Achilles Tendon Injury:
Causes, Symptoms & Treatment
The Achilles tendon is a large tendon located at the back of the lower leg. It attaches the Gastrocnemius and Soleus calf muscles to the Calcaneus (heel bone). The major action of the Achilles tendon is to assist in the ability to push off during gait and running as well as help people stand upright. Achilles tendon injury may be the result of various factors such as:
- Sudden increase in load (i.e increase in exercise intensity or frequency).
- Decrease in appropriate rest/recovery after exercise or activity.
- Wearing inappropriate footwear.
- Foot and ankle abnormalities such as excessive pronation.
- Exercise on hard or uneven surfaces.
- Poor myofascial flexibility and strength of the calf muscles.
- Reduced ankle joint mobility.
Achilles Tendon Injuries
- Achilles tendon partial tear or rupture: This refers to a partial or complete tear that occurs when the Achilles tendon is stretched beyond its normal limit. This usually happens during a forceful jump, pivot or sudden acceleration activity. Illness and medication may lead to tendon weakness and predispose people to Achilles tendon ruptures. When a rupture occurs an audible pop or cracking sound may be noticed at the back of the ankle. Surgery may be required to assist with healing and resolution.
- Achilles tendinitis: Tendinitis is a term that is used to describe inflammation. Achilles tendinitis is an overuse injury that is commonly seen in runners, joggers and jumpers due to the repetitive nature of their activity. Burning pain may be noticed in the Achilles tendon area during activity as well as reduced flexibility of the associated calf muscles.
Diagnosis Of Achilles Tendon Injuries
Your practitioner will conduct a thorough history and physical examination. Additional imaging may be clinically necessary to ascertain the exact severity and level of damage of your injury.
- Physical Examination: A Physiotherapist or Sports Chiropractor will examine your lower leg, foot and ankle. This will involve a series of assessments such as observing you walk, stand on your toes as well as orthopaedic evaluation (Thompson test – calf squeeze) to determine if there is an Achilles tendon injury present.
- Patient History: Your practitioner will discuss your complaint and mechanism of injury. Questioning may include the quality of pain, presence of relieving or aggravating factors, recent sporting activity and past history of injury.
- Diagnostic Imaging: If following these procedures that your practitioner determines that further imaging is necessary then referral for MRI and Ultrasound may be required.
Achilles Tendon Treatment Options
Achilles tendon injuries are one of the more common sports injuries that Sports Chiropractors manage. According to research, treatment programs should progress through six stages of healing in order to assist return to normal activity. These six phases are:
- Acute pain reduction.
- Regain normal range of motion and biomechanics.
- Restore eccentric muscle and soft tissue strength.
- Restore concentric muscle and soft tissue strength.
- Restore proprioception, agility and power.
- Facilitate appropriate return to sport/activity.
Chiropractic & Physiotherapy
Chiropractors & Physiotherapist’s are musculoskeletal therapist that are trained in sports injury management procedures. Hands on management that may be administered by such professionals may include:
- Mobilisation of the ankle and foot to improve range of motion and biomechanics as well as assessment of the knee, hip, pelvic and lumbar spine kinetic chain
- Soft tissue therapy such as Massage to the Achilles tendon to assist tendon healing
- Physiological therapeutics such as Ultrasound, Shockwave therapy, low level laser to assist with inflammation and healing
If it is found that you have associated structural abnormalities other devices to assist your recovery may be recommended by your Chiropractor or Physiotherapist. Devices may include foot orthotics, ankle straps/braces and moon boots in serious cases.
In worst case scenarios such as Achilles tendon rupture surgical intervention may be required. Surgery is aimed at stitching the tendon together to allow appropriate healing. As with all surgical intervention appropriate rehabilitation is recommended to assist with normal return to activity post procedure.
Chiropractor Achilles Tendon Research
- A combination of conservative rehabilitation strategies such as those implemented by Chiropractors and other allied health professionals can assist individuals suffering from Achilles tendon injuries return to normal activities of daily living in a timely manner. Papa, J. A (2012). Conservative management of Achilles Tendinopathy: A case report. The Journal of the Canadian Chiropractic Association, 56(3); 216 – 224
- A specific treatment and rehabilitation protocol of heat, soft tissue mobilization, eccentric exercise, stretching, and cryotherapy assisted complete recovery from Achilles tendinopathy. Miners, A (2011). Chronic Achilles tendinopathy: A case study of treatment incorporating active and passive tissue warm-up, Graston technique, ART, eccentric exercise & cryotherapy. The Journal of the Canadian Chiropractic Association, 55(4); 269 – 279.