Achilles tendinopathies (AT) encompass inflammation (tendinitis) or fibrosis/scar (tendinosis) of the Achilles tendon.1 A tendinopathy is a degenerative state of the tendon. A typical cause of AT is the application of repetitive and or excessive loads to the achilles tendon. An increase in the prevalence of AT has been reported in the last 10 years.2 Achilles tendinopathies reportedly comprise 6.5% of all running injuries.
Abnormal biomechanics such as overpronation (flat foot) places an asymmetrical stress on the achilles. The tendon “bows” with a convexity medially (toward the inside) and a concavity laterally (toward the outside). The turned-in position of the heel will increase strain medially and slacken the achilles laterally. The soleus and gastroc, the two parts of the calf muscle, share the achilles tendon as their insertion into the back of the heel bone. The soleus is active as a stabilizer while we stand. The gastroc is most active during the push-off phase of gait. The activity in both muscles is exaggerated during weight bearing sports especially tennis and basketball where play entails excessive positioning on the balls of the feet. The literature contains many references to articles that try to control the forces on the Achilles tendon through heel lifts, foot orthotics, and taping techniques.⁴ Although there is variable evidence regarding the efficacy of these strategies, anecdotal reports suggest the effectiveness of these interventions. At Walk Well Rehabilitation, we not only read the evidence, we scrutinize it!
Principles of Treatment:
- Activity Modification: refer to P.R.I.C.E link
- Specialized Manual Therapy Techniques: Achilles tendinosis presents as a palpable thickening of the Achilles tendon. This thickening is the result of micro-trauma during activity which results in scar tissue. Scar tissue is considered dysfunctional if it binds onto adjacent healthy tissue and prevents normal movement of that healthy tissue. Techniques such as ART, Graston and Cupping Therapy are used to release these adhesions.
- Altered Biomechanical Forces: We can fabricate custom foot orthotics in order to dissipate the shock caused by a supinated foot or the excessive torque created by an overpronating foot. We may utilize taping techniques to reposition the Achilles tendon during activity or during functional retraining exercises.
- Stretching: Stretching exercises are used to increase the length and elasticity of your tissues. We utilize passive and dynamic stretches as well as the neurological principles of reciprocal inhibition to hasten your recovery. We utilize self-mobilization techniques on styrofoam rolls or use “The (massage) Stick” as part of a home exercise program to break adhesions. It is very important to correct the abnormal position of the heel while stretching the calf so as to not place an asymmetrical strain on the achilles.
- Strengthening: The Achilles tendon is the second most powerful tendon in your body next to the quadriceps tendon. It needs to be strong enough to push and/or raise your body weight. We use graded and controlled resistance exercise to reconditon the Achilles tendon. We also use the principles of eccentric exercise training to recondition and stimulate healing. Eccentrics are contractions in which the muscle elongates against resistance ie slowly lowering your heel off the edge of a step. Scientific evidence supports the use of eccentrics. Please refer to The Missing Link-Scar Tissue
- Home Exercise Program: The rest is up to you! Compliance with your home exercise program is paramount to a speedy recovery.