May 2019

Achilles Tendon Injuries
The condition of Achilles tendonitis and tendonosis is a common injury in the running community.  The Achilles tendon is the largest and strongest tendon in the body.  It connects the powerful muscles of the calf (gastrocnemius & soleus) with the bone of the heel (calcaneus).  The tendon transmits force from the calf muscles to the heel to provide the movement of plantar flexion of the foot primarily during the propulsive phase of the gait cycle. 

The two main problems that develop with the Achilles tendon is an acute tendonitis or chronic tendonosis.  A tendonitis denotes inflammation within and surrounding the tendon usually following an acute strain or a relatively large increase in training volume over a short period of time.  
Characteristics of an acute tendonitis are the following:
• Redness
• Swelling
• Tenderness
• Increased pain/stiffness with inactivity or in the morning
• Pain or discomfort early with activity

A tendonosis is considered a chronic condition that is the result of an accumulation of micro-trauma, or small tears in the tendon from repetitive overuse over a period of time.  Over time scar tissue can develop and cause the tendon to shorten, stiffen, and weaken.  A rupture of a tendon is more common in degenerated tissue.  It is important to note that most often an acute episode of Achilles "tendonitis" is really a chronic condition that has progressed to the point of becomming symptomatic.  Additionally, over 90% of all Achilles tendon ruptures happen in this chronic state.  Research has determined that much of what was commonly diagnosed as tendonitis may actually be tendonoisis, therefore treatment should be adjusted accordingly (1). 
Achilles tendonitis and tendonosis can result from the following:
• Excessive training volume
• Pronation of the medial longitudinal arches
• Improper running technique
• Running on uneven surfaces
• Improper/worn footwear
• Weakness/imbalance of lower extremity musculature
Treatment of an acute tendonitis:
• Rest, Ice, Elevation, NSAIDS
Treatment of a chronic tendonosis:
• Restore muscular and tendon health/functionality: Active Release Techniques®, self-myofascial release
• Professional evaluation of the stability of the arches of the feet: orthotic support, if necessary
• Professional evaluation of proper footwear
• Corrective rehabilitative exercise
An exercise to increase blood flow and the rate of collgen synthesis of the Achilles tendon is an eccentric (lowering) calf raise (2). 
Achilles tendon eccentric calf raise exercise:
Standing on the edge of a step with your heels hanging off, raise yourself up on both feet, then slowly lower your heel down into a calf stretch just on one foot.  Each repetition should take 6 seconds to lower.  Perform 2-3 sets for 15-20 repetitions 1-3 x/day.    
1. Khan, K. M., Cook, J. L., Tauton, P. E., & Bonar, F. (2000).  Overuse tendinosis, not tendonitis: Part 1: A new paradigm for a difficult clinical problem. The Physican and Sports Medicine. 28 (5).
2. Langberh, H., Ellingsgaard, H., Madsen, T., Jansson, J., Magnusson, S. P., Aagaard, P., & Kjaer, M. (2007). Eccentric rehabilitation exercise increases peritendinous type 1 collagen synthesis in humans with achilles tendonisis.  Scandinavian Journal of Medicince and Science in Sports. 17 (1), 61-66 .

Active Performance Chiropractic focuses on the diagnosis, treatment, and rehabilitation of athletic-related injuries.  Treatment is a unique blend of Active Release Techniques®, traditional chiropractic therapy, and physical rehabilitation designed to match each patient’s goals and lifestyle.