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.