The Achilles tendon is made up of the combined tendons of the gastrocnemius and soleus muscles (the two calf muscles). It is the thickest and strongest tendon in the body. But, that doesn’t make it immune to injury. Even the legendary Achilles – amongst the strongest and bravest Greek warriors – met his untimely demise following an injury to his Achilles tendon.
Injury to the Achilles tendon occurs when the load applied to the tendon exceeds the ability of the tendon to withstand that load. It is most common among males aged 30-50. These over-use Achilles tendon injuries may arise with increased training volume or intensity, change in training surface or footwear or decrease in recovery time between training session.
An athlete’s biomechanics might also predispose them to Achilles tendinopathies. These biomechanics include excessive pronation or supination of the foot (where the foot tends to fall inwards towards the arch or be pushed outwards), calf weakness and altered tibial or femoral mechanics etc.
Most of the time the athlete will notice a gradual development of symptoms, complaining of morning stiffness and pain, which diminishes with walking and application of heat. The two common sites of pain are the midportion of the Achilles tendon and the insertion of the Achilles tendon at the calcaneus.
One of the first things to look at when treating these problems is to identify and correct any predisposing factors i.e. training methods, footwear, orthotic and biomechanical correction.
Once these have been addressed the athlete should commence an eccentric training program, where they focus on controlling the negative motion of the repetition i.e. where the muscle is working in a lengthened state. The Alfredson painful heel-drop protocol for Achilles tendinopathy has shown to be very successful in treating midtendon Achilles pain. It consists of two main exercises – the ‘gastrocnemuis drop’(knee fully extended) and the “soleus drop”(knee bent to 45 degrees). Both exercises start on a step with the calf in a raised position. From this position the patient slowly lowers the heel so that the foot is parallel to the ground. Patients should do 3 sets of 15 repetitions twice daily for 12 weeks everyday of the week.
Patients should not be put off by the fact that the pain may worsen at the start of the program as this is part of the normal recovery process. If a patient experiences no pain during the exercises, they are advised to increase the load until the exercises provoke some pain i.e. add a weighted backpack. If you are suffering from pain at the insertion of the Achilles tendon then you should do a similar exercise program but remove the step, just do it standing on the floor, as this has been shown to be more effective.
With the correct treatment approach and the guidance of your physiotherapist, Achilles tendinopathy can be successfully managed and overcome.
BY: Andrew Savvides
Ankle injuries, Foot injuries, Lower Limb injuries