Achilles Tendonitis - The Operating Sports Injury

Running Injuries

Achilles Tendonitis is very common in runners. Common belief is that rest works well in the Click here know more about Prairie Trail Physiotherapy & Sports Injury Clinic Winnipeg. As most people will testify, this in fact is not the case and careful management of this condition is needed. Usually the painful symptoms around the achilles tendon return when training resumes.

Continual bouts of exercise and rest periods develop a chronic situation and will eventually prevent the runner from performing. A programme of rehabilitation is needed to assist full recovery and prevent further bouts of this irritating condition.

The achilles pain syndrome is divided into two main areas which involves both tendon and sheath

( paratenon tissue ) The achilles tendon does not in fact have a true tendon sheath but has paratenon tissue which surrounds the tendon and assists lubrication of the tendon on movement. Inflammation of the paratenon tissue usually shows as a thickening and increases the size and appearance of the tendon. Palpation over the area is usually painful and any running is difficult.

Causes

Overuse and lack of conditioning will both irritate the achilles tendon as will overstretching, which may come from running up hills or steep inclines on a treadmill. Tight calf muscles due to lack of proper stretching can also result in a sore achilles tendon which will result in inflammation and pain.

Previously mechanical irritation from badly designed training shoes with a high achilles protector used to be a problem but manufacturers have altered this by designing a "V" cut into the top of the protector which has helped considerably.

 Treatment

This may vary depending on the severity of the condition and workload of the athlete. Most runners get twitchy if they are told to rest and stop running for a while, so a treatment plan needs to consider this factor. Runners may be on a training regime in preparation for a marathon and any gaps in training may have a negative effect on their performance. This however needs to be balanced with the realization that this type of injury has to involve rest periods in order to allow healing to take place

It is vital that the cause of the injury is identified before treatment is undertaken. Once the cause is identified then the correct treatment plan can be introduced. Many physiotherapists use ultrasound as their treatment modality and although this is a good choice it will not be successful if used in isolation.



If the tendon sheath is thickened it will require specific deep friction massage to break down adhesions. This will obviously irritate the achilles tendon and be painful, but if ice is used throughout to reduce inflammation and pain, the process can be administered successfully.

Friction massage is used in an attempt to re-injure the tendon and create a healing crisis response from the body. As we know the achilles tendon is not blessed with a good blood supply so by manufacturing an inflammatory response you will encourage vasodilation of blood vessels, increase blood flow to the area and promote healing.

My recommendations would be :

3 x treatments per week for the first 3 weeks with no running done. During this time the patient should wear heel lifts in both shoes to reduce the stress on the injured achilles tendon. By the end of the 3 weeks the fibrous adhesions should be broken down and the painful part of the treatment plan is complete. The treatment plan has to involve factors such as pain relief, increased vasodilation, and breaking of fibrous adhesions around the tendon and sheath.



Weeks 4 and 5 should allow the tendon to recover and both ultrasound and interferential treatments together with soft tissue work administered 3 x weekly will promote healing. Removal of heel lifts is now advised in order to provide passive re-stretching of the tendon. No running should be done during this time.

Weeks 6 and 7 should involve 2 x treatments per week with active stretching after home exercises. Ensure a gentle stretch of both soleus and gastrocnemius calf muscles and hold the progressive stretch for 2 minutes at a time. Begin strength conditioning by performing 20 repetitions of calf raises 3 x daily, the stretching can then follow. Complete the process by icing the area when stretching is completed.

Week 8 Replace heel lifts in running shoes and begin half pace jogging for 15 minutes every other day, stretch off gently after exercise and ice. Heel lifts should only be worn in running shoes now and not during daily activities. Treatments of electrotherapy and soft tissue work should continue twice per week.

A gradual increase in distance should follow over the weeks with a gradual increase in pace and if pain free the heel lifts should be removed. When heel lifts are removed during running, reduce pace and distance again to accommodate the extra stretch on the tendon. This can be gradually increased as before until back to full fitness.