominence at the heel or the surrounding bursa.
Because treatment varies depending on the underlying cause, it is important to assess the exact location of the pain, morning stiffness, and how the pain changes during and after exercise. When necessary, ultrasound or MRI can be used to evaluate tendon thickness, the degree of tissue damage, and the presence or absence of a partial tear.
The Basics of Treatment: Adjusting the Load While Strengthening the Tendon
The cornerstone of treatment is not complete immobilization. Instead, the goal is to adjust the load according to the level of pain and gradually strengthen the tendon through rehabilitation.
When pain is severe, reducing running distance and jumping, as well as avoiding hills and hard surfaces, can help. Using a heel lift to slightly raise the heel may temporarily reduce the load placed on the Achilles tendon.
Painkillers and topical medications can help relieve symptoms, but they do not make the tendon stronger by themselves. Successful recovery requires an appropriate balance between periods of reducing the load and periods of gradually increasing tendon strength.
Rehabilitation and Adjunctive Treatments
Rehabilitation plays a very important role in the treatment of Achilles tendinopathy. One of the most commonly performed exercises is the calf raise, in which the heel is repeatedly raised and lowered.
Initially, the exercise can be performed using both legs. As the pain settles, the program can gradually progress to single-leg calf raises, slow lowering movements, and exercises performed while holding light weights.
A useful guide is whether pain during exercise remains mild, movement quality is maintained, and pain or swelling does not become significantly worse the following day. Conversely, if pain persists for a long time after exercise, the load may be excessive, and the number of repetitions or the intensity should be reduced.
Stretching may also be helpful in some cases, but excessive stretching can actually aggravate symptoms. In particular, for patients with pain where the Achilles tendon attaches to the heel, exercises that involve deeply lowering the heel below the level of a step may place excessive stress on the tendon.
Therefore, exercises should be selected according to the location of the pain and the condition of the tendon. If you are unsure how to proceed, having a physical therapist assess your exercise form and determine an appropriate training load can help you progress safely.
If symptoms remain largely unchanged despite several months of rehabilitation, adjunctive treatments may be considered.
Extracorporeal shock wave therapy (ESWT) is a treatment that applies mechanical stimulation to the tendon and surrounding tissues with the aim of reducing pain and promoting a healing response.
Another option is PRP therapy. PRP is a treatment in which a component containing a high concentration of platelets is prepared from the patient’s own blood and injected into the painful area. Platelets contain various substances that are involved in tissue repair, and PRP is therefore expected to support the recovery of damaged tendon tissue.
PRP may be considered as one treatment option for chronic Achilles tendon pain that has not improved sufficiently with conservative treatment alone. However, research findings have been inconsistent, and PRP cannot be considered a treatment that is guaranteed to work for everyone. Some studies have reported potential benefits in reducing pain and improving function.
Importantly, PRP should not be considered a standalone treatment. A comprehensive approach combining an accurate diagnosis, appropriate load management, and rehabilitation is essential. Factors such as cost, the number of visits required, and temporary pain or swelling following the injection should also be discussed carefully with your physician before making a decision.
When Symptoms Are Difficult to Treat
Surgery may be considered when symptoms continue to interfere with daily activities or sports despite more than six months of rehabilitation, when there is significant tendon degeneration, or when a partial tendon tear is present.
Surgical treatment may involve removing damaged tissue or releasing adhesions around the tendon. Depending on the symptoms and the location of the lesion, minimally invasive procedures using smaller incisions may be selected in some cases.
However, surgery does not mean that a patient can immediately return to their previous level of activity. Postoperative rehabilitation remains extremely important for restoring tendon strength and safely returning to sports.
Preventing Recurrence
Even after the pain has subsided, suddenly returning to the previous level of exercise or training can increase the risk of recurrence.
First, make sure that walking and using stairs can be performed without pain. Then gradually progress to light jogging, speed training, and eventually jumping activities.
It is also important to assess calf muscle strength, single-leg stability, and the quality of jumping and landing movements.
Training volume should be increased gradually from week to week. If pain returns, reduce the load and return to the previous stage of rehabilitation.
A gradual return to activity ultimately leads to a faster and safer return to sports.
Conclusion
Achilles tendon pain is an important signal from your body. Simply resting completely for a prolonged period or continuing to exercise despite pain may not lead to an optimal recovery.
The first step is to identify the underlying cause and adjust the load appropriately while gradually increasing the tendon’s capacity to tolerate stress.
Adjunctive treatments such as ESWT and PRP, as well as surgery in selected cases, may be considered. However, the foundation of treatment is always an individualized treatment plan based on the condition of the tendon.
By working closely with your physician and physical therapist, you can aim for a gradual and safe recovery without rushing the process.
If you experience discomfort or pain anywhere in your body—not only in the Achilles tendon—please feel free to contact our clinic.
Our entire team will continue working together to help as many people as possible “look forward to tomorrow.”
