Wednesday, November 14, 2012

Achilles Tendinopathy



ACHILLES TENDINOPATHY

The Achilles tendon is the largest and strongest tendon in the lower body.  Located in the back of the lower leg it connects the powerful calf muscles to the heel bone.  Achilles tendinopathy is the inflammation and gradual degeneration of the Achilles tendon that results in damage to the collagen.  Damage to the collagen increases the development of tissue adhesions and scar tissue formation, which may limit muscle, tendon and joint mobility.  Tendinopathy can develop gradually over time or immediately, due to a one-time trauma.  Achilles tendinopathy should not be left untreated as tendons and ligaments have low metabolic rates and poor circulation which contribute to slow healing, potential tearing and lengthy recovery. 

WHAT CAUSES ACHILLES TENDINOPATHY?

There are several contributing factors that cause Achilles tendinopathy.  The most general cause is physiological demands placed on the tendon exceeding its capabilities:
  •         Activities that involve sudden starts and stops or repetitive jumping (i.e basketball, running)
  •         A sudden increase in activity level
  •         Decreased recovery time between exercise sessions
  •        Training on changing surfaces (i.e. running on trails vs. concrete sidewalks)
  •         Poor footwear selection (i.e. high heels, sandals)
  •        Over-pronation of the foot (when the feet roll inward too much)
  •         Limited ankle range of motion
  •        Calf muscle weakness and inflexibility

SIGNS AND SYMPTOMS

The symptoms of Achilles tendinopathy usually develop over time, however in some cases they can be a direct result of trauma to the Achilles tendon.  Repetitive stress on an already torn Achilles tendon may lead to a complete tear.  Signs of Achilles tendinopathy include:
  •          Pain and stiffness in the back of the lower leg just above the heel during or after exercise
  •         Swelling and redness over the Achilles tendon
  •        Tenderness with palpation along the inside/outside of the Achilles tendon
  •          Reduced strength and mobility in the lower leg
  •         Severe pain in the morning

SELF MANAGEMENT

There are several ways that you can prevent the development or recurrence of Achilles tendinopathy including:
  •       Post activity foam rolling or trigger point ball therapy through the calf, glutes, hamstrings and quads
  •       Wear appropriate footwear with heel support
  •        Avoid activities that place a constant strain on the Achilles
  •        Eccentric stretching and warm-up prior to activity 
    •    Eccentric heel drops 
    •    Theraband resistance pointing the foot downwards

MANAGEMENT

Consultation with a healthcare professional is recommended. It might be necessary to modify or minimize the activity that causes pain.  Your healthcare professional may recommend any of the following treatment regimens to rehabilitate the tendon and increase its capabilities:
  •         Modify activity that reduce stress on the tendon (i.e. cycle, elliptical machine, swimming)
  •         Active Release Techniques© (ART) and/or Graston Technique© to help elongate the tissue and breakdown any scar tissue or adhesion formation
  •       Functional Rehabilitation to strengthen the kinetic chain
  •       Joint mobilization to improve ankle and tarsal (bones of the foot) mobility
  •      Gait analysis and gait training
  •         Passive modalities (i.e. low volt therapy, ultrasound)
  •         Wear appropriate footwear
  •          Heel lifts inserted in the shoes
  •         Foot orthotics (over the counter or custom)
  •         Night splints/Kinesio Taping©
You may find that resting from activity may decrease the pain, however when you return to activity the pain remains unchanged.  This is due to adhesion formation and/or shortening of the tissues that never changed.

The intent of this article is to provide a brief overview of Achilles tendinopathy.  In no way does it describe all causes or treatment options or intended for self-diagnosis.  If you are questioning your pain please follow-up with a licensed health care provider.