Achilles tendon tears can be graded from grade 1 to grade 3, according to the severity and size of the tear. If a big enough force is applied from the start, it can cause a big tear in this strong tendon. But often, it starts out with a small grade 1 tear, and if the right steps are not taken to get the tendon back to a healthy state, it progresses. The structure of the tendon weakens over time and starts to degenerate and fray. In the end, your Achilles tendon can tear completely.
Grade 1 Achilles tendon tear
Let’s say you felt your Achilles ‘pulling’ while running uphill one day. After a while the discomfort seems to go away, so you continue with your run. The next morning you feel some Achilles tendon pain and stiffness, but it seems to ease during the day. Each day, the pain lingers and you find that you can’t run as fast as you used to. It’s uncomfortable, but it doesn’t stop you. It makes you worried and you wonder if you could have strained or torn your Achilles tendon.
When you ‘pulled’ your Achilles tendon during that first run, it was strained beyond it’s limit. This caused a grade 1 Achilles tendon tear. Usually, there are more than one tear with a grade 1 injury, but they are very small. Straining and overloading your Achilles tendon over & over again causes micro-trauma and leads to tears in the collagen network structure. Thus, the tendon is still completely intact, but injured and weakened. As with any injury, there will be some inflammation and swelling in the tendon as your body tries to start the healing process. It will cause you pain and stiffness and it affects the ability of the Achilles tendon to contract. That is why you feel like you can’t run as fast or as far as you used to.
At this stage the tendon has the potential to recover completely if you manage it the right way. However, if you push through this pain every time, you are repeatedly causing micro-trauma to your Achilles tendon. It simply starts up the inflammation cycle again and leaves you in more pain.
Grade 2 Achilles tendon tear
A grade 1 Achilles tendon tear can progress to a grade 2 tear if you don’t give it a chance to recover. The collagen structure of the Achilles tendon won’t be as strong as it should be after a grade 1 tear. As your body tries to heal the tendon, extra collagen fibres are formed to heal the tears. This causes the Achilles tendon to become thicker and less flexible (almost like scar tissue). With repetitive strain, these fibres tear away from each other, like a cable or a rope where the individual strands fray. Applying more force will cause more damage and a bigger tear.
A grade 2 Achilles tendon tear can be classified as a partial tear. It means that a section of the tendon is torn apart, but there is still a large part that is intact. Now, can you imagine the strain on that piece of tendon that has to do all the work? Remember, with a bigger tear, there will be a bigger inflammatory reaction and more swelling. The sheath around the tendon has probably been partially torn as well and the bursa underneath the tendon could also become inflamed. You’ll have a protective calf muscle spasm, which leaves you to feel like you’ve injured your calf muscle as well.
The Achilles tendon changes permanently.
With an injury like this you will struggle to walk properly, nevermind run. Your calf muscles are hanging on by a thread, so you can imagine that each movement of your foot will be severely sore. Even if you give it enough time to heal, the scar tissue will cause your Achilles tendon to become thickened and stiff. At this stage you will feel a lot better, but you will struggle to get going with your running routine. You’ll feel an aching pain in your Achilles tendon each time you walk too far or go for a run and it will take longer to ease.
You can cause irreparable damage to your Achilles tendon if you push through your pain at this stage. The tendon structure gets weaker and degenerates, leaving you with problems like Achilles tendonitis. It is a vicious cycle that keeps your pain and inflammation going.
Grade 3 Achilles tendon tear (rupture)
An Achilles tendon rupture could happen to a completely healthy tendon due to a severe traumatic force like a sudden fast sprint. But often the structure of the tendon has simply weakened, sometimes without you even knowing about it, and one day it simply snaps.
With an injury like this, you’ll know that you’ve torn something. It leaves you with a floppy and useless foot, because your calf muscles has nothing to anchor them to your heel. You could either feel very little pain, or feel extreme pain with lots of swelling and bruising.
Don’t let your Achilles tendon tear progress to a full rupture. Let us walk this road of recovery with you and prevent if from getting to this point.