Achilles Tendonitis - The Running Sports Injury


Running Injuries

Achilles Tendonitis is very common in runners. Common  belief is that rest works well in the Click here know more about Prairie  Trail Physiotherapy & Sports Injury Clinic. As most people will  testify, this in fact is not the case and careful management of this condition  is needed. Usually the painful symptoms around the achilles tendon return when  training resumes.

Continual bouts of exercise and rest periods develop a  chronic situation and will eventually prevent the runner from performing. A  programme of rehabilitation is needed to assist full recovery and prevent  further bouts of this irritating condition.

The achilles pain syndrome  is divided into two main areas which involves both tendon and sheath

(  paratenon tissue ) The achilles tendon does not in fact have a true tendon  sheath but has paratenon tissue which surrounds the tendon and assists  lubrication of the tendon on movement. Inflammation of the paratenon tissue  usually shows as a thickening and increases the size and appearance of the  tendon. Palpation over the area is usually painful and any running is difficult.

Causes

Overuse and lack of conditioning will both irritate the  achilles tendon as will overstretching, which may come from running up hills or  steep inclines on a treadmill. Tight calf muscles due to lack of proper  stretching can also result in a sore achilles tendon which will result in  inflammation and pain.

Previously mechanical irritation from badly  designed training shoes with a high achilles protector used to be a problem but  manufacturers have altered this by designing a "V" cut into the top of the  protector which has helped considerably.

 


Treatment

This may vary depending on the severity of  the condition and workload of the athlete. Most runners get twitchy if they are  told to rest and stop running for a while, so a treatment plan needs to consider  this factor. Runners may be on a training regime in preparation for a marathon  and any gaps in training may have a negative effect on their performance. This  however needs to be balanced with the realization that this type of injury has  to involve rest periods in order to allow healing to take place

It is  vital that the cause of the injury is identified before treatment is undertaken.  Once the cause is identified then the correct treatment plan can be introduced.  Many physiotherapists use ultrasound as their treatment modality and although  this is a good choice it will not be successful if used in isolation.



If the tendon sheath is thickened it will require specific deep  friction massage to break down adhesions. This will obviously irritate the  achilles tendon and be painful, but if ice is used throughout to reduce  inflammation and pain, the process can be administered successfully.

Friction massage is used in an attempt to re-injure the tendon and  create a healing crisis response from the body. As we know the achilles tendon  is not blessed with a good blood supply so by manufacturing an inflammatory  response you will encourage vasodilation of blood vessels, increase blood flow  to the area and promote healing.

My recommendations would be :

3  x treatments per week for the first 3 weeks with no running done. During this  time the patient should wear heel lifts in both shoes to reduce the stress on  the injured achilles tendon. By the end of the 3 weeks the fibrous adhesions  should be broken down and the painful part of the treatment plan is complete.  The treatment plan has to involve factors such as pain relief, increased  vasodilation, and breaking of fibrous adhesions around the tendon and sheath.



Weeks 4 and 5 should allow  the tendon to recover and both ultrasound and interferential treatments together  with soft tissue work administered 3 x weekly will promote healing. Removal of  heel lifts is now advised in order to provide passive re-stretching of the  tendon. No running should be done during this time.

Weeks 6 and 7 should  involve 2 x treatments per week with active stretching after home exercises.  Ensure a gentle stretch of both soleus and gastrocnemius calf muscles and hold  the progressive stretch for 2 minutes at a time. Begin strength conditioning by  performing 20 repetitions of calf raises 3 x daily, the stretching can then  follow. Complete the process by icing the area when stretching is completed.

Week 8 Replace heel lifts in running shoes and begin half pace jogging  for 15 minutes every other day, stretch off gently after exercise and ice. Heel  lifts should only be worn in running shoes now and not during daily activities.  Treatments of electrotherapy and soft tissue work should continue twice per  week.

A gradual increase in distance should follow over the weeks with a  gradual increase in pace and if pain free the heel lifts should be removed. When  heel lifts are removed during running, reduce pace and distance again to  accommodate the extra stretch on the tendon. This can be gradually increased as  before until back to full fitness.


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