What is it?
Achilles tendinitis is a common overuse injury that occurs in
people of all fitness levels. The causes can be variable,
but one factor that seems to be consistent with all cases is
stress to the gastroc and soleus muscles in the calf region with
irritation and loading at the tendon insertion at the heel
bone. This stress may be a result of continued forces placed
through the tendon structure from activities ranging from standing,
walking, exercise, to recreational activity or sport. A
variety of factors that may be present with cases of achilles
tendinitis are weakness or tightness of the gastrocsoleus muscle
which would place additional stressors on the connective tendon,
improper gait pattern, and poor circulation. There are
varying degrees of injury to the achilles tendon ranging from an
acute tendonitis which could be present the first 3 months, to a
tendinosis which is considered more chronic in nature lasting
greater than 2-3 months, and finally a tendinopathy which
encompasses all levels of tendon injury including rupture.
So do you have an achilles tendon
injury?
Symptoms may include pain or soreness to the heel and the region
between your calf muscle and rear foot. This pain is
typically associated with pushing off with the foot or rising up on
your toes. Pain will typically subside with rest, but in more
extreme cases can linger even following breaks in activity.
Other associated signs could include weakness with pointing the
toes and foot and swelling behind the heel.
How do we treat the problem?
Depending on the severity and how long the problem has
persisted, treatment may range from conservative to more aggressive
approaches. Manual physical therapy techniques have strong
evidence to support their application in treating the injury.
With a highly acute tendinitis injury, treatment may include:
- periods of rest from activity
- use of a slight heel lift to decrease stress to the tendon
- anti-inflammatory medication such as ibuprofen or naproxen
- ultrasound modality
- massage to tight calf muscle structures
- gentle stretching
- application of ice after activity
With less irritable tendonitis the treatment may also
involve:
- low impact aerobic conditioning,
- dynamic warm-up stretching prior to exercise
- manual therapy PNF exercises designed to work on eccentric
control at the achilles tendon which involves the lengthening of
the muscle and tendon versus the contraction/shortening involved
with raising up on your toes
And finally with chronic tendinosis and end stages treatment to
achilles tendinitis:
- weight bearing functional exercises are incorporated
- eccentric lowering from a heel raise position including
exercises such as raising up with both legs and lowering on the
involved injured leg alone
Precautions
For individuals who are currently or have recently taken
antibiotics in the fluoroquinolones class of drugs including
Levaquin, check with your physician prior to exercise, as these
antibiotics have been found to be involved with cases of tendinitis
and potential for achilles tendon rupture. Also,
corticosteroid injections can potentially lead to the further
weakening of the tendon structure.
Prevention
Ultimately striking a balance between strength training and
flexibility is the key to a healthy tendon. Have a
check-up or physical therapist do a structural examination
prior to initiating a new sport related activity to ensure proper
gait mechanics, joint mobility, flexibility and strength needed for
participation. Doing a proper warm-up routine involving
gradual physical movement or dynamic flexibility exercise
significantly will reduce the chances for injury. Also, make
sure to stretch properly after intense activity and prolonged
standing or walking. Finally be sure to wear appropriate
footwear for specific activities that is not worn out and offers
the proper support.