Achilles tendon pain and how Osteopaths treat and manage it
Osteopathic treatment and Achilles tendon pain - Rejuvenate Osteopathy
Anatomy of the Achilles tendon, and what does it do?
The Achilles tendon is a brous band that connects the heel to the calf muscle, which is comprised of the soleus and gastrocnemius muscles forming the gastroc-soleus muscle group.
When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group helps when you sprint, jump, or climb. Several different problems can occur that affect the Achilles tendon, some rather minor and some quite severe.
Achilles Tendon Problems
The Achilles tendon can be affected by various conditions, such as tendonitis, tendinopathy, tendocalcaneal bursitis, and tendonosis. The following conditions will be dened and elucidated. Athletes, particularly those participating in running, basketball and jumping sports, tend to experience these issues more frequently.
These conditions are prevalent among middle-aged adults who are both active or sedentary (inactive) . These problems cause pain at the back of the calf. Severe cases may result in a rupture of the Achilles tendon.
Tendocalcaneal Bursitis
Bursae are sac-like structures lled with uid that reduce friction between rubbing parts. Bursitis occurs when a bursa becomes inamed. Tendocalcaneal bursitis is the inammation of the bursa behind the heel bone. This bursa limits friction where the Achilles tendon glides up and down behind the heel.
Achilles Tendonitis
Trauma to the calf muscles or Achilles tendon can result from a recurrent micro strains / tears, also known as tendonitis. This injury often occurs during intense muscle contractions, such as running or sprinting. Jumping and landing on the ground can also cause injury by forcing the foot upward. The strain may affect different parts of the muscles or tendon, including the center of the muscle or where it joins the Achilles tendon (musculotendinous junction).
Achilles Tendinopathy/Tendonosis
Overuse can cause alterations in the Achilles tendon, resulting in its degeneration and thickening. Research indicates the absence of inammation in tendon overuse injuries. Therefore, experts commonly use terms such as tendinopathy or tendonosis instead of tendonitis to describe this condition.
Achilles Tendon Rupture
In cases of severe strain, the tendon may rupture. This often occurs in middle-aged individuals who participate in high-impact activities like tennis. Prior to the rupture, the tendon may become weakened due to tendonitis.
Causes of Achilles tendon issues
Overuse - Individuals who engage in excessive training may experience overuse injuries, particularly disorders affecting the Achilles tendon. Runners and those who participate in sports involving frequent jumping, such as basketball, are especially vulnerable to these types of injuries.
Structural and functional foot Issues - Excessive pronation (attening of the arch) can cause foot problems. This puts greater demands on the Achilles tendon when walking. The attened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress can cause inammation, pain, and swelling of the tendon. Being overweight can make the problem worse.
Incorrect footwear - Improperly tting footwear can cause additional stress and instability to the feet during physical activity, increasing the risk of injury. Wearing heels frequently can cause the Achilles tendon to shorten, which can lead to injury when at shoes are worn during exercise.
Signs and symptoms
The most frequently reported symptom is pain in the lower leg or back of the ankle, typically in close proximity to the heel.
Typically, pain tends to be more intense in the morning as weight is applied to the foot.
Symptoms of tenderness, redness, and warmth may be present in the affected area.
There is a decrease in ankle mobility.
Symptoms of pain and stiffness may occur after periods of inactivity of the calf muscles, such as prolonged sitting or after sleeping.
Inammation and pain may occur after overuse of the calf muscles, such as during activities like walking, running, or jumping.
Symptoms of tendocalcanea bursitis include pain and irritation at the back of the heel, along with redness and swelling in the affected area. Shoe wear may exacerbate the condition.
An Achilles tendon rupture is typically identiable as bystanders may hear a snap and the victim will feel a sensation similar to a forceful kick to the calf. After the rupture, the calf may become swollen and the individual will likely be unable to lift onto their toes.
Osteopathic treatment and management
During the consultation with an osteopath, a thorough medical history and physical examination will be conducted to assess the injury and determine appropriate treatment for your achilles tendon problems.
A thorough examination of your back, pelvis, legs, and the rest of your body will be conducted to determine your level of physical activity and if your walking or running cycle is having any abnormal effects on your feet and ankles.
Massage of the soft tissue in the muscles of the lower leg.
Joint mobilisation is a technique used in physical therapy to improve joint function.
Application of deep friction techniques on the Achilles tendon.
It is recommended to limit or avoid activities, such as running, that may worsen the condition.
Your osteopath may suggest consulting with a GP or pharmacist for the prescription of nonsteroidal anti-inammatory drugs (NSAIDS) to aid in the reduction of inammation if tendonitis.
The use of anti-inammatories and ice for tendon problems is being questioned. Overusing these treatments may prevent normal healing processes in cases of true inammation. Inammation is needed to clean up cellular debris in the injured area, delaying or incomplete healing can result in chronic problems of tendonosis and/or tendiopathy.
In cases of injury severity, immobilisation of the foot through casting or booting may be necessary to restrict ankle movement, decrease pressure on the Achilles tendon, and facilitate healing.
Additional examinations may be necessary, including a foot x-ray, ultrasound, and potentially blood tests to assess inammation. An MRI scan of the tendon may also be recommended.
As the tendinitis improves, introduce strengthening and stretching exercises to assist in restoring the ankle back to its “normal” state and improving the strength to avoid the injury from reoccurring
As the tendinitis heals, incorporate exercises that focus on both strengthening and stretching the ankle to aid in returning it to its pre-injury state and to prevent future reoccurrences.
The treatment and management approach will be selected on the basis of how long the injury has been present and the degree of damage to the tendon. It is imperative that you look after your feet and ankles. They keep you moving and give you the ability to roam day to day, it it wise to look after them accordingly, especially when they are in pain.
Exercise rehabilitation
Phase 1: Weeks 1-2
Patient status: Pain and diculty with all activities, diculty performing ten 1‐legged heel raises
Goal: Start to exercise, gain understanding of their injury and of pain‐monitoring model Treatment program: Perform exercises every day
Pain‐monitoring model information and advice on exercise activity Circulation exercises (moving foot up/down)
Two‐legged heel raises standing on the oor (3 sets of 10‐15 repetitions/set)
One‐legged heel raises standing on the oor (3 sets of 10) Sitting heel raises (3 sets of 10)
Eccentric heel raises standing on the oor (3 sets of 10)
Phase 2: Weeks 2-5
Patient status: Pain with exercise, morning stiffness, pain when performing heel raises Goal: Start strengthening
Treatment program: Perform exercises every day
Two‐legged heel raises standing on edge of stair (3 sets of 15) One‐legged heel raises standing on edge of stair (3 sets of 15) Sitting heel raises (3 sets of 15)
Eccentric heel raises standing on edge of stair (3 sets of 15) Quick‐rebounding heel raises (3 sets of 20)
Phase 3: Weeks 3–12 (longer if needed)
Patient status: Handled the phase 2 exercise program, no pain distally in tendon insertion, possibly decreased or
increased morning stiffness
Goal: Heavier strength training, increase or start running and/or jumping activity Treatment program: Perform exercises every day and with heavier load 2‐3 times/week
One‐legged heel raises standing on edge of stair with added weight (3 sets of 15)
Sitting heel raises (3 sets of 15)
Eccentric heel raises standing on edge of stair with added weight (3 sets of 15)
Quick‐rebounding heel raises (3 sets of 20) Plyometric training