Treating Achilles Tendinitis/Tendinosis

Releasing Achilles tendon fascia

Lengthening the tissue on each side of the Achilles tendon

Stretching the large calf muscles

Stretching the large calf muscles

Stretching the soleus, a key muscle in treating Achilles tendinitis

Stretching the soleus, a key muscle in treating Achilles tendinitis

The Achilles tendon, also known as the calcaneal tendon, is approximately six inches long, the strongest tendon in the body, and located on the backside of our lower leg. It attaches to our two calf muscles, the gastrocnemius and soleus on the upper end, and to the calcaneus (heel bone) on the foot. It’s a strong tendon that handles the brunt of the high force loads required during motions such as walking, running, or landing from a jump. Achilles tendinitis (AT) or tendinosis can develop at any age, especially with those engaging in activities without proper conditioning, but is more prevalent in seniors.

Tendinosis is tearing of muscle or muscle-tendon fibers in the absence of inflammation. Tendinitis indicates inflammation of muscles and of muscle-tendon attachments. AT can be acute or chronic, and usually occurs at the insertion of the tendon at the calcaneus (heel bone), an area of poor blood circulation.

Not all tendon pathologies have inflammation and are more appropriately called tendinosis, however injury of the Achilles tendon usually involves inflammation resulting from overuse, so tendinitis is a more accurate designation when referring to an Achilles tendon problem.

 AT is described as a painful sensation on the backside of the heel that is aggravated with walking or running, and is a common lower extremity injury, especially among runners. If not treated properly, tendinitis causes further tendon weakening and can lead to either partial or complete tendon ruptures.

Causes: Repetitive motions of running, jumping, and landing on the toes are common causes of AT, and usually occur at the muscle-tendon junction of the two calf muscles (gastrocnemius & soleus), or where the tendon attaches to the calcaneus, an area which has very poor blood circulation, and can become the site of degenerative changes and damage to the Achilles tendon. Lack of tendon healing due to ischemia (without blood) at the calcaneus can contribute to this disorder.

A shortened and contracted soleus (deep calf muscle) from overuse is usually the main cause of AT. The soleus originates on the posterior surfaces of the tibia and fibula (lower leg bones) and attaches to the Achilles tendon just above the calcaneus.

Previous injuries or problems with calf muscle strength, foot pain, or posterior heel pain are factors that may indicate biomechanical deficiencies in the foot or ankle that aggravate Achilles tendon pathology.

Recent studies show a link between certain medications—antibodies such as ciprofloxacin (Cipro) appear to produce tendon pathology in large tendons of the body, even in the absence of vigorous repeated activity.

In addition, systemic disorders such as hyperthyroidism, renal insufficiency, gout, or rheumatoid arthritis, can also contribute to AT.

Treatment: Fascia (tough connective tissue) surrounding the tendon is released with deep gentle myofascial spreading and stretch protocols. Connective tissue, that encases the gastrocnemius muscle and surrounds the Achilles tendon, is expanded with Myofascial Release techniques. Blood flow is increased at the capillary level, removing metabolic wastes, mobilizing the fascia, and allowing it to adapt to the new lengthened position.  Additional broadening and lengthening tight muscle bands, reducing trigger point activity, and softening any adhesions takes the tension off the Achilles tendon–key  components of the treatment.

Home Self Care: As soon as stretching is tolerable, it is helpful to stretch the Achilles tendon several times a day. Achilles tendon disorders are best controlled through rest and activity modification. Rest should not be confused with immobilization. Rest means stopping offending activities; Immobilization means inactivity, and may lead to the development of fibrous adhesions. Cold applications and anti-inflammatory medication are at times prescribed to address inflammation if present.

Stretching the calf muscles is important, especially the soleus—it’s indispensable. Note:  Most clients do not know that it’s necessary to flex the knee to 90 degrees to stretch the soleus.

Orthopedic Assessment in Massage Therapy, Whitney Lowe

Clinical Massage Therapy- A Structural Approach to Pain Management, James Waslaski

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About kenyoungberg

Ken Youngberg, Ken Youngberg Therapeutic Bodyworks, is a nationally certified therapeutic bodyworker offering a variety of clinical treatment modalities combining body/mind systems designed to relieve and eliminate acute and chronic soft tissue pain and tension from stress. His conservative approach effectively resolves dysfunctional patterns, and restores postural balance, resulting in a positive outcome for his clients--pain free status as quickly as possible.

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