The Achilles tendon is a thick and springy band of tissue connecting the calf muscle to the heel bone. The calf muscle points the toes, pushes off when you walk or run and gets you up on your tippy toes to reach that high object overhead. Since it is involved in almost everything we do when standing, it is highly susceptible to injury, especially in athletes who run and jump.
The extent of damage to the tendon will determine the grade level of the injury. Muscle and tendon injuries are referred to as strains.
• Grade I is a minor strain, with damage to just a few fibers. Pain, swelling and stiffness are generally mild to moderate. Functionally, people will report heel or Achilles pain toward the end of an activity that generally subsides quickly after stopping.
• Grade II will be a disruption of more fibers with pain and other symptom levels increasing to more moderate and possibly severe level. Functionally, people will have more pain during the entire activity as well as having difficulty walking.
• Grade III is a complete rupture of the tendon with instant pain and incapacity to bear weight or walk. When it ruptures, a “pop” is felt and often people turn around and ask who hit them from behind.
Repetitive strain or trauma to the Achilles tendon can cause a slow breakdown of the tissue and result in chronic Achilles tendinopathy. This type of injury can usually be treated with physical therapy successfully; however a Grade III injury, or complete tear of the tendon, will usually require surgery followed by physical therapy.
The following factors contribute to the development of Achilles tendon problems:
• Overuse – not allowing the body to recover
• Calf and hamstring muscle tightness
• Absence of proper stretching
• Improper footwear, such as high heels (sorry, ladies!)
• Foot problems, such as fallen arches which can cause over stretching of the muscles and tendons due to the arch of the foot collapsing
• Training errors like stepping up your physical activity level too quickly
If you experience tightness in the calf, heel or Achilles tendon tenderness, swelling around the Achilles tendon, pain and stiffness while walking or going up on your toes, the culprit may be Achilles tendinopathy.
A physical therapist (PT) can help assess the injury through an evaluation and series of tests to establish the severity of the injury as well as determine if there are any strength, flexibility or balance deficits. After a thorough review of your medical history, exercise habits, daily activities and footwear choices the PT will be able to identify additional factors that may be contributing to the condition.
As always, your PT will devise a personal program specifically designed for your needs, ability and degree of your injury. They will work with you on pain management through the use of ice or a brace, help to increase the range of motion through the ankles and knees, address any lower extremity weakness or imbalances found in the evaluation. Manual therapy, which is a hands-on treatment, is specifically directed at the Achilles tendon and calf muscle. Commonly used techniques are Graston and ART. These techniques help to improve range of motion and promote healing in the tendon. Once you attain a satisfactory level of improvement you will also receive functional exercises that are designed to help you get back to the activity you want to do, included in this are eccentric exercises. Finally, a comprehensive home exercise program is developed to maintain mobility, muscle strength and balance of the lower extremities to help to prevent Achilles re-injury. At the appropriate time, a gradual return to activities is undertaken to prevent a re-occurrence of the pain and disability.
If you think you may have injured your Achilles tendon, don’t let it get worse by putting it off. Contact one of our clinics to get your treatment started today.