What is achilles tendonitis?
Achilles tendonitis is a common overuse injury of the achilles tendon. Usually Pain is often located 2-6 cm above heel where the achilles tendon attaches to the calcaneus (heel bone). Tendons have a poor blood supply and heal at a slower rates than muscle strains so expect a complete recovery of 3 to 6 months.
The pain is due to inflammation of the tendon caused by repeated loads/stress that exceeds the tissues ability to recover.
For runners, this is often caused by rapidly increasing your milage while running and/or not scheduling rest days in your running routine. Running is a great aerobic activity. However, due to the high impact nature of running, it it easy to over do it because running places about 10X the force of your bodyweight onto the achilles tendon. 1
Due to this stress is is important to slowly and gradually increase the distance you run to prevent achilles tendonitis. I would recommend increasing your milage by 10% every week. For example, if you ran 10 km three times a week, i would recommend increasing the distance of your runs to only 11 km the following week. By doing so you are allowing your achilles tendon and the surrounding soft tissues to recover and to adapt to future challenges
“From my experience, most causes of achilles tendonitis and most running injuries in general are due to runners who routinely run 5 to 10 KM and suddenly want to want to run a marathon and increase their milage drastically .”
Taking a look at your shoes is important component to consider when determining possible causes of your achilles tendonitis. Running shoes lose about 60% of their shock absorption after about 500 KM 1. In addition many running shoes, such as the Nike Free shoes have a flat flexible soles and offer no arch support to help disperse the forces associated with running.
Beginning the rehab before you see the chiropractor or physiotherapist
Associated impairments of Achilles Tendonitis include decreased ankle dorsiflexion 2,3,4 , abnormal subtalar rom, and decreased plantar strength 2,5
The 1st step of treatment of achilles tendonitis is to rest and to begin to load the tissue isometrically with plantar flexion as soon as it becomes pain free. Isometrics are a good place to start for rehab process due to their is minimal strain due to the muscle not shortening or lengthening.
If tolerable and pain free, try to mobilize and stretch the achilles to regain dorsiflexion mobility of the ankle joint.
See a manual therapist, such as a chiropractor or physiotherapist, for sub-talar mobilization
Differential Diagnose
I recommend that you see a chiropractor to correctly diagnose the injury and rule out other possible injuries. Other injuries that are similar to achilles tendonitis, include tennis leg, posterior tibialis tendonitis, and retrocalcaneal bursitis
References
- Vizniak. Evidence Informed Orthopedic Conditions. Professional Health Systems Inc. 286-287. 2020
- Mahieu, NN, et al: Intrinsic risk factors for development of Achilles tendon overuse injury: a prospective study. AM J Sports Med 34(2): 226-235, 2006.
- Solan, MC, Carn A, and Davies, MS: Gastrocnemius shortening and heel pain. Foot Ankle Clin 19(4):719-738, 2014
- Whitting, JW, et al: Dorsiflexion capacity affects achilles tendon loading during drop landings. Med Sci Sport Exerc 43(4): 706-713, 2011.
- Sibernagel, KG et al: Evaluation of lower leg function on in patients with achilles tendinopathy. Knee Surg Sports Traumatol Arthrosc 14(11): 1207-1217, 2006
Dr. Brandon Parnham, DC 