The Achilles Tendon
The Achilles Tendon: Prevention, Injuries and Treatment Options
The Achilles tendon in the back of the ankle and is the largest tendon in the body. The tendon is an extension of the calf muscles, running down the back of the lower leg attaching to the heel bone. The Achilles tendon connects the leg muscles to the foot and gives the ability to push off during walking and running.
The two most common injuries of the Achilles tendon are Achilles Tendinopathy and tearing or rupture of the tendon. Until recently Achilles Tendinopathy was referred to as Achilles Tendinitis. However, research has found that this type of injury is due to tissue overload and degeneration rather than pure inflammation. It is believed that the injury occurs most likely due to a series of micro- tears that involve changes in collagen fibre structures and arrangement, which weakens the tendon.
Common Causes For Achilles Tendon Injuries
Overuse or too much too soon is generally considered to be the main factor for Achilles tendon injuries, however, the exact cause is still unknown and other factors can contribute to developing the condition.
- Genetics – Individuals with the polymorphism of the TT genotype of the functional GDF5 rs143383 variant have twice the risk of developing Achilles tendon problems. Other research suggests that the condition may be polygenic and may involve complex interaction between multiple genes.
- A sudden increase in the intensity, frequency and duration of physical activity and not enough time for recovery after activity.
- Inadequate warm up, stretching and cool down.
- Misalignment – Unequal leg length, over or under pronation, disproportionally weak calf muscles, etc
- Improper footwear – Worn out shoes, shoes with too much or too little arch or heel support. Wearing high heels constantly shortens the tendon and calf muscles. Exercising in flat running shoes plaes an abnormal strain on the tendon.
- Poor muscle flexibility (e.g. tight calf muscles,weak calf muscles) and decreased joint range of motion (e.g. stiff ankle joint). Weak calf muscles can tighten or go into partial spasm which again increases the strain on the achilles tendon by shortening the muscle.
- Side effect of certain medications- the quinolone group of antibiotics weaken some people’s tendons. The weakness is most often felt in the Achilles tendon because it is one of the largest and most heavily used tendons.
Tendinopathy has an increased incidence with age and the male gender. There is also an
association between tendinopathy and hormone replacement therapy and oral contraceptives in women.
Achilles Tendinopathy Symptoms
- Mild to severe pain and tenderness in the Achilles tendon area (tenderness may be more noticeable in the morning)
- Swelling
- Stiffness
- Decreased strength and movement; a feeling of sluggishness in the leg.
Achilles Tendon Rupture
An Achilles tendon can partially tear or completely rupture when the tendon is stretched beyond its capacity.
While a partial tear presents similar symptoms as a tendinopathy, a complete rupture causes pain and sudden loss of strength and movement.
It comes on suddenly, sometimes with a popping sound, and can be very debilitating. The pain of a torn Achilles tendon feels like a gunshot in the leg.
How To Treat Achilles Tendon Injuries:
The immediate treatment consists of the RICER protocol – rest, ice, compression, elevation and referral. RICE protocol should be followed for 48–72 hours. The aim is to reduce the bleeding and damage within the joint.
No heat, no alcohol, no running or activity, and no massage. This will ensure decreased bleeding and swelling in the injured area.
Once pain has settled a program of rehabilitation exercises may be prescribed to gradually strengthen the tendon to enable it to cope with increased load before return to activity.
The Bauerfeind AchilloTrain and AchilloTrain Pro braces help to relieve symptoms of tendinopathy and are an ideal follow-up treatment of Achilles tendon ruptures.
Take the MH Enhance Tissue Regenex which contains a combination of herbs and nutrients to help collagen construct cross links and aid the stability of the connective tissue, and promote healing after injury.
Ensure optimal magnesium intake to maintain leg muscle flexibility and prevent tightening of the calf muscles.
Use the Emed’s Musculo Skeletal Profile to assess the levels of nutrients that are essential for maintaing connective tissue strength and flexibility and to help you maintain those nutrients in the optimal range.
A completely ruptured Achilles tendon is most often repaired surgically. Surgery is often followed by immobilisation in a plaster cast. Following this immobilisation period the Achilles will require intense rehabilitation followed by a strengthening program.
Achilles tendon can require weeks to months of rest for the tendon to slowly repair itself, so it is very important to try and prevent this kind of injuries. Prevention is the cure!
9 Easy Steps To Minimise The Risk Of Achilles Tendon injury:
1. Eat a balanced diet, drink plenty of water, and get enough sleep.
2. Wear adequate footwear.
3. Warm up before stretching or exercising.
4. Allow adequate recovery time between workouts or training sessions
5. Use TheraBand Resistance Bands to do regular strengthening and stretching exercises and maintain muscle and tendon strength and flexibility.
6. Maintain a healthy weight.
7. Gradually increase the intensity and duration of training
9. Avoid smoking and excessive caffeine, alcohol, and drugs use.
9. Avoid anti-inflammatory drugs and pain killers, as Achilles tendinopathy is a degenerative injury rather than an inflammation. The pain killing drugs will mask the problem, which is likely to cause the degeneration to get worse. In addition to being ineffective, anti-inflammatory and pain killing drugs have many dangerous side effects.
Further reading:
References:
Posthumus M, et al., 2010, Components of the transforming growth factor-beta family and the pathogenesis of human Achilles tendon pathology-a genetic association study, Rheumatology (Oxford). 2010 Nov;49(11):2090-7.
Harvie P, et al., 2004, Genetic influences in the aetiology of tears of the rotator cuff. Sibling risk of a full-thickness tear, J Bone Joint Surg Br. 86:696–700.
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