St Albans Osteopathy Blog

Achilles Tendonitis

Achilles injuries are commonly associated with sports that require a lot of running, jumping and change of direction. Excessive twisting or turning of the ankle and foot can result in a rupture or strain. The sports that are most susceptible to Achilles injury include running, walking, cycling, football, basketball and tennis.

What is an Achilles tendon Injury?

The Achilles tendon is located at the rear (posterior) of the bottom half of the lower leg. It is a thick band of connective fibre that runs from bottom of the Gastrocnemius muscle to the heel bone. The Achilles tendon is used to plantar flex the foot, or point the foot downward. This allows a person the run, jump and stand on one’s toes. The Achilles tendon is the strongest tendon of the body, and able to withstand a 500Kg force without tearing. Despite this, the Achilles ruptures more frequently than any other tendon because of the tremendous pressures placed on it during competitive sports. There are two main types of injuries that affect the Achilles tendon; Achilles Tendonitis and Achilles Tendon Rupture. Achilles Tendonitis is simply an inflammation of the tendon, and in most cases is caused by excessive training over an extended period of time. Achilles Tendon Rupture, on the other hand, is a tear (or complete snapping) of the tendon, and usually occurs as the result of a sudden or unexpected force. In the case of a complete rupture, the only treatment available is to place the lower leg in a plaster cast for 6 to 8 weeks, or surgery.

Causes and Risk Factors

There are a number of causes and risk factors associated with Achilles Tendonitis. One of the most common causes is simply a lack of conditioning. If the tendon, and muscles that connect to the tendon, have not been trained or conditioned, this can lead to a weakness that may result in an Achilles injury. Overtraining is also associated with Achilles Tendonitis. Doing too much, too soon places excessive strain on the Achilles tendon and doesn’t allow the tendon enough time to recovery properly. Over time small tears and general degeneration result in a weakening of the tendon, which leads to inflammation and pain. Other causes of Achilles injury include a lack of warming up and stretching. Wearing inadequate footwear, running or training on uneven ground, and simply standing on, or in something you’re not meant to. Biomechanical problems such as high arched feet or flat feet can also lead to Achilles injuries.

How to prevent Achilles Tendonitis

1. Warm Up properly

A good warm up is essential in getting the body ready for any activity. A well- structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint.

2. Balancing Exercises

Any activity that challenges your ability to balance, and keep your balance, will help what’s called proprioception: - your body’s ability to know where it’s limbs are at any given time.

3. Stretching exercises

  • Towel Stretch: This simple Achilles tendonitis exercise can be done by anyone whether you are suffering from tendonitis or not. As the name suggests you will need a towel for this exercise. Sit on a hard floor and spread one of your leg outside, but keep your other leg folded. Now loop the towel around the toes and ball of the spread leg. Then pull the towel towards you, but be careful that you do not bend your knee. You can hold this position for 20-25 seconds. Repeat this exercise 3-4 times.
  • Calf Stretch: This exercise will help you release the strain on the tendon. Face a wall and place your hands on the wall at eye level. Take a deep lunge with the back leg heel touching the ground. Place the back leg as though it were slightly pigeon toed. Now slowly push your weight on the wall and feel the stretch on the back leg. Hold this stretch for 20 seconds. Change the legs and repeat the same for the other leg as well. Repeat 3-4 times on each of the legs.
  • Leg Lift: This is also called ‘Side-lying leg lift’. Lie on your uninjured side. Keep your body in straight line. Place both the legs on top of one another. Now tighten the quadriceps muscle of the leg on top, then lift the leg off ground to make 45-60 degree angle with the leg below. Again do not bend either of the legs in the knee. Hold the leg in the same position till you count 20 and slowly bring it down. Repeat this exercise 3 times.
  • Heel Raise: One of the easiest of the Achilles tendonitis exercises. Take support of a wall or a chair and raise your body and balance all the weight on your toes. Count for 5 counts and slowly come down. Repeat for 5 times. When the pain reduces, you can try bringing only one leg down at a time and balance all the weight on one leg.
  • Quadriceps Stretch: Hold a wall or a chair. Stand on the uninjured leg. Hold the foot of the injured leg and slowly pull the heel of the injured leg towards the buttocks. Stay in this position for 15-20 seconds. The stretch is felt in the quadriceps and on the Achilles tendons. Repeat the quadriceps stretch 8-10 times.

4. Strengthening exercises

  • The Eccentric Knee Squat. To complete the Eccentric Knee Squat, stand facing a wall with posture erect, feet shoulder-width apart, and your toes just a few inches from the wall. Then, simply bend your legs at the knees, while keeping your upper body upright, so that your knees lightly touch the wall. You may have to adjust the distance from your feet to the wall to accomplish this effectively. Return to the starting position, and then bend your legs at the knees again, but this time point your knees to the left as you move them toward the wall. Note that this produces a dandy ‘eversion’ (outward movement) of the right heel, which is exactly what happens to your heel when you pronate during the stance phase of running. What happens is that this motion replicates the twisting forces applied to the Achilles and calves during running, helping them to fortify themselves in a rotational as well as straight- ahead plane. Return to the starting position, and then bend your legs at the knees again, but this time move your knees toward the right, giving your left heel a nice eversion. Come back to the starting position to finish the cycle (straight-ahead, left, and right). Repeat several more times, and your first experience with the Eccentric Knee Squat is over. Over time, the two-footed Eccentric Knee Squat will become easy for you. That will be the signal for you to abandon the two-footed version of this exercise and move on to the one-footed Eccentric Knee Squat. This squat is exactly like the two-footed exertion, except that now full body weight is on one foot, as it is when you run. You repeat the same pattern (straight-ahead, left, and right) which you used for two-footed eccentric squatting, carry out several reps on one foot, and then move over to the other one. The toe of the non-weight-bearing foot can be tucked neatly against the heel of the weight-bearing foot as you complete the drill. You’ll soon find that the one-footed knee squat is an absolutely dynamite activity for boosting Achilles and calf strength - in the same planes of motion (front to back, side to side, and rotational) which are present during the stance phase of running!
  • The Balance and Eccentric Reach with Toes. Start by standing on your right foot only as you face a wall, with your right foot about 75 cms or so from the wall (you may need to adjust this distance slightly). Your left foot should be off the ground and positioned toward the front of your body, with your left leg relatively straight.
  • Then, bend your right leg at the knee while maintaining your upper body in a relatively vertical position and nearly directly over your right foot. As you bend your right leg, move your left toes toward the wall until they touch, keeping the left leg relatively straight. End the movement by returning to the starting position. Then, conduct essentially the same motion, but move your left foot forward and to the left, again keeping your left leg straight and attempting to make contact with the wall. Your left foot may not quite reach the wall, since you are moving in a frontal plane (from right to left) in addition to the straight-ahead, sagittal plane. Return to the starting position, and then carry out essentially the same motion, but with your left foot crossing over the front of your body and going to the right as you attempt to touch the wall. Then return to the starting position. Do a few (4-6) reps (the straight, left, and right motions make one rep) on your right foot, and then attempt the same exercise with your body weight supported only on the left foot. Like the Eccentric Knee Squat, the Balance and Eccentric Reach with Toes forces your calf muscles to work eccentrically and in a variety of planes of motion, as they do during the stance phase of running (you will really feel it!). Both exertions also do a nice job of strengthening your knee and hip muscles and coordinating their activities with what is happening down at the Achilles and calves.
  • The Balance and Eccentric Reach with Knee. Stand on your right foot about an arm’s length from the wall, with your left leg flexed at the knee and your left shin roughly parallel to the floor. You should be standing with erect posture, and you may place a finger from each hand on the wall for balance. Then, simply bring your left knee forward until it touches the wall - while moving your upper body backward from the hips so that it remains roughly over the right foot. You will feel a very fine strain in your right calf and Achilles-tendon region. Finish the movement by returning to the starting position. Again, thrust the left knee forward to the wall, but this time move the knee in a frontal plane (towards the left). Return to the starting position, and then move the knee well towards the right. Finish by going back to the starting position. Continue this pattern (straight, left, and right) a few more times, and then change over to the other foot. As you move your knee to the left and right and back to the starting posture, you’ll notice that your activity is forcing the calf muscles and Achilles to withstand ankle-twisting rotational forces and side-to-side (frontal-plane) movements, not just straight-ahead pulling. That’s what you want, because improved strength in all appropriate planes of movement will make you more stable and injury-resistant when you run.
  • The Dynamic Achilles Stretch. This will actually be the easiest movement to carry out, since it’s somewhat similar to traditional stretching routines for the calf-Achilles complex. Begin this one by facing that familiar wall, about an arm’s length away, with your weight supported on your right foot, your right knee slightly flexed (as it would be during the stance phase of running), your left leg imitating the swing phase of the gait cycle, and your hands against the wall for support. Then, simply rock forward toward the wall, so that you feel a nice stretch in your right calf and Achilles tendon. After 20 seconds or so, pronate your right foot (roll it toward the inside), and hold the stretch for 10 more seconds. Finally, supinate the right foot (roll it toward the outside), and hold for 10 seconds. After you have stretched for a total of about 40 seconds, lean towards the left so that your right Achilles tendon and calf are now being pulled in a lateral-left direction. Hold for 20 to 30 seconds or so. Finally, lean towards the right, crossing your left leg over your right, so that the right Achilles and calf are being pulled in a lateral-right direction. Again, hold for 20 to 30 seconds. Repeat one more time, and then shift over to the left foot for the same pattern of stretching.

5. Footwear

Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion.

March 3rd 2019

Philip Bayliss, St Albans Osteopathy, 43 Thames Street, Christchurch 8013 ☎️ 03 356 1353