All About The Achilles Tendon

by Rahul Kapur

If anyone knows about achilles tendonitis, it is me.  I was running of stretch of 1/2 marathons and was having achilles pain but was trying to ignore it.  If I had followed this protocol at that time, I would not be suffering from chronic tendonitis now.  Let's dive into the anatomy and treatment of this injury.

The Achilles tendon is the strongest and largest tendon in our body.  It is located in the posterior aspect of the lower leg and attached to the posterior calf.  The Achilles tendon is formed by two muscles, gastrocnemius and soleus, joining together.  This allows the Achilles tendon to withstand high loads of tensile strength during activities such as running, walking, and jumping. This is also partly due to the kind of fibers that the Achilles tendon is composed of. It consists of Type II fast twitch fibers and Type I collagen and elastin. The collagen is responsible for the strength of the tendon. Because these fibers form a spiraling pattern it allows for more stress and increased movement. 

 Although this tendon is the strongest in the body, it is easily prone to injury or rupture.  This is often due to common overuse injury in individuals who run or participate in jumping sports.  The repetitive microtrauma causes the two muscles that compose the Achilles tendon to be under extra stress and strain, which can cause inflammation and degeneration of the tendon.   This is called Achilles tendinopathy or Achilles tendonitis.  Other factors that may play a role in Achilles tendonitis are poor nutrition leading to excess body inflammation, poor blood supply, increase or starting a new offending activity.

 So, what does Achilles tendonitis feel like?  Most will have pain along their Achilles tendon. It is usually exacerbated by movement. The pain is usually in the back of the ankle just above the heel.  The stiffness and soreness are typically worse in the morning and it is difficult to stand on your toes.  Often times, Achilles tendonitis is misdiagnosed for an ankle sprain.

 So now what? Unfortunately, improper treatment of this tendonitis can lead to a rupture that may need surgical intervention. It is best to avoid aggravating activities and allow for a period of rest. Here are some other therapies you can you do to help with your recovery process:

• Take a short course of anti-inflammatory, like Motrin, if you can tolerate them and have no contraindication to taking them.  Do not take for more than 7-10 days.
• Buy or get fitted for a heel lift to help alleviate stress off the Achilles during a flare up.
• Ice your Achilles when symptomatic. If you notice the pain mainly after an activity, use a cold gel pack for 15 minutes every hour for up to 6 hours total in a day.
• Follow the Alfredson protocol stretch. It is a specialized eccentric heel-drop exercises to improve the tendon’s strength and great for Achilles tendinopathy. The best way to perform this is to stand on a step with the balls of your feet hanging off.  Lift both feet and rise up on the balls of your feet. Keep the offending foot on the step and lift your non-injured foot off the step or you can do this exercise with both feet. Slowly lower your foot down so that your heel moves towards the floor but the ball of your foot remains in contact with the step.  You can also add weight as your Achilles gets stronger and there is less pain.  It is important that you do this stretch slowly.  It is ideal to do this stretch 180 heel drops everyday for 12-24 weeks or until you see complete relief. 

 What can you do help avoid getting or having it reoccur?

• Warm up! If you’re going for a long run make sure you to stretch beforehand and start off with a light jog and slowly increase your speed.
• Avoid sudden intensity increases in your workout. Build up your strength so your body can adjust to the changes,
• If running or exercising outside in cold weather, dress warmly
• Get fitted for proper shoes. Having good shoes with proper stability is key to prevent injuries.
• Avoid running on hard surfaces which puts an increased strain on your joints and tendons.

 

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