Inflammation of the Achilles tendon is arguably the most common injury of the lower extremity. The largest tendon in the body is a vital component during walking and running. If the Achilles tendon is unprepared for stressful activity, then damage can occur, leading to inflammation. If not properly treated, it can lead to long-term degeneration of the tendon (tendonosis, which is another subject entirely).
The Achilles tendon is made up of two muscles, the gastrocnemius and soleus. The gastrocnemius is the most prominent muscle that you can visibly see and it begins above the knee, crosses the knee joint as it becomes a tendon. In addition, it crosses the ankle joint as a tendon. The soleus is the muscle that is less visible, but only crosses the ankle joint as the Achilles tendon. Both of these muscles function based on their location in the body, i.e., both of them can plantarflex the ankle, but the gastrocnemius can also bend the knee, making its ankle joint motion less effective. The soleus can function irregardless o the knee’s position. During ambulatory activity, the muscles (and to a lesser extent the tendon) are both lengthened when the leg swings forward during walking or knee lift during running. The lengthening continues during foot contact and then begins to contract as the body moves over the planted foot, with the greatest activity during toe-off.
Like any overuse injury, there are intrinsic and extrinsic factors causing Achilles tendonitis. The biggest extrinsic factor (and arguably the most important of them all) would be activity that exceeds the strength of Achilles tendon. Examples include a sudden change of activity from low-intensity to high-intensity, i.e., walking to sprinting, introduction of hills to a walking or running program and returning to exercise after an insufficient or excessive long period of rest. In all these cases, the Achilles tendon was not sufficiently prepared for this change of activity, causing the tendon to become damaged.
Intrinsically, the foot posture is a large factor in Achilles tendonitis. A low-arched foot lengthens the tendon naturally by its position. This gives the Achilles tendon little opportunity to absorb foot impact during ambulatory activities, causing increased stress on the tendon. A high-arched foot has a natural reduction of flexibility in the Achilles tendon, so the increased stress of foot impact can cause damage to the tendon.
Treatment of Achilles tendonitis involves multiple steps guided by the injured individual and the simple fact that is usually takes three to five days for a normal tendon to recover from injury. First, the stress of the Achilles tendon must be reduced in order for the tendon to recover adequately. Heel lifts are a classic example, along with shoes with a higher heel. Orthotic therapy for foot posture can reduce Achilles tendon strain also. Next a progressive rehabilitation program to improve the function of the Achilles tendon. This program should be devised according to pain and activity level of the individual. An example of a program would be a progression of: isometrics (pressing ball of foot against the wall), toe raises (moving from double to single leg), short two-legged jumps, single leg hops, explosive hops, skipping and then running. The intrinsic factors must be continued to addressed in order to prevent recurrence, i.e., orthotic therapy or strengthening exercises for the foot posture. If it is not addressed, it could lead to tendonosis.
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Health and happiness!
In my never-ending search in trying to help my patients, I have long thought about how to make my patients better long-term. I have had some success in treating patients’ injuries and getting them functional again. But what I can do in the office is only a small fraction of what patients goes through during a day or even a lifetime. Patients are forced to wear shoegear with a heel lift, shortening the calf muscles and possibly leading to lower back pain. Patients have to sit down for long hours at the job, causing tightness of the hip flexor muscles.
To combat these external influences, I have a designed a protocol that helps restore proper body alignment and function. If it used daily, it should help with prevention of overuse injuries due to faulty mechanics of the body. Of course, each individual is unique and may require additional treatment, but I feel this to be an adequate starting point.
If you are interested in this protocol, email me at: email@example.com and I will send you a copy. I plan to make a YouTube video of it soon, along with some other things.
Health and happiness!
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