Achilles Tendonitis

The Achilles tendon is the strongest tendon in the body and the tensile loads placed on it are extremely high. It attaches the calf muscles (the gastrocnemius and soleus) to the calcaneus for forward movement and upward propulsion. The loads are also extreme when the calf muscles are used for deceleration and shock absorption. It is of fundamental importance in nearly all activities such as walking and running and is a common area for acute strain and over-use.

Achilles tendonitis may be the response to microtears in the tendon caused by repetitive stretching of the tendon. Blood supply to the tendon is relatively low and so Achilles tendonitis is difficult to overcome. Early treatment is important and athletes should resist trying to run through the pain. Some studies have indicated that collagen degeneration in the tendon may be a critical contributor to pain in the Achilles tendon and Achilles tendonitis is especially common in athletes over thirty because of the degenerative changes that take place which make them tighter and weaker.

The potential for developing Achilles tendonitis is magnified by variations in blood supply in the different regions of the tendon. Problems are more likely to occur when the blood supply is poor and the flow of nutrients for tissue repair is limited. The lower portion the tendon has poorer blood supply and is generally where degeneration occurs first.

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The onset of Achilles tendonitis is gradual and pain occurs with use, there may be swelling over the tendon. There may be creaking in the tendon (crepitus) which can be felt when moving the ankle backwards and forwards. If, as commonly happens, the athlete ignores the conditions then there may be pain and stiffness before, during and after exercise and the tendon can become tender to the touch. Distance runners are particularly vulnerable to developing Achilles tendonitis.

Interestingly Achilles tendinitis can develop in some people without the stress of repetitive motion (or biomechanical dysfunction). One family of antibiotics (fluoroquioiones) can cause similar degenerative process to the collagen in the tendon as repetitive overuse. The antibiotics affect the Achilles tendon more than any other tendon in the body and continued use of them has been linked to ruptures of the Achilles tendon.

The most important factor in treating Achilles tendonitis is to eliminate the factors that caused the inflammation/collagen degeneration in the first place. The athlete will have to change activity, training surfaces, shoes, etc in order to stop aggravating the tendon. Stretching of the calf muscles is also commonly used to reduce the amount of tension on the tendon. Cortisone injections used to be a common treatment method but the practice is not as frequent as they may have detrimental effects on the collagen structure of the tendon, leading to tendon rupture.

Massage Techniques for Achilles Tendonitis.
Massage can be a highly effective method for addressing Achilles tendonitis where the therapist aims to reduce the tensile load on the tendon by massaging the calf muscles and by deep friction applied directly to the tendon to encourage collagen production.

The calf muscles should be massaged using compression broadening techniques and by deep longitudinal stripping to assist in reducing tension in the lower limb and hence decrease the tension on the Achilles tendon. Myofascial trigger point work to the calf muscles can also be effective.

Deep friction massage is applied directly to the affected tendon to stimulate collagen production in the damaged region. The areas around the tendon should be massaged with considerable pressure to clear congestion, break up adhesions and to improve circulation around the tendon. Applying deep strokes up the tendon when it is in a slightly stretched position may assist in releasing some adhesions between the tendon and the inside of the sheath. The application of ice following deep friction massage to the Achilles tendon is a good precautionary measure as the massage may result in inflammation.

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