Posted: December 2, 2003

Tracy Montgomery's Sports Injury & Treatment Column: Achilles tendonitis

Achilles tendonitis

Tendons are soft tissue, which connect muscle to bone.

Tendonitis is a condition that results when the tendon of a muscle gets aggravated and inflamed. Pain associated with tendonitis will usually be worse at the beginning of activity but tends to feel better as the muscle and tendon warm up through continued activity. Most tendonitis occurs after cumulative trauma or overuse of the area.

There are two major things to consider with Achilles tendonitis. First you need to look at the muscles that are attached to the Achilles and second you need to look at the tissues anterior to the tendon where the structures may become adhered.

The Achilles tendon is a very strong tendon, which attaches two large superficial muscles in the posterior lower leg to the calcaneous (the heal). These two muscles are known as the Gastrocnemius and the Soleus. The Gasrtrocnemius attaches above the knee and is the most superficial. The Soleus attaches below the knee with a large portion of the muscles lying posterior to the Gastrocnemius. Both muscles bind into a common tendon and attach to the calcaneous via the Achilles tendon. If these muscles get excessively tight they will pull on both the calcaneous and the Achilles tendon. This pull and overuse of the calf muscles is generally the cause of tendonitis. Strains and ruptures can also afflict the Achilles tendon but these injuries are usually caused by a more traumatic event.

In many cases, people will feel tightness or stiffness in the calf muscles prior to experiencing pain in the Achilles tendon. The first step in treatment should always be to decrease the inflammation around the tendon and decrease the pull or tension on the tendon. Ice will help decrease the inflammation while stretching and heating the calf muscles should help decrease the tension on the tendon. In more aggravated cases of Achilles tendonitis the person will not be able to stretch without pain. In this case, I suggest the client find a Lower Extremity Certified Active Release (ART) Provider in their area. ART is by far the fastest, safest way to loosen the muscles and restore them to their proper length.

In my opinion, the biggest mistake I see with Achilles tendonitis treatment is with regards to strengthening. Although these muscles may eventually need to be strengthened, it will have absolutely no positive effect on the pain and inflammation until the muscles are lengthened back to their healthy state. In this case, strengthening will actually be counterproductive. Strengthening will tighten up the muscles even further, adding more tension to the Achilles.

Another common mistake used to treat Achilles tendonitis is frictioning directly on the Achilles tendon. You should not let anyone friction directly on the Achilles tendon, it will only case more aggravation and possible lead to further injury. Always remember the Achilles tendon is where the symptom has presented. In almost all cases the actual problem area lies further up in the lower leg.

The second thing to consider is the tissue that lies anterior to the tendon. In the body we have many layers of tissues comprising of muscles, tendons, nerves, fascia, ligaments etc. These tissues are all designed to move independent of each other (i.e. as movement occurs, muscles slide past muscles, nerves slide past muscles etc.). In an area that has had cumulative trauma (overuse), these tissues may not slide independently but move as one unit. Why is this a problem? If two structures are stuck together they will not move in their normal range. The major muscles in the lower leg may return to a healthy length but they may be adhered together or the Achilles tendon itself may be stuck to the anterior tissues that it rests on. This will prevent the tendon from moving properly through its' range of motion which in turn will not allow the tendonitis to fully resolve. ART is again the best way to separate these tissues and return them to proper function. ART works with very specific muscle motion allowing the provider to do very specific work.

Homecare I usually suggest for my clients involves stretching and heating the lower leg muscles. Often people are told only to ice. Let me explain why I promote heating. I have explained the lower legs muscles are in a tightened state. Heat will bring blood flow to the area and soften the muscles. If you have inflammation at the tendon you may want to ice the tendon and heat the lower leg at the same time. The heat will obviously soften the calf but will also act to help pull some of the inflammation out of the Achilles. In more extreme cases I will often have the client put heal lifts in both shoe to temporarily take some tension off the tendon. The lifts are intended for short-term relief only and are not to be left in for an extended period of time.

This Fall I saw an abnormal number of Achilles problems and even suffered some tendonitis myself. Being like most athletes, I did not want to take time off while allowing things to heal. Although sore initially, I found that the pain subsided after several minutes of running. Instead of suffering through these initial minutes of discomfort, I found that heating my lower leg with a heating pad prior to running allowed me to run relatively pain free from the start. Although that gave me temporary relief, I had my associate treat the area with ART for a more permanent resolution.

Visit Tracy's web site at: www.montgomerymassage.com.