Treating Achilles Tendonitis
Achilles Tendonitis (or Tendinopathy) is often treated very poorly and achieves only limited positive results. This is because the practitioner often take the perspective of only treating the “areas that hurt” without evaluating concerns in the rest of the body.
To really resolve Achilles Tendonitis, practitioners need to look at the entire kinetic chain. By looking at the kinetic chain, you consider the biomechanics of all the structures involved, from the foot right up to the hip, on both the front and back of the body.
- In the weekend warrior who suddenly increases his or her physical activity, or suddenly starts a new sport without proper training, stretching, or preparation.
- In women who have changed from wearing high heels to low heels. In such situations, the Achilles tendon has become accustomed to remaining in a shortened position and is unable to adapt to the stretching required by wearing flat shoes.
- In athletes who suffer from over pronation, inflexibility, or lack of strength. Weakness in the gastrocnemius and soleus muscles can cause abnormal pronation during the stance phase of the normal gait cycle.
- In runners who increase their mileage too rapidly, who attempt hill training without proper strengthening exercises, or who are using sub-standard running gear.
- In people with weak or unstable calf muscles, who suddenly place increased stress upon their Achilles tendon. A tight muscle is a weak muscle. Runners with weak or unstable calf muscles place increased stress upon their Achilles Tendon.
The repetitive stresses caused by walking, running, cycling, or other sports can cause friction and inflammation in the area of the Achilles Tendon.
The body responds to this inflammation by laying down scar tissue (adhesive tissue) in an attempt to stabilize the area. Inflexibility is often caused by the build-up of these adhesions, either within the soft-tissue, or within structures above or below the tendon’s kinetic chain.
From an anatomical perspective, the Achilles Tendon is the strongest and largest tendon in the body. Yet it is extremely vulnerable to injury due to its limited blood supply and the numerous forces to which it is subjected.
The Achilles Tendon is known as a co-joined tendon. This tendon directly joins into the different calf muscles. The Achilles Tendon transmits the force of the calf muscles to produce the push-off during walking, running, and jumping.
The area of the tendon (approximately 2 to 6 cm above the heel) has the poorest blood supply, and therefore heals the most slowly. This makes it extremely susceptible to injury.
Often what happens is that chronic irritation to the Achilles Tendon leads to small tears within the tendon (such as in runners). This chronic irritation makes the tendon susceptible to further injury and causes a build-up of scar tissue within the tendon. Once this inflammatory condition starts, even the simple task of standing can put considerable pressure on the Achilles Tendon.
This constant internal pressure limits circulation to the tissue resulting in decreased delivery of oxygen to the tendon. Decreased oxygen causes several biochemical changes that result in the formation of yet more adhesions within the Achilles Tendon. This in turn creates more restrictions, inflammation, and swelling.
The body responds to inflammation by laying down additional scar tissue (cross fibers across the tissue) in an attempt to stabilize the affected area.
This scar tissue:
- Restricts motion.
- Reduces circulation.
- Inhibits nerve function.
- Causes ongoing friction and pressure.
- Results in the production of yet more cross fibers and adhesions across inflamed soft-tissues.
We have treated numerous case of Achilles Tendonitis that were needlessly prolonged or that became chronic problems due to the application of ineffective treatments. Improper treatment of an Achilles Tendon injury can lead to major problems.
- Cross friction massage often irritates this area, increasing the time required for recovery rather than reducing recovery times.
- Additional problems often arise when a therapist uses direct, heavy pressure and tension over the Achilles Tendon.
- Steroid injections should be avoided whenever possible. Research has shown the steroid injections cause an increase in the incidence of rupture of the Achilles Tendon.
Effective treatment of the Achilles Tendon, or of any soft-tissue injury, requires an alteration in tissue structure to break up the restrictive cross-fiber adhesions and restore normal function to the affected soft-tissue areas.
When treatment is executed properly, you will substantially decreases healing time, treat the root cause of the injury, and be back on the road in no time.
We have found the following methods to be most effective for treating Achilles Tendonitis:
- Active Release Technique (ART®)
- Massage Therapy
The key to a successful treatment is to remove restrictive adhesions between both the superficial and deep tissue structures along the entire kinetic chain. To find these adhesions, the practitioner must perform a biomechanical analysis of the athlete/runner to determine the exact location of these restrictions.
Treatment must be very specific and should be based upon the individual needs and where restrictions are located in each athlete, rather than upon some preconceived idea about what area needs to be treated.
We believe that effective, focused exercises play an important role in the healing and regeneration of damaged tissues. Every patient at our clinic receives appropriate exercises. Our exercises are based on four basic principles:
- Cardiovascular function.