THE LEGEND OF ACHILLES
According to Greek legend, the unstoppable greek warrior Achilles was shot with an arrow in his left heel during battle. This just so happened to be the one vulnerable part of his body not dipped into the River Styx, which led to his demise. His injury, located where the primary tendon of our principal calf muscle attaches to the heel bone (calcaneus), was excruciating enough that the legendary warrior fell and couldn’t fight off his adversaries. While modern day achilles injuries are common, they fortunately have quite different outcomes! So far, we have yet to treat a client with an achilles problem from being shot with an arrow, but hey, you never know!
Although our demise is likely not going to be caused by an arrow to the heel like the poor Greek warrior Achilles, achilles tendon issues can put a real limitation on your activity levels.
A tendon is a thick matrix of strong fibrous tissue that connects a muscle to a bone. As the muscle contracts (shortens or lengthens,) the tendon acts as a cord that manages the forces of contraction within a movement to stay connected to the bone. Heavy stress on a tendon can cause damage to the tissue, no matter how strong. Tendons are protected by strong and functional muscles and proper mechanics. This means that our muscles must be both strong and mobile, and require good range of motion, functionality and stability. Limited calf function causes tightness in the muscles which effectively ‘shortens’ the length of the calf/tendon putting added tension against it. Tendons are also nourished by muscles via blood flow and circulation of fluids. Unfortunately, this is a major flaw of the achilles tendon: it has low vascularity from blood vessels, which means it is dependent on the muscle pump of the calf to nourish it. For optimal function, the achilles must be supple in order to work well, along with the calf muscles and rest of the lower extremity.
A tendon is a thick matrix of strong fibrous tissue that connects a muscle to a bone.
The achilles tendon attaches the calf muscles of your lower legs to the base of your heel bone (calcaneous). Often the weak link along the chain of muscle, tendon, and bone is where the tendon attaches to the bone. Thus many achilles tendonitis sufferers feel pain at the base of the heel even though the source of the problem may be coming from up above. Like most tendon issues, the key is catching things early.
The pain associated with achilles tendinitis often begins as a mild ache in the back of the lower leg or above the heel after activity. Episodes of severe pain can occur after prolonged strain or explosive movement such as during distance running, stair climbing or sprinting. Overuse repetitive strain injury is common, as with walking and easy jogging. Typical symptoms also include tenderness or stiffness in the morning, which usually improves with mild movement/activity.
Comparatively, achilles tendinopathy is degeneration of the tendon from acute or repeated injury. Many small injuries can occur over time, which breaks down the tissue integrity and strength, ultimately causing degraded function or tendon failure in severe cases. Many attributes can cause long term issues: poor foot posture, improper footwear stability (or too much!), and compromised circulation are major factors in chronic tendinopathy.
An achilles tendon rupture is a sudden acute tear of the tendon itself. This happens mostly to people between the ages of 30 and 50, and is most commonly caused by intense sports activity such as tennis. This catastrophic injury typically requires immediate surgical care, and can potentially cause long term tendon dysfunction.
What increases the risks or tendinitis, tendinopathy or rupture? How can we treat and prevent?
COMMON CAUSES OF ACHILLES TENDINOPATHY
WAYS TO TREAT AND PREVENT ACHILLES TENDINOPATHY
We should always treat problems on a continuum: from the onset of pain and injury, through comfortable movement and rehab, to strengthening to optimal function. We present this continuum regularly to our clients to help them see it’s a process and we don’t want to stop at short term pain relief, but want to go after the root causes and long term objective.
(A) Protect Damage
(B) Restore Function
(C) Adapt Strength
SHORT TERM MEASURES
LONG TERM MEASURES AND OBJECTIVES
Achilles problems can really set us back, but the good news is that there are many things that you can do to facilitate a quicker return to activity. Making good choices based on mobilization, lowering intensity but still moving, and frequent exercises to help rebuild can all make a big difference. That being said, because blood flow is limited to this area, it is a slower injury to heal. Our bodies can only heal at a certain rate so the last necessary component is patience (and one of the most difficult components for many of us!). The body requires up to ~27 weeks to fully repair damage to ligament and tendon so we have to give it the proper care, attention and loving patience to get the job done. Work with the body and it will work with you!