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TotalMSK Running Related Injury Series - Achilles Tendinopathy

TotalMSK Running Related Injury Series - Achilles Tendinopathy

Achilles Tendinopathy is a condition that can be very painful, severely hamper ones running ability and can often prove problematic to resolve once Chronic. The injury is typically characterised by pain, swelling and general stiffness just above the heel bone (1 - 2 inches). As with many conditions with an inflammatory component, symptoms are usually worst first thing in the morning and appear to improve with movement. Hence, it is quite common for people to push through the discomfort and or even run through the pain. However, the tissues then usually feel far more painful after the activity, and the pain, stiffness and swelling come back after rest or a nights sleep.

Common Causes of Achilles Tendinopathy include:-
  • Blunt force trauma.
  • Excessive calf muscle tension.
  • Not warming up or cooling down sufficiently.
  • Failing to stretch tissues effectively.
  • Ankle injuries and unresolved tissue damage.
  • Changes in joints, structures and or soft tissues affecting the kinetic chain (biomechanics).
  • Unsuitable or damaged footwear.
  • Changes in training and tissue adaption.
  • Changes in running style or surface (barefoot running, cross country, hills etc.).
  • Changes in training affecting distance, speed, duration or load.
The Achilles Tendon deals very well with forces along its length, though tends to react poorly to horizontal shearing type forces. Such loads can create damage/microtrauma to the collagen fibres within the Achilles Tendon matrix and even the muscles and fascia forming the tendon. Damage to the tissues results in the initiation of the bodies natural healing processes and the inflammatory tissue response (see healing article). The inflammatory response leads to an accumulation of fluids and swelling around the Achilles Tendon, which partly acts as a cushion. However, one can view inflammation as a “double-edged sword”. On the one hand, the inflammatory process is a necessary aspect of tissue damage control and healing, and yet too much inflammation can create additional tissue/cell damage. Hence, this is why in the early stages of the vast majority of soft tissue injuries R.I.C.E. (Rest, Ice, Compression and Elevation) is advised and at least within the first 72 hrs post injury.

The Achilles Tendon is in essence made up of two lower leg muscles, the Gastrocnemius and the Soleus via the Musculotendinous junction. Each muscle has a separate origin (start point) and similar insertion (endpoint), though join at the Musculotendinous junction to form the Achilles Tendon. The image below shows the Gastrocnemius muscle above, or superficial to the Soleus Muscle. The Musculotendinous junction can be found in the lower one-third of the two muscles and forms the Achilles Tendon.

Images produced with kind permission of from Essential Anatomy 5
(Copyright © 2018 3D4Medical. All rights reserved.)

The Gastrocnemius muscle attaches at the (distal) lower portion of the upper leg and crosses the posterior portion or behind the knee joint and attaches to Calcaneus (heel). Hence, the Gastrocnemius muscle passes over two joint structures.

Images produced with kind permission of from Essential Anatomy 5
(Copyright © 2018 3D4Medical. All rights reserved.)

Unlike the Gastrocnemius, the Soleus muscle is connected to the posterior portion of the lower leg and the Calcaneus (heel) and thus only passes over one joint structure.

Images produced with kind permission of from Essential Anatomy 5
(Copyright © 2018 3D4Medical. All rights reserved.)

One can often encounter problems with the calf and Achilles Tendon if one does not stretch these two muscles separately. In essence, the muscles have similar, but slightly different actions due to the attachment point locations. The fascial network within the tissues of the body will allow non-dysfunctional and hydrated tissues to slide across each other without pain or restriction, a critical factor in running and activity. Even with regular stretching one may still find that areas of tissues can become stuck, as self-stretching has limits.  Changes to tissue structures can occur in both active and non-active people due to tissues adaption (see tissue adaption article for a more detailed explanation).

Once an Achilles Tendon injury has occurred, it is well worth seeking professional help or advice. The pain of the initial injury will start to affect how one moves, as the body tends to adapt to avoid pain as with most physical injuries. Over time these avoidance adaption patterns can become learnt and create other problems in the kinetic chain. Furthermore, the longer the problem is left unaddressed, the harder it can prove to resolve, due to multiple tissue changes (see Biotensegrity article). Identifying, the cause of the problem is always crucial if one wants to have a speedy recovery. There is a multitude of therapists who regularly see and treat Achilles type injuries including;  Sports Medicine Doctors, Sports and Remedial Massage therapists, Chiropractors, Physiotherapists, Osteopaths, Sports Therapists, Acupuncturists and more. Each type of profession tends to have a different way to look at a problem due to differences in training, experience and even philosophy.

In some, cases it may be possible to self-treat, though to do so one needs to identify the cause and safely address it. The Foam Roller and Trigger Point Therapy (TPT) articles can prove useful, provided one is has no contraindications relating to either technique, can perform them safely and has correctly identified the cause of the pain/condition.

The author has found a combination of McTimoney Chiropractic, advanced Soft Tissue Therapy techniques (Sports Massage, Remedial Massage, IASTM, Dry Needling) and a graded rehabilitative programme to be highly effective in resolving Achilles Tendinopathy injuries, acute and chronic. However, that said it is better to avoid damage in the first place by following reasonably simple preventative measures. Injuries can still occur for unforeseen reasons, though preventative measures can help manage or minimise some of those risks.

The next Running Related Article will cover Plantar Fasciopathy (Plantar Fasciitis)

Article written by Dr Terry Davis MChiro, DC, B.Sc (Hons), Adv. Dip. Rem. Massag.,  Cert. WHS.
The Corporate Wellness, Musculoskeletal and Chiropractic Specialists

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