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02 Aug 2013

Achilles Tendonitis

After writing about the Plantar Fascia last month, I want to talk about the connecting tissue of the calf muscle and the heel bone and a common condition associated with it: the Achilles Tendon and Achilles Tendonitis.

The Achilles Tendon

The Achilles Tendon is the largest and strongest tendon in your entire body. It is the thick, wide band of connective tissue stretching from the gastrocnemius and soleus (calf) muscles and connecting right behind the calcaneus (heel) bone. Whether you are a high performance athlete or a stay-at-home mom, this part of your leg is constantly being used as you perform daily tasks. It is vital that it is conditioned and used properly to prevent injury.

Mechanics

The Achilles Tendon has everything to do with proper walking mechanics. Different from the bone to bone connection of the Plantar Fascia from the Calcaneus to the Metatarsal (toe) bones, the Achilles Tendon connects the Gastrocnemius and Soleus muscles to the calcaneus, creating a muscle to bone connection. Contraction of the calf muscles are what mobilize the ankle joint and propel the body in a forward walking motion. The ankle and knee joints along with all the muscles in your leg must work together to create a smooth fluid motion when you are walking. Any tight muscles in the calf or the bottom of the foot prevent a painless, fluid motion and put added stress on your Achilles Tendon.

Think of jumping straight up in the air. The Gastrocnemius muscle is the primary source of strength used for the upward movement. The motion is reversed when the Soleus and Gastrocnemius muscles absorb impact of the landing. The Gastrocnemius takes the initial load and transfers it to the Soleus as the knee bends. Think of a basketball player going in for a slam-dunk or a dancer leaping off the floor.

They would not be able to execute such amazing activities without conditioned calf muscles.

What causes Achilles Tendonitis?

Achilles Tendonitis is caused by repetitive or intense strain on the Achilles Tendon.   Inflammation follows and is worsened when coupled with lack of rest and/or flexibility. High performance activities on an unconditioned and imbalanced lower leg make it very likely that you will develop Achilles Tendonitis.

The tendon can also get inflamed when the shape of the heel of the shoe rubs uncomfortably on the back of the foot where there is not a thick layer of flesh to protect it.

Achilles tendonitis is a very common condition in runners, particularly those who practice uphill running. This places an overload on their calves and achilles tendon. The mechanics used to run uphill safely and without strain or injury are very specific.

The Importance of Good Posture

Some professional runners and running coaches advocate leaning forward with the incline of the hill as they run. When I evaluate the uphill running technique of long-distance runners, I notice that in most cases they lean forward too much. This is often due to a weak core and they slouch from their mid body (low back) rather than bending at the ankle joint. Posterior muscle groups of the thigh and the glutes do not engage properly, making the calf muscles do all the work. These runners end up with overdeveloped calf muscles and underdeveloped hamstrings and glutes.

On the other hand, when you observe a 100-200 meter sprinter with good posture, you can appreciate the symmetry of the thigh and gluteal muscles and that the calves are not overdeveloped. This is a great example of a balanced weight being distributed on legs that absorb the force evenly rather than force that stresses the ankle joint.

Try this test. Stand upright in good posture with your head over your shoulders. Now walk a few steps. Then with your shoulders collapsed and head slouched forward, walk again. You will be able to feel the added stress on your achilles tendon/ankle when you’re in a state of poor posture.

How Can We Correct Achilles Tendinitis?

First of all, you must reduce activities that you suspect are provoking the problem. Try taking 1-2 weeks off to stop the inflammation and increase the natural healing process of the body.

To an athlete who needs to continue in event preparation or working out but has achilles tendonitis, I would suggest that you change up your activities. Try “running” in the pool. This is a great way to continue gaining muscle strength from movements with water resistance without the weight of the heel striking the ground.

These are some other things you can do to help heal the condition:

  • Ice the inflamed area
  • Get a friction massage
  • Use night splints
  • Change shoes
  • Use an incline board or stretch the ankle joint with assistance
  • Kinesio taping

In Conclusion

An important thing to remember is that rotation of the trunk is a must if you want to avoid overstressing the lower leg. “Cross crawling” is what we call the mechanics of proper gait. For example, as we walk or run, the right leg propelling forward makes the opposite (left) arm do the same. Once again, you can test yourself. Have a friend video you to see if you are crossing your limbs symmetrically. Time after time I have observed people only crossing one side properly or not at all. This hinders a balanced walking rhythm and causes the unbalanced weight to fall on your legs.

Flexibility of the ankle joint and leg is essential to avoid achilles tendinitis. Short, restricted shin muscles, for example, can put continuous stress on the achilles tendon because of lack of movement.

A full range of motion in your ankles is very important. Assisted stretching from a sports therapist or using an incline board can be helpful.

Treat any possible hidden trigger points. The achilles tendon covers the soleus muscle and there can often be active trigger points on that area that feel like a hot spot right on the achilles tendon. What you may think is achilles tendonitis could possibly be tightness or inflammation in your calf. Have a professional sports massage therapist evaluate this possible ghost effect.

Lastly, remember that pain is NOT gain! Pain signals are your body trying to tell you that something is not working the way that it’s supposed to! Train hard? Rest hard!

“Keep on moving”

Luis Ponce Sr.

(408) 778-5577

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