The Achilles tendon is the largest tendon in the human body but very prone to injury and tearing.

Achilles Tendonitis

Achilles Tendonitis

The Achilles tendon is the largest tendon in the human body!  It connects the calf muscles to the heel and is highly involved in walking, running, jumping etc. – essentially all weight bearing activities!!  Despite this tendon being the largest and strongest, it is very prone to tendonitis, tearing and degeneration – ughh!

Types of Achilles Tendonitis:

Non-Insertional:

Fibers in the middle portion of the tendon break down and develop tiny tears, degenerate, swell and thicken

Insertional:

Fibers that attach to the heel bone may breakdown and/or tear.  Damaged tendons may calcify and extra bone growth often forms (heel spurs)

Symptoms of Achilles Tendonitis:

*Pain behind the ankle and/or along the tendon – worse in morning and with activity/exercise

*Elevated pain the day after exercising

*Scar- like bump formation/thickening and/or swelling

*Limited ROM in ankle and decreased ability to flex foot

*Isolated pain/tenderness at inflamed/damaged site

**A sudden “pop” in the back of the calf or heel may indicate a ruptured Achilles!!

Causes of Achilles Tendonitis:

*Reduced flexibility and/or weakness in calf muscles

*Overuse or increased training intensity or volume

*Inadequate recovery time between running sessions

*Increased hill or speed work

*Unequal leg length

*Pronation or Supination

*Ankle/Foot joint restrictions/mal-alignments

*Poor Heel Posting and/or improper shoe selection

*Antibiotic usage and/or cortisone – weakens tendons

*Poor warm-up/cool down habits

Management of Achilles Tendonitis:

**Properly diagnose with functional examination, MRI and/or diagnostic ultrasound**

Ultrasound and Iontophoresis therapy – 2-3X/week

Manual soft tissue release therapy – 1-2X/week

Myofasical Dry Needle Therapy – 2-3X/week

Specific manual adjustments of foot, ankle, knee, hip and lower back – adjust until clear

Custom Orthotics – cast to support proper biomechanics

Improve heel posting and consider adding a heel pad/lift to accommodate temporarily

Dorsi-flexion night splint – wear to stretch tendon and align fibers while sleeping ~ 6 weeks

Practice avoidance and Water Running, Recumbent Bike, Ellipitcal temporarily to “Actively Rest”

Consider Platelet Rich Plasma (PRP) Injection for resistant cases

Nutritional Anti-Inflammatory protocol: Proteolytic Enzymes, Bioflavonoids, Fish Oil – 3 mos

Nutritional Connective Tissue Protocol: Collagenics and Ligaplex for connective tissue integrity – 3 mos

Kinesio-tape Achilles and Calf to support healing and fiber alignment

 

Terrel Suggs, the Raven’s former defensive player of the year tore his Achilles in the spring and typically this injury would have ended his season.  However, thanks to technology and compliance to a comprehensive regimen similar to the one above, he returned to the field without re-occurrence!

Due to the nature of this injury and tendon, it requires a comprehensive multi-faceted approach to resolve.  From training modifications, orthotics, manual and physical therapy, modalities, and clinical nutrition, promoting healing and allowing the tissue to restore is paramount for a successful outcome and prevention of re-injury.

Image: Gray’s Anatomy
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Dr. John Michie

About Dr. John Michie

John L. Michie, D.C., C.C.S.P., founder of Whole Health Chiropractic, embraces Edison's wisdom and incorporates a balance of nutrition, exercise, physiotherapy and chiropractic care to positively impact his patients’ health. Whole Health Chiropractic is a holistic, patient-centered practice. "It's our goal to uncover the causes of debilitating symptoms and follow with an action plan that addresses necessary steps for sustained healing."

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