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Prepared for World Triathlon Corporation by Dr. Brian
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Injuries to the Achilles Tendon
By
Dr. Brian Abelson DC. Calgary, Alberta, Canada
http://www.drabelson.com/
https://activerelease.ca/
In this article
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Injuries to the Achilles
Tendon Causes of Achilles Tendon
Injuries Always Consider the Kinetic
Chain The Need for a Specific
Diagnosis |
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Athletes suffer from
three common types of injury to the Achilles Tendon: Paratenonitis usually referred to as Achilles Tendonitis. Tendinosis. This is usually a non tender palpable nodule or cord at the Achilles tendon. Rupture of the Tendon (either partial or complete).
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About the Achilles Tendon
The Achilles tendon is the strongest and largest tendon in the body. It is extremely vulnerable to injury due to its limited blood supply and the numerous forces to which it is subjected.
The Achilles tendon is known as a co-joined
tendon. This tendon directly joins into
Gastrocnemius and the Soleus muscle (calf muscles). The Achilles tendon transmits the force of the calf muscles
(Gastrocnemius and Soleus) to produce the push-off during walking, running, and
jumping.
The area of the tendon (approximately 2 to 6 cm above its insertion into the Calcaneus) has the poorest blood supply, and therefore heals the most slowly. This makes it extremely susceptible to injury.
Causes of Achilles Tendon Injuries
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In triatheletes, the
most common cause of injuries to the Achilles tendon is overpronation,
inflexibility, or lack of strength. The repetitive stresses caused by running and cycling can cause friction and inflammation. The body responds to inflammation by laying down scar tissue (adhesive tissue) in an attempt to stabilize the area. Once this happens, an ongoing cycle begins that worsens the condition. Inflexibility is often caused by the build-up of these adhesions, either within the soft tissue or within structures above or below the tendons kinetic chain. In
cyclists, the initial stress is often caused by having a low saddle height.
This low saddle height can result in excessive dorsiflexion of the foot,
which stresses the Achilles Tendon. In runners, too rapid an increase in mileage, hill training without proper strengthening, and recent or inadequate changes to running gear can cause injuries to the Achilles Tendon. A tight muscle is a weak muscle. Runners with weak, or unstable calf muscles place increased stress on their Achilles Tendon. Weakness in the Gastrocs and Soleus can cause abnormal pronation during the stance phase of the normal gait cycle. |
Always Consider the Kinetic Chain
Any restrictions in the kinetic chain of the Achilles tendon, either above or below the tendon, can affect the functioning of the Achilles tendon. Such structures would include:
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1. Hamstring muscles - The upper portion of the gastrocnemius (superficial calf muscles) are in contact with biceps femoris, semitendinosus, and semimembranosis (three sections of the hamstrings). 2. Plantaris muscle - This muscle inserts into the middle one third of the posterior calcaneal surface (heel bone), just on the inside of the Achilles Tendon. 3. Popliteus muscle - This muscle is involved in medial knee rotation. When it is restricted, it may cause increased stress on the lower extremities. 4. Flexor Hallicus Longus, Flexor Hallicus Brevis, and the Tibialis Anterior, muscles. These muscles are involved in cases of increased pronation and hyperpronation. |
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The Injury Process
Hyperpronation,
muscle restrictions, or lack of flexibility
of the Achilles tendon creates increased stress, internal pressure, or a
state of friction that leads to inflammation.
Copyright Dr. Mike Leahy
Ineffective Treatments
We have seen numerous case of Achilles Tendonitis that were needlessly prolonged or that became chronic problems due to the application of ineffective treatments. Improper treatment of an Achilles Tendon injury can lead to major problems.
Cross friction massage often irritates this area, increasing the time required for recovery rather than reducing recovery times.
Additional problems often arise when a therapist uses direct, heavy pressure and tension over the Achilles Tendon.
Steroid injections should be avoided whenever possible. Research has shown the steroid injections cause an increase in the incidence of rupture of the Achilles tendon.
At the very least, many of these treatments have drastically decreased the Triatheletes level of performance.
The Need for a Specific Diagnosis
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It is extremely important to be as specific as possible when identifying the soft tissue structures involved with this condition. Different athletes may present with identical pain patterns at the Achilles tendon, yet they may have completely different structures that are impairing motion or causing the injury. Before treatment takes place, an extremely specific examination and diagnosis must be performed. It is important to look past the initial point of pain and identify all the other structures that are involved in the kinetic chain. |
Treating Injuries to the
Achilles Tendon with ART
Active Release Technique (ART®) is very successful at treating this type of injury since it removes restrictive adhesions between both the superficial and deep tissue structures along the entire kinetic chain.
Trained ART practitioners perform a biomechanical analysis of athletes to determine where the restrictions are located along the entire kinetic chain. ART treatments are specific and based upon the individual needs of each athlete. It is not a cookbook approach to treating a non-specific diagnosis.
For example:
If the fascial tissue anterior to the tendon is restricted (which commonly occurs in this condition), ART procedures can be used to release the adhesions.
Other structures in the kinetic chain are similarly treated.
ART® finds the specific tissues that are restricted and physically works them back to its normal texture, tension, and length by using various hand positions and soft tissue manipulation methods. While breaking up the adhesions can be uncomfortable at times, it is important to reproduce the symptoms.
Effective treatment of the Achilles tendon, or of any soft tissue injury, requires an alteration in tissue structure that breaks up the restrictive cross-fiber adhesions and restores normal function to the affected soft tissue areas. When executed properly, this process substantially decreases healing time, treats the root cause of the injury, and improves athletic performance.
With ART we often see immediate improvement after treating the involved structures.
Post Treatment Exercises
Strengthening
the Calf muscle and the entire related kinetic chain is extremely important in order
to ensure that injuries to the Achilles Tendon do not return.
Strengthening
exercises are only effective if they are executed after the adhesions
within the soft tissue have been released.
Attempts to strengthen muscles bound by adhesions often cause the
structure to become more restricted, which in turn causes additional tension
within the soft tissue.
Research has shown that using eccentric contractions (lengthening of the muscle during contraction) is one of the most effective types of strengthening exercises for the calf muscles. This concept can be applied to the entire kinetic chain.
In addition to the strengthening component, stretching, and
balance exercises continue to be key components in correcting the problem
to ensure that the problem does not reoccur.
Where can I find more information about ART?
We have recently published the first book about Active Release Techniques, written specifically for the general public.
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Release Your Pain - Resolving Repetitive Strain Injuries with Active Release Techniques® (ART®) is an informative, easy-to-read book, that helps you to understand the true cause of repetitive strain injuries. Did you know that many common therapies (such as medication, physiotherapy, chiropractic treatment, massage, electrical muscle stimulation, rest, exercise, and surgery) have all failed to effectively resolve repetitive strain injuries. RSI sufferers are rarely able to find effective or complete treatment with these traditional treatments! Read Release Your Pain now to understand why these treatments often fail to solve your problem. |
Understand the true cause of your pain, learn how it can be resolved, then use the specially designed exercises included in this book to prevent its reoccurrence.
Read our new book, Release
Your Pain, to see how Active Release Techniques can help you with
your injuries.
Dr. Brian Abelson
DC, ART
Copyright: Dr. Brian Abelson 2003. All rights
reserved.
Dr. Brian Abelson is
Clinical Director of Edgemont Chiropractic Clinic. Dr. Abelson is a native
Calgarian who graduated from Palmer College of Chiropractic West with an award
for clinical excellence, holds a Level 3 Active Release Certification, and is
an ART Assistant Instructor. He is also
the author of the award winning
websites: www.drabelson.com and www.activerelease.ca .
Author: Dr. Brian Abelson
Editor: Kamali Abelson, Rowan Tree Consulting Ltd.
Edgemont Chiropractic Clinic
Bay #10, 34 Edgedale Drive N.W.
Calgary, Alberta, T3A-2R4
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Click here to book an appointment with us! To make an appointment at Kinetic Health in Calgary:
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