A Snapshot of Achilles Tendon Injury

by Dr. Josh Renkens

Achilles tendon problems may be most prevalent in athletes who run or jump, but the truth is, anyone can be afflicted by the often stubborn syndrome. Research shows that injury to the tendon is usually secondary to biomechanical deficits that place excess stress on the tendon, and most will respond favorably to conservative care, including manual therapy and corrective exercise. Please let me explain more.

The Achilles is the combined tendon of two muscles on the back of your lower leg - the gastrocnemius and the soleus - and is surrounded by a paratendon. The tendon, paratendon, and muscles are connected to the heel bone via the fascia. That's a lot, right? I know. Just know, it is all connected.

 

If you have ever experienced Achilles tendonitis, you know there is usually a focal spot about 1-2 inches above the heel bone that is most painful (and also the most common site for a rupture). This is due to the stress and decreased vascularization to the tissue. By now you are probably asking, "What typically causes the stress and how do you get rid of it?"

There is a lot of evidence of excessive pronation being the fault. Stiff and tight tissue, weakness, and imbalances, including poor mid-foot stability and poor eccentric control from the hip cause conflicting rotational forces at the tibia, which can cause a wringing out of the tendon.

If this is allowed to occur over time and / or occurs repetitiously (think running / walking), mini-trauma occurs. The body can no longer repair fast enough, so the tendon begins to fail, becomes deranged, receives less blood flow and oxygen, and becomes painful.

Of course, as with most repetitive strain injuries, the sooner the insulted tissue is treated, the better.

As stated above, it may be working to better balance the quads, hamstrings, and adductors; it may be waking up those inactive gluteal muscles; or it may be utilizing an insert in your shoe to give you more medial support. For some, it may be all of the above. The key is to identify the faults involved, release and lengthen tight tissue and employ the proper exercises to get strong and stable.

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