Injury Tip Sheet: Achilles Tendonitis

Bryan Christie

Bryan Christie

Injury Tip Sheet: Achilles Tendonitis

Learn what you need to know about achilles tendonitis

Kathy Weber, M.D., M.S.
Daphne R. Scott, PT, Dsc
Chicago, IL

Fast facts

  • Achilles injuries account for over 10% of all running related injuries
  • Can be referred to as achilles tendinopathy or achilles tendinosis
  • The strongest and largest tendon in the human body; the tendon most often injured
  • The achilles tendon can absorb over 1,000 pounds of force

What you need to know

What is the achilles tendon?

  • A tendon is a thick band of tissue that connects muscle to bone; tendonitis occurs when that band gets irritated or inflamed
  • The Achilles tendon is the tendon that attaches the calf muscle to the heel bone and helps lift the heel off the ground
  • Achilles tendinitis is an irritation or inflammation in the achilles tendon and is considered a common overuse injury


Signs & symptoms

  • Pain or stiffness in the tendon or at the tendon  attachment at the back of the heel during exercise and after periods of inactivity
  • Swelling or thickening of the tendon can occur
  • Pain when lifting the heel during sports, especially running uphill, climbing stairs, or jumping


When should I see a doctor or other professional?

  • You should see a doctor if walking  becomes painful or if the symptoms do not improve over the course of a couple of weeks
  • Physicians may prescribe physical therapy to address pain, decreased flexibility, and decreased strength.
  • Imaging such as MRI’s and X-Rays are typically not indicated early in the treatment of Achilles tendonitis. Imaging is used in cases of on-going pain despite compliance with conservative management or if there is concern for a tendon tear.

Causes

  • Achilles tendinitis is a common overuse injury and can be caused by an increase in training or mileage
  • Can also be caused by mechanical gait problems such as overpronation or inadequate heel and arch support
  • Weak or tight calf muscles can place additional strain on the tendon and cause irritation
  • Running up hills or exercising without properly stretching the calf muscles and achilles tendon first

Risk factors

  • Because the achilles tendon can become less flexible with age, middle-aged athletes are more susceptible
  • Sports and activities that emphasize jumping or stop-and-go movement can place more demands on the achilles tendon, such as basketball, ballet, hill running, and tennis
  • Women who wear high heels regularly may find that their tendon shortens over time, placing excessive strain on the tendon during exercise when it is forced to stretch out again
  • If achilles tendinitis is not properly treated, it can become a chronic condition or lead to a tear or rupture in the achilles tendon

What you can do

Prevention

  • Strengthen the calf muscles and ensure that the achilles tendon is properly stretched prior to activity
  • Ensure that the heel is supported with adequate cushioning and arch support
  • Do not suddenly increase the frequency  and intensity of workouts or training programs

Recommendations for treatment and rehab

  • Rest is an important component of recovery.
  • Avoid exercise that increases or reproduces pain in the Achilles tendon
  • Ice is used to decrease pain and inflammation.  Ice for 15-20 minutes ever hour, multiple times during the day can be an effective way to reduce swelling and pain
  • Oral or topical anti-inflammatories may be prescribed by your treating physician to or reduce pain and swelling in the tendon and surrounding tissue
  • After the initial 3 days of an onset of pain with rest and recovery,  heat can be used on the heel to help improve circulation and blood flow to the area and prior to stretching
  • However, ice should be used following any exercise (see above)
  • For chronic or severe cases, doctors may also recommend physical therapy and specific rehabilitation exercises to help address decreased flexibility and loss of strength

What can I do to stay active?

  • Participation in activities that do not create pain are important to allow a full recovery
  • Stationary cycling, swimming , elliptical trainer or circuit weight training that avoids lower leg strengthening, if tolerated without pain, can be exercises that can be performed while the Achilles tendon heals

More Information

These  stretches can help make the achilles tendon more flexible.

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