Achilles Tendinitis: What it is and the injury rehabilitation?

Achilles Tendinitis defined by Orthoinfo AAOS as “A common condition that occurs when the large tendon that runs down the back of your lower leg becomes irritated and inflamed”. Achilles Tendinitis can be acute or chronic depending on the cause of injury. For example, acute tendinitis is caused by quick stretch or contraction while chronic tendinitis is caused by repetitive loading to the tendon; activities that results in repetitive motions in the lower leg relating to mechanism of chronic tendinitis (Diaz pg. 266). According to Orthoinfo AAOS, they stated 3 other reasons for the cause of injury like sudden increase intensity and/or amount of exercise. For example, increasing running pace and distance every other day without giving your body any adjustment to the amount and intensity of exercise. Tight calf muscles putting extra stress on the Achilles tendon and a bone spur growing to the heel bone can cause Achilles Tendinitis.

Achilles insertional calcific tendinosis (labeled).jpg
Bone spur growing causing Achilles Tendinitis Source/Credit: Mikael Häggström from Wikimedia CC

There are 3 risk factors that could lead to Achilles Tendinitis like improper lower extremity alignment, friction against the shoe, and/or poor body mechanics during activity like running or walking (Diaz pg. 266).

File:Bad-running-form.png
Bad running form Source/Credit: E-cuellar from Wikimedia CC

Tight calf muscles and sudden increase intensity or amount of exercise can tie into risk factor. The signs and symptoms of Achilles Tendinitis include pain, mild swelling, point tender, crepitus with activity, and thickening of the tendon if the injury is chronic (Diaz pg. 266). The treatment typically uses the RICE method for immediate care. You can use other treatment options for Achilles Tendonitis. In the book “Survey of Athletic Injuries for Exercise Science “ by Linda Diaz, a physician should recommend nonsurgical methods like non-steroidal anti-inflammatories medications, corticosteroid injections, and physical therapy for exercises and stretches for the lower leg muscle and tendon (Diaz pg. 266). Orthoinfo AAOS adds a protocol called Eccentric Strengthening Protocol, which is contraction while the muscle is getting longer. Exercise like bilateral and single leg heel drop help to strengthen the Achilles tendon. This should be done with supervision by physician first, then practice until you can do it by yourself. There is surgical treatment options which include Gastrocnemius recession, release and lengthening of the calf muscle, Debridement and repair, or debridement and tendon transfer for relief of the Achilles Tendinitis.

The joints that are affected by ROM deficits is the knee joint because knee flexion involves gastrocnemius and ankle joint for plantar flexion. The muscles most likely to have deficits in flexibility or strength are mainly the calf muscles like gastrocnemius and the soleus muscle.

Table of exercises for calf muscles

Muscles                                           Single-Joint Exercise                 Multi-Joint Exercise

Gastrocnemius Standing Calf Raises Squat with calf raises
Soleus Seated Calf Raises Squat
Eccentric Exercise.png
Eccentric exercise Calf raises Source/Credit: Bessieeboo from Wikimedia CC

In the article “PT Exercises for Achilles Tendon Tear“ by Brett Sears, it identifies 2 exercises that are considered functional for Achilles Tendonitis: BOSU trainer single leg balance and hopping forward and backward agility exercise. Although the exercises listed in the article are for Achilles Tendon Tear, the exercises can also help for Achilles Tendinitis. The BOSU trainer single leg balance helps to improve balance, proprioception (awareness of one’s body) and coordination to help decrease chances of falling down. The agility exercise use plantar flexor muscles for assistance and it can help a person to return to high-level sports and recreational activities if the goal is to go back to sports for competition or recreational purposes.

BOSU ball Source/Credit: Seaman Aime Lykins from Wikimedia CC

Reference

Diaz, L. (2014). Survey of Athletic Injuries for Exercise Science. Jones & Bartlett Learning.

Sears, B. (2018, June 11). PT Exercises for Achilles Tendon Tear. Retrieved November 20, 2018, from https://www.verywellhealth.com/pt-exercises-for-achilles-tendon-tear-4165931

Achilles Tendinitis – Orthoinfo – AAOS. (n.d.). Retrieved from

https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/

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